Surveying the costs of mass testing children and other NPIs in educational settings
This piece was originally written for the British Medical Journal. They rejected the piece. The Daily Sceptic have also published it, but we feel this of the utmost importance and needs to be given the attention it deserves.
Dr Zenobia Storah, Child and Adolescent Clinical Psychologist, Clinical Lead, Knowsley Neurodevelopmental Pathway, Liverpool UK.
Professor Ellen Townsend, Professor of Psychology, Self-Harm Research Group, School of Psychology, University of Nottingham, UK
Professor Allyson Pollock, Clinical Professor of Public Health, Newcastle University, UK
Sarah Waters, Psychotherapist and DDP Practitioner, Penzance, Cornwall, UK
Twice-weekly asymptomatic testing for Covid-19 was introduced in secondary schools in the UK in January 2021. Although guidance was specific to secondary education, many primary schools, nurseries and pre-schools also requested routine testing of children in their care. Regular self-testing by students has also been required at colleges and universities.
In the last month, the government removed its testing advice for staff and pupils in most schools. We welcome this change. Mass testing has been harmful for many, especially for children. Indeed, experts have cautioned against asymptomatic mass testing (1). The lack of evidence on impact on transmission (2), high costs, and likely diversion of resources from important activities such as mental health support (3) have all been cited. Incredibly, even though mass testing is screening, the UK government ignored the Wilson and Junger 1968 principles of screening (4) and never sought the advice of the National Screening Committee. We are not aware of any evidence-base for this policy or any risk assessment regarding potential psychological or physical harms.
Swabbing for either PCR or lateral flow devices (LFDs) is an unpleasant and invasive procedure that is distressing to children. In October 2020, when testing was introduced in Italian schools, paediatricians raised concerns about the risks posed by nasopharyngeal swabs, including the breakage of the swab with subsequent inhalation and possible injury to the nasal, oral and pharyngeal mucosa (5). Subsequently questions were raised in the European Parliament (6). Disappointingly there has been little interest in such concerns from professionals and policy-makers in the UK.
Risk of psychological trauma has also been ignored despite widespread acknowledgement amongst parents of children’s distress during testing (7). Conditioned distress responses have been reported in young children, with older children displaying anxiety around testing, parents restraining children when swabbing, children exhibiting fear responses to parents following testing, and teens experiencing social embarrassment due to physical responses including vomiting following self-testing in school. Staff running testing centres confirm that these stories are commonplace and professionals have expressed concerns (8). Given that many nursery and school leadership teams insist on testing and that those administering tests are aware of these harms, lack of evaluation of this policy is unacceptable.
Wider-reaching psychological impacts have also been ignored. Routine testing of children teaches them that they are vectors of disease and a risk to others. It places on them a moral and civic obligation to subject themselves to invasive procedure for the supposed benefit of the community (9). Testing also normalises behaviours which are symptomatic of Obsessive- Compulsive Disorder or health anxiety. We have observed parents who, encouraged by government messaging, behave as if they have a version of factitious disorder in relation to covid testing. Psychologically problematic practices have been promoted and become normalised. We have similar concerns with relation to other interventions imposed on children, including face masks, social distancing and over-rigorous hand hygiene regimes.
There is no precedent for a generation of children being routinely subjected to such practices. We can only hypothesise as to immediate and long-term consequences. However, we can extrapolate from existing knowledge of the sensitivity of children’s brain to environmental influences and stressors that there is real potential for significant harm (10, 11). This may include instilling and normalising obsessive compulsive and/or health anxious behaviours, damage to children’s sense of self and safety, their relationships, their trust in authority and care-givers, and their capacity to engage in normal social interaction and intimacy, both currently and long-term.
The last two years have taken a devastating toll on the well-being of children and young people. There is now compelling evidence of a significant increase in distress amongst children and young people since March 2020 (12, 13, 14). There is also increasing evidence of physical harm to children as a result of the pandemic response (15,16). It is clear that for children and young people, Covid-19 does not pose significant risk (17). However, they are facing an unprecedented crisis of mental health and well-being. As we move to ‘living with the virus’ (18), we must prioritise their recovery. Resources should now be redirected towards promoting health and well-being. Policy-makers and professionals should be reminded of trauma-informed practice – a concept promoted and accepted widely in schools and colleges pre-pandemic, through initiatives such as THRIVE (19) and the Trauma-Informed Schools programme (20) – and urgently promote recovery.
In the UK, pre-pandemic, the UN Convention on the Rights of the Child (21) was universally endorsed. Our legal, clinical and educational systems reflected the principle that children’s best interests are paramount . It is disturbing that, during the pandemic, this principle was forgotten. We must ask ourselves how we got to a point where young people were routinely subjected to harmful and unevidenced interventions. As we support their recovery, we must ensure that they are never subjected to such experiences again.
- Mass screening for asymptomatic SARS-CoV-2 infection | The BMJ
- Coronavirus mass testing – a gross waste of money and resources | The BMJ
- Wilson, James Maxwell Glover, Jungner, Gunnar & World Health Organization. (1968). Principles and practice of screening for disease / J. M. G. Wilson, G. Jungner. World Health Organization.
- Nose Injuries And Trauma: Should Italy’s Schoolchildren Undergo Regular COVID Swab Tests? (forbes.com)
- Problems relating to swab tests performed on children (europa.eu)
- Page 5 | Are anyone else’s kids getting distressed with all the testing? | Mumsnet
- ‘Is it right to expect parents to take Covid-19 swabs from their young child?’ | Nursing Times
- Back to school campaign launches – GOV.UK (www.gov.uk)
- The Amazing Teen Brain – Scientific American
- Principles of plasticity in the developing brain – Kolb – 2017 – Developmental Medicine & Child Neurology – Wiley Online Library
- Youth mental health in the time of COVID-19 – PubMed (nih.gov)
- Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19 (nih.gov)
- The state of children’s mental health services 2019/20 | Children’s Commissioner for England (childrenscommissioner.gov.uk)
- COVID-19 and the impact on child dental services in the UK | BMJ Paediatrics Open
- Childhood obesity: a growing pandemic – The Lancet Diabetes & Endocrinology
- Assessing the age specificity of infection fatality rates for COVID-19: systematic review, meta-analysis, and public policy implications – PubMed (nih.gov)
- COVID-19 Response: Living with COVID-19 – GOV.UK
- The Thrive Approach – a trauma-sensitive approach to emotional resilience
- Trauma Informed Schools UK
- UN Convention on the Rights of the Child (UNCRC) – UNICEF UK