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Covid 19: Why we can’t risk another wave

BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n609 (Published 04 March 2021) Cite this as: BMJ 2021;372:n609

Read our latest coverage of the coronavirus outbreak

  1. Fiona Godlee, editor in chief
  1. The BMJ
  1. fgodlee{at}bmj.com
    Follow Fiona on Twitter @fgodlee

The opening of schools across the UK and elsewhere in the world will bring relief to many families. It will also give children back the educational, social, and safeguarding benefits of interacting with teachers and friends. This is a vital, but still risky, step toward emerging safely from lockdown. Children’s futures are not the only things at stake if we get this wrong.

The risks to children of serious covid-19 illness are low,1 and cumulative international evidence indicates that schools are not amplifiers of transmission.2 But this does not mean that nothing further needs to be done to make schools safe. Nor does it mean an end to the many controversies around school closures during the pandemic, as our webinar on covid-19 and schools showed.3

Countries have taken a range of approaches, from keeping schools almost entirely open throughout the pandemic to prolonged periods of school closure. Scotland is phasing the return to school for different year groups, whereas England is opening them all at once. The Independent Scientific Advisory Group for Emergencies has recommended that schools reopen only when there are fewer than 100 confirmed cases per 100 000 population per week,4 but levels in England are currently higher than this. Then there are the questions of how to reduce class sizes, whether children should wear masks, and how to ensure proper ventilation.

Helen Salisbury writes that we have a responsibility to minimise exposure to infection for those who can’t control their own environments. As well as people in schools, this means those in workplaces, prisons, and asylum detention centres.5 What seems abundantly clear is that, although the success of the vaccine rollout is to be celebrated,6 we can’t rely on the vaccine alone. Avoiding another wave and further lockdowns will need, among other things, speedier access to accurate data for local public health teams and, as has been repeatedly called for, proper financial and practical support for those who need to self-isolate.7

“Getting back to normal” is what we all want, but this won’t be easy for the health service and those working in it. Recovering from the pandemic will be as challenging as the pandemic itself, say Christina Pagel and Edward Palmer.8 The past year has taken a heavy toll on all healthcare workers, with high rates of mental ill health and post-traumatic stress. Doctors have been particularly hard hit.9 Redeployment to unfamiliar roles and disruption to training have added to the burdens of delivering care. Healthcare leaders must ensure that staff have time to rest, recuperate, and reflect. And they must urgently look beyond the immediate demands of the current outbreak to act now on measures that will increase recruitment and retention, without which there will be little hope of delivering high quality care for all.

There are many reasons for doing everything possible to avoid another wave of the pandemic. The impact on healthcare staff and the future of our health services are two of them.

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