Clinical trial in secondary school children to replace isolation of close contacts with daily testing

[noblegiraffe]

You might have thought that the government plan to replace isolation for school children with daily LF testing was binned in January when schools had to close. Not so. Apparently they realised that a planned nationwide rollout to children of an intervention when they had no idea if it would increase or decrease transmission rates in schools was not particularly well-supported.

So now they are running a clinical trial. A few schools started this on 15th March and it is being widened to more schools next week. A child who has been identified as a close contact of someone who has tested positive (not within their household as higher risk) will be able to choose 10 days of isolation or 7 days of supervised LF tests at school. Those sitting around them in lessons will not be asked if they are happy with this. Outside of school they will still be expected to isolate because of their increased risk, the testing only allows them to go to school.

Given the general picture of the government's proposals and actions - LF tests now available to all, plans for testing before sports events etc, it's clear that despite serious concerns over their sensitivity (false negatives), they will be forming a large part of future virus control measures. Operation Moonshot.

Expect to see something tested on school children rolled out to workplaces by September.

Details in this twitter thread: twitter.com/karamballes/status/1382838861714296833?s=21

In Liverpool LF tests missed 60% of positive cases and using them as "Green light" tests, instead of the scientifically approved usage which is to test ONLY people who would otherwise have no reason to suspect they may be infected (i.e. NOT close contacts, and NO symptoms) has already resulted in multiple deaths.

www.theguardian.com/world/2021/jan/28/how-uk-spent-800m-on-controversial-covid-tests-for-dominic-cummings-scheme

We should probably just do away with the LF tests as the general consensus seems to be that they’re useless. The 2 positive cases at DS’s school turned out to be false positives resulting in a load of dc being sent home to self isolate for a day then back in again when a PCR test showed the LF was wrong. I’ve not heard one good thing about them.

@Daisydoor12

If Lf tests are good enough for my children to go to school if they are a close contact then they will be good enough to allow them to carry on with other activities they participate in!

We already have this argument in schools “I just did an LFT this morning, why do I need to wear a mask?

I’ve certainly seen on here posters using LFTs (or being told to by school) instead of booking a PCR test when someone has symptoms.

The idea that LFTs are not reliable when giving a negative doesn’t seem to be widely understood.

I'm so disappointed by this, I really thought it had been binned.
My dd school did pick up a positive through LFT, confirmed through PCR, which has made me more positive about the testing currently happening. I don't think test instead of isolating is sensible, people seem to have short memories, once the B117 variant took hold in December and January strict lockdown was the only way to get infection rates down. I don't think anyone wants to revisit that.

As a teacher who caught covid last March, almost certainly at school I would really like to see current infection measures in place until all adults have had at least 1 dose. I hate the masks, the social distancing, the year bubbles, all of it, but while most school staff and parents remain unvaccinated we need to keep them safe.

I can't believe as we get so close to getting life back we're considering increasing risks like this.

This is the stupid idea that just will not die, isn't it. Like in a zombie movie when you think it's dead but oh no, back it comes again.

If they're going to do this for schools then why not for everyone else? So if I get notified that I'm a close contact of someone then I could take a test every day and keep on going to work, shop etc. If they're not prepared to do this then how can they say it's fine for schools?

@Cantaloupeisland because schools are magical places where COVID can't spread like everywhere else. We have tape on the floor.

@Cantaloupeisland

If they're going to do this for schools then why not for everyone else? So if I get notified that I'm a close contact of someone then I could take a test every day and keep on going to work, shop etc. If they're not prepared to do this then how can they say it's fine for schools?

But you could only go to work (equivalent of school), nothing else.

It’s a stupid idea and will lead to more mutations and more deaths. Just to use up overpriced, ineffective lf tests

But then that makes no sense at all- the tests are good enough that you're safe to be in a crowded school but not in a supermarket or at a sports club? I work in a school so be interesting to see whether this would apply to adults! Also imagine trying to tell teenagers it's safe for them to be in school all day but not anywhere else. What if the kids are coming in on public transport and then test positive? It's bonkers.

Ffs. Daily testing? Fkn ridiculous. Its a no from me.

I would go the other way.
If we keep cases low kids wont need to isolate.
Also presuming 50% get AZ that doesnt work well on SA strain maybe wouldnt want to be in class with them even vaccinated.

I'd rather ds do a lft to be allowed out to exercise than to go to school.

The accuracy rate for an LFT diagnosing coronavirus in someone who has it has been shown to be poor. In some studies, it's less than 50%. As a close contact, it's the equivalent of flipping a coin and going to school if it's tails.

You can be infectious and it not show up on an LFT. Following this idea logically just suggests that it'll end up with more cases and an increased transmission, particularly when they decide to remove masks from classrooms.

They're hoping that repeatedly testing for 7 days will overcome the not so great sensitivity of the tests.

The issue appears to be that no one knows how sensitive the tests are on kids in the first place. If they were very sensitive, this would be a good plan.

I'd love to read the protocol - what's their definition of success in this trial? The guidance linked to in the twitter thread seems to suggest that it will be better than 'whole year group isolations' but in secondary schools whole year group isolations were very rare and the average number of kids isolating per positive case was about 23.

I had a spare LFT so I didn't swab myself at all but processed the test as if I had, expecting a void result. It came back negative.

@noblegiraffe

I don't think they've conducted a trial to ascertain how accurate LF tests are when administered by children?

Bmj says they're 50/50 when done by kids

I just hope that if they trial this at the dds school, we are able to take them out. Their brother is clinically vulnerable and has shielded all year, it is bad enough having to try and navigate getting back to some sort of 'normal' without him being vaccinated, but sending his sister's into a class where they could be sat next to someone who should be isolating just adds another layer of risk.

Very happy with it and a much more rational approach

• on what basis should teachers be expected to be in such close daily contact with people who may have the virus? Is this even reasonably part of their job?
• what about vulnerable children? Why don’t they deserve to know who around them may have the virus? Should my vulnerable child be forced to be sitting next to someone for 5 days who then tests positive?

@Iamnotthe1

The accuracy rate for an LFT diagnosing coronavirus in someone who has it has been shown to be poor. In some studies, it's less than 50%. As a close contact, it's the equivalent of flipping a coin and going to school if it's tails.

You can be infectious and it not show up on an LFT. Following this idea logically just suggests that it'll end up with more cases and an increased transmission, particularly when they decide to remove masks from classrooms.

Tbf to the LFTs, they were designed for use in symptomatic cases not asymptomatic ones. The fact that asymptomatic cases may not have a high enough viral load to get a positive result isn't their fault. Nor is the fact that our government are using them for a purpose they weren't intended for.

Using them as an extra line of defence was OK as long as people don't change their behaviour if the result is negative. Using them to replace one of the main non-pharmaceutical interventions is completely idiotic. And I do think there is an issue about the consent of others around you not just the person taking the test.

When a positive case occurred in dd's school, the whole class isolated - they were also asked to do proper (ie PCR) tests and three more came back positive. None of those positive pupils had any symptoms. Would they have been picked up under this scheme? Or left to sit in class infected another three each perhaps?
I would not send my children to school if this was happening here.

Is that primary or secondary, Hayday? In most secondary schools the whole class doesn't isolate, just the pupils who have sat immediately around the infected pupil over the course of the day. If those 3 positive pupils were sat around the infected pupil, then in this new scheme they may (and that's not especially confident) be picked up by the LFTs. In the old scheme they would have been sent home to isolate.

In either scheme, if they were in the class but not sat directly around the infected pupil they would have neither taken LFTs nor been sent home to isolate.

It seems sensible to me to trial this. I think moving forward this is the way to go rather than isolating healthy people on the off chance they might develop symptoms. Especially with asymptomatic positives in the first place.

It was a primary. Little ones.
I assume they would have infected a few others if no class isolation, especially as they didn't have their own symptoms. It's been a recent change to ask them to get tested at the start of isolation. So with the LFTs half of them might have reported a positive? Or none of them Mad scheme.

www.bbc.co.uk/news/uk-56789454

Slightly linked to this, on the subject of government covid trials. I'd have thought there'd be a bit more active monitoring post this gig rather than just 'give T&T your details' if it's a trial. Especially given some of the studies about the level of compliance with testing when people have symptoms and the 'success' of our T&T system. I'd imagine that's compounded by a bit of selection bias too.

Again a reliance on LFTs rather than a PCR.

Perhaps we can start using government trials in lessons for 'spot the limitations of this trial' in secondary.

Yes, if they are really interested in testing whether crowds at gigs are safe, wouldn't they use the more accurate tests to pick up cases? Or even better, both, to establish whether LFTs are useful?