Background

Early in the pandemic, the role of children in transmission of SARS-CoV-2 was still unclear and many countries implemented national lockdowns which included school closures.1 As the pandemic progressed, studies showed that children were comparatively less affected by COVID-19, representing only 1%–3% of confirmed COVID-19 cases, with fewer hospital admissions and deaths compared with adults.2–4 On the other hand, the negative impact of the pandemic on the physical, social and mental well-being of children and adolescents has been widely reported; school closures and home quarantine have been associated with increased anxiety and depressive symptoms, reduced physical activity, as well as worsened integration and social competence in school children.5–9

In the UK, children of key workers and vulnerable children continued to attend school throughout the first lockdown. Subsequently, from 01 June 2020, some school years (nursery, reception, year 1 and year 6) returned to school, followed by some secondary school years (years 10 and 12) from 15 June 2020, although school attendance was not mandatory.10 The second half of the summer term continued until 18 July 2020 before summer holidays began. During this period, strict physical distancing and infection control measures were implemented in schools, including limiting class sizes to small numbers, which remained in strict social bubbles that did not interact physically or socially with other bubbles in school.11 The success of the summer term (where few cases and outbreaks of COVID-19 were reported) contributed to the wider reopening of all schools with full attendance in the autumn term, which started in September 2020.12

The large number of students attending primary and secondary schools during the autumn term of 2020/2021 was likely to raise significant challenges for implementing and reinforcing physical distancing and infection control measures. In addition to the challenges of maintaining infection control measures in educational settings, community SARS-CoV-2 infection rates were higher at the start of the autumn term compared with the previous summer term.13 This in turn raised concerns about increased risk of SARS-CoV-2 introduction into education settings, via outbreaks that result in isolation of large class bubbles or potential closures if infection could not be controlled through current national guidelines and recommendations.14

To enhance understanding of the impact of SARS-CoV-2 in educational settings, UK Health Security Agency (UKHSA, formerly Public Health England (PHE)) has been conducting SARS-CoV-2 surveillance since the start of the pandemic in England which has included swabbing and serological sampling in selected primary and secondary schools.12 As part of this surveillance, we assessed the experiences and challenges of returning to school during the autumn 2020/2021 term by inviting the schools taking part in UKHSA's school studies to participate in an online survey aimed at staff and parents 2 months after the students returned to school in September 2020.

MethodsSchool surveillance

As part of national surveillance, UKHSA initiated enhanced surveillance in 132 primary schools which were selected as previously described15 in five sites across England (East London, North and West London, Derby, Oxford and Manchester), during the second half of the summer term, where staff and students were tested for SARS-CoV-2 infection through weekly swabbing or blood sampling for SARS-CoV-2 antibodies at the beginning and end of the second half of the summer term (sKIDs Study). From September 2020, surveillance was extended to include 19 secondary schools (sKIDsPLUS Study) who agreed to participate.16 17

Study design

A descriptive cross-sectional survey was conducted among staff—including teachers, teaching assistants and senior leadership teams—and parents/guardians in the 132 primary schools and 19 secondary schools participating in sKIDs and sKIDsPLUS surveillance.

UKHSA’s studies

These schools were invited to take part in the online survey during the first week of November 2020, when schools returned from the half-term holidays. Schools expressing an interest in taking part were provided with an online link to forward to the teaching staff and all the parents in that school, irrespective of whether they were taking part in the sKIDs surveillance. The surveys were disseminated on 10 November 2020 and up to five email reminders were sent to encourage participants to complete the questionnaire until the last day of the survey on 28 December 2020. In total, 151 schools participating in sKIDs and sKIDsPLUS across England were contacted, of which 56 (37%) participated in the survey.

Questionnaire design

Staff and parent questionnaires were adapted from those used during summer 2020 in a survey for headteachers which was informed by government guidelines on the reopening of schools.18 The questionnaires were designed using the Snap Professional V.11 (Snap Surveys, New Hampshire, USA) survey platform to be disseminated online. Participants were provided with a list of preventive measures and were asked whether any of the measures were being implemented at their school as far as they were aware. Interventions were grouped into those related to students, staff or the classroom and school environment. Parents were asked to rate to what extent their child was able to follow certain preventive measures from a scale of always follows/follows most times/follows sometimes/never follows/not applicable. Similarly, staff were asked to rate the ease of implementation of the control measures from a scale of easy to implement/some challenges/very challenging.

Data analysis

Questionnaire responses from SnapSurvey were imported into Stata V.15.1 (StataCorp, Texas, USA). Data were cleaned and a descriptive analysis performed, stratified by parent/staff category and primary/secondary school. School profiles obtained from the Department for Education data were used to compare school demographic characteristics including type of school, school size, percentage of students on free school meals and percentage of persistent absence in responding schools and non-responding schools.19 To report questions related to control measures at a school level, responses were weighted such that for schools with multiple responses, the contribution of each response summed to 1 in the weighting to compensate for over-representation of schools with more responses than others. Categorical variables are presented as proportions and compared using Χ2 or Fisher’s exact tests, where appropriate. Data that did not follow a normal distribution are described as median with IQRs and compared using the Mann-Whitney U test.

DiscussionSummary of key findings

More than 150 schools taking part in sKIDs across England were invited to take part in the questionnaire survey and 56 agreed to forward the online questionnaire links to their staff and parents of students attending their schools. In general, when asked about preventive measures implemented in their schools, parents reported variable rates of implementation for their schools. In primary schools, staggering drop-off and collection times and stopping large gatherings of students such as assemblies were the only preventive measures reported by more than 75% of parents, and the latter was the only measure reaching this frequency in secondary schools. Overall, however, 90% and 82% of primary and secondary school parents were either completely or partly reassured by the preventive measures implemented in their schools. Further to this, reassuringly, more than half of parents were positive about their children returning to school, similar to findings of a similar US survey of parents.20 However, around one-third of parents reported being a little anxious, while 13% and 16% of primary and secondary school parents, respectively, reported being extremely anxious about their children returning to school.

Among staff, a significant finding of this survey was that 80% of primary staff and 87% of secondary school staff felt that they were at higher risk of COVID-19 because of their profession. Indeed, only 52% of primary school staff and 38% of secondary school staff felt safe at school despite the implementation of a wide range of social distancing and infection control measures. According to the teaching staff, preventive measures for staff were variably implemented, apart from regularly hand cleaning, maintaining a 2-metre distance between staff members and, for secondary school staff, wearing face masks or face coverings while at school. In particular, most staff members did not feel like they were given the option to work from home if possible, even if there was a clinical reason to do so. According to the teaching staff, most preventive measures were well implemented apart from requiring 2-metre distancing between staff.

For preventive measures involving students, too, maintaining the 2-metre distance was found to be particularly difficult to implement for both primary and secondary schools, while secondary schools also struggled to maintain small groups at all times or ensuring that the same staff members were assigned to each student group—a problem also commonly reported by parents. This was also reflected in teaching staff experiencing difficulties with maintaining space between seats and desks in both primary and secondary schools. Another problem faced particularly by secondary schoolteachers was ensuring that the students used the same classroom throughout the day and ensuring that the students do not carry materials between home and school. Other measures were implemented to a variable extent, except for parents dropping off or picking up secondary school students, which may be because most secondary school students are not picked up by their parents.

Comparison with published literature

In England, the experiences of the 2020/2021 autumn term when all the students returned to school were very different to the previous summer term, when only some primary and secondary school years returned to school and with small class bubble sizes. At that time, detailed interviews with headteachers of the sKIDs schools identified different challenges in implementing infection control measures, including difficulties in prioritising teaching because of the additional requirement and practices, physical space constraints, staffing issues, finances, lack of adequate protective equipment and parent.21 Our survey from the autumn term showed that many of these challenges still remained, but were also further complicated by the return to near-normal class sizes. The inability to maintain the 2-metre distance between the students and between students and staff, especially in primary schools, has been a consistent finding and not only challenging to implement with 51% of headteachers reporting ‘major challenges’ but is also considered incompatible with good teaching, especially in early years classrooms.22 23

One cross-sectional survey study in England, using a convenience sample of 442 participants, measured parental perceptions of control measures implemented in their child’s school in June. Their findings suggested that suboptimal practices were widespread, with only half of parents reporting hand washing or hand gel dispensing facilities at school entrances and in classrooms and almost 40% reporting class sizes being larger than the recommended 15.24 This compared with over three-quarters of staff reported use of hand gel dispensers in classrooms and at entrances, and only 40%–60% of parents reporting this in our study. A qualitative study conducted among primary school staff in Wales reported challenges in monitoring good hygiene practices, particularly with a ‘class of 30’.25

Parents interviewed in another England study found that the most common reason for parents not sending their children to school when their child was eligible was that ‘it was too risky’, reported by 52% of 423 parents who did not send their child to school.26 Another qualitative study conducted in another region of England did report that while parents and staff were concerned about the increased risk of COVID-19 transmission in schools—they did feel on balance the benefits outweighed the risks and there was good acceptability of COVID-19 infection control measures implemented in schools.27

Studies outside the UK on this topic are limited; furthermore, varying community SARS-CoV-2 infection rates and implementation of local infection control measures to mitigate the risk of infection in their settings make it difficult to compare the experience of educational staff and parents of primary and secondary school students during autumn 2020/2021 with other countries.

Strengths and limitations of this study

This is to our knowledge one of the largest surveys conducted among parents and school staff in England on the implementation of preventative measures during the COVID-19 pandemic in primary and secondary schools. One key strength of this survey was the establishment of close relationships with schools taking part in school surveillance studies which enabled a good response, with parents from 56 schools and staff from 73 schools completing nearly 3000 questionnaires within 3 weeks, before schools were required to close for the subsequent national lockdown. We also used a standardised questionnaire, which contrasts with other studies which mainly involved detailed interviews, often with a small number of staff and parents.

However, there are some limitations. We did not assess responses by demographics, such as ethnicity or socioeconomic status, which are very likely to influence questionnaire responses among staff and students, as has been reported elsewhere.20 Instead, we provided a summary of the demographics and results for all participants combined to ensure that the key messages reflect the group as a whole. Of those who took part, it is likely that there was an under-representation of families for whom English was not their main language as well as those with limited access to digital platforms and the internet.

Not all schools agreed to forward the questionnaire to their staff and parents, mainly because they were too busy and this may have also introduced selection bias if those who felt less prepared were less willing to participate in the questionnaire survey, perhaps anxious about what this might reveal. Additionally, responses may be affected by desirability bias as participants may not have wished to reflect poorly on their schools, their actions or of their children in selecting less favourable responses. Another limitation was that for some schools, responses were only provided by one participant so may not necessarily be representative of the whole school. While participating primary schools had a broad geographical spread across England, they are not representative of all primary and secondary schools in England. Primary schools participating in sKIDs were selected because they reopened with at least 30 students in attendance during the summer term. Similarly, secondary schools were identified for sKIDsPLUS because they were located in five regions where paediatric teams were available for taking blood samples for antibody testing from staff and students.

Implications of findings

The findings of this survey provide educationalists and policymakers with real-world data to help make more informed decisions to ensure that educational settings remain open throughout the pandemic. Education staff, including teachers, are working hard to follow national recommendations which are continually being updated, to help keep schools safely open during the COVID-19 pandemic, despite most of them considering themselves to be at increased risk of COVID-19 because of their profession and being concerned for their own health. Parents too expressed concern about schools reopening and, while most were not worried about the health of their children, they were worried about their children transmitting the virus to others, including vulnerable household members.

While most recommendations in the national guidance have been implemented to some extent in most schools, consistent concerns include difficulties in maintaining physical distancing within the school environment.22 This, along with difficulties of maintaining small bubble sizes following full reopening of schools, raises the question whether all staff and students should wear face masks/coverings in school,28 as has been implemented in other countries.29 Indeed, most parents appear to be supportive of children wearing masks in school.20 More generally, more studies are needed to assess the relative benefits of current infection control measures, including, but not restricted to, face masks/coverings, so that future guidelines are more evidence based.29 30

In particular, smaller class sizes, through blended in-school and home learning, for example, would enable more effective implementation of the recommended infection control measures and provide additional reassurance for staff, parents and students.31 This would, however, only be possible if schools are provided with the appropriate computer hardware, internet support and technical support to allow the students to attend their classes online.32 We also identified a need to improve communication between policymakers and education staff in schools.29 Many staff members commented on some unrealistic recommendations in the national guidance, such as maintaining physical distancing and seating arrangements within the class, while attempting to bring all the children back to school in the current autumn term. Previous findings from research in the summer term had also highlighted teachers’ concerns that physical distancing requirements had negatively impacted effective teaching practices which would normally include group activity and practical work.23 Providing individualised and pragmatic support for schools that are unable to implement some specific measures, including financial support where needed, would help improve relationships and ensure optimal prevention practices in educational settings.33 By the same token, improved communication with parents, either directly by policymakers or through schools, would provide additional reassurance about the safety of their children attending school. Consistent messaging and using social media to reach younger people would also help communicate public health messages to promote behaviours that reduce COVID-19 transmission.34 35

The return to full school attendance exacerbated the challenges of maintaining physical distancing and infection control measures. At the same time, community infection rates were much higher between September and December 2020 than they were in June 2020, with increased numbers of cases in school-aged children,36 and outbreaks in primary and secondary schools.37 This had a large impact on the number of staff and student contacts required to self-isolate as part of the contact bubbles. Often whole classes and year groups had to self-isolate following a single confirmed case, and many staff and students had to self-isolate multiple times because they were contacts of different cases in their bubble. This was disruptive not only for the self-isolating students but also the remaining students because of the inconsistencies in school attendance and teaching staff.23

Overall, there is growing evidence the risk of infections and outbreaks in educational settings correlate strongly with community SARS-CoV-2 infections rates in adults.36 38 39 Interventions to reduce local community infection rates, including local and national lockdowns without school closures as was recently implemented in England, not only reduced SARS-CoV-2 infections in adults but also in school-aged children. Ongoing surveillance in educational settings, as well as review of school guidance, however, remains critical due to/as a result of the changing landscape of the pandemic, even more so with the emergence of new variants.40