On masks in schools – like everything else in this pandemic – Johnson is winging it | Trish Greenhalgh

  • 8/27/2020
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oris Johnson has once again copied Nicola Sturgeon’s homework and handed it in late. On Tuesday, he sent Gavin Williamson to announce that, as in Scotland, face masks would now be required in communal areas of schools in England. Earlier the same day, his own press office had announced that England’s policy on face masks in schools was not going to change. And on Sunday, he had approved a briefing by chief medical officers that the risk of Sars-CoV-2 transmission in schools was very low. Apparently there is now sufficient evidence to mandate the wearing of masks by 12-year-olds in school corridors – but not by 12-year-olds in classrooms or 10-year-olds in corridors. But watch this space. Anything could have changed by tomorrow. I’m a parent, an ex-school governor, a GP and a scientist. I know that one of the few things we value more than our children’s education is their safety. I also know that the science of controlling the spread of the pandemic is complex, contested and fast-moving. Winging it is not an answer to scientific uncertainty. Nor is signing off on policy without engaging with the detail. Nor tailoring policies to garner populist appeal with the electorate, or defining the problem in over-simplified terms to give the appearance of a straightforward solution. Ditto succumbing to arm-twisting by lobbyists, disappearing into a yurt, or teetering unsteadily between all these options. Yet these are exactly the strategies the government has opted for throughout this pandemic. The answer to scientific uncertainty lies in the people we entrust with decision-making as well as the decisions themselves. Virtues such as honesty, integrity, reflexivity and transparency – always valued in politicians, though rarely found – are critical at moments like this. Our children’s lives – and those of other, perhaps highly vulnerable members of our households – are at stake. If decisions need to be made in the light of imperfect and incomplete data, we need to know how and to what extent those data are flawed, and with what assumptions and guesstimates we must buttress them. To that end, we – and those to whom we entrust our children’s safety – need a dialogue with our political leaders, not an opaque algorithm or outsourced consultancy project. We could be talking about whether children should wear masks in corridors (this week’s priority question), whether teachers should wear visors in the classroom (perhaps next week’s) or how often and by whom children should be swabbed (the week after?). Whatever the topic, flipping from “the evidence is weak” to “the evidence is strong” without explanation or qualification is not just bad science but bad politics. If politicians want to pull the wool over our eyes for partisan ends, they should choose a topic less important than our kids. I don’t have a simple, universal solution to the question of who should wear what kind of mask at school, in what circumstances or for how long. Nobody does – not least because this kind of problem requires deliberation. We need to consider, in different localities and settings, the trade-offs between partial and imperfect solutions; between comfort and safety; between the needs of the majority and those of children and staff with unique (perhaps hidden) medical conditions; between the priorities of the privileged and the rights of the disadvantaged; and between scientific evidence and local contingencies. While a competent government can play an important role in guiding and resourcing particular courses of action, these deliberations should generally occur locally and involve (in the case of school health) teachers, parents, health professionals – and most importantly, children themselves. Nothing I have seen of the present government (and little I’ve seen of previous governments) has persuaded me that anyone in Whitehall knows better than a school’s headteacher, heads of year, governing body, student council and school nurse what the priority issues are for that school or how they might best be addressed. A colleague of mine teaches in a school where all the children and many of the staff are deaf. Another teaches in an inner-city academy that adjoins a busy road, where opening the window means that people must shout to be heard above traffic. Some 98% of the pupils are from minority ethnic groups where multi-generational households are the norm, putting them at greater risk of Covid-19. Neither of these schools needs a blanket policy instructed from on high; both need to work out how best to balance infection control with achieving the school’s educational and pastoral mission – perhaps for many months, even years to come. Johnson knows better than most how dangerous this virus can be. He should be setting a broad policy direction, drawing on the expertise of his scientific advisers, but allowing the people who care most about a school and its community to lead the negotiations about what is best for them. Trish Greenhalgh is professor of Primary Care Health Sciences at the University of Oxford

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