Some more things to note from SAGE papers

As well as the much discussed “move teaching online” recommendation in the SAGE circuit breaker papers from September, there’s a couple of other things to note from that and some previous SAGE papers.

Yesterday we looked at the online teaching thing in detail as well as stuff in SAGE papers on the migration of students around the country.

But one overlooked aspect from the 21st September document dump was the advice on students in quarantine (or self-isolation if tested positive or contact traced).

I didn’t bang on about it yesterday because I’m like a broken record on this issue, and because it was contained in a section on quarantine for new students in HE to prevent seeding into university (or testing of all new university admissions and isolation of positives).

SAGE reckoned that that tactic would have low impact – it might help prevent the seeding of outbreaks in HE and spill-over to local communities, but its argument was that one-off screening (or quarantine) has a time-limited effect:

It may be more effective in campus universities in areas of low community transmission”

However in the section on “implementation issues” we get an evaluation of the issues that surround quarantine or self-isolation that are there regardless – and are still there right now.

Students, it says “require substantial support from their institution during the period”, and “failing to provide support will lead to distress, poor adherence and loss of trust.”

That was on September 21st. Yet there’s still no actual help from the government on supporting students in self-isolation, and we only got UUK advice on it last week:

Support must therefore include (a) practical needs (food etc.), (b). study needs (IT) and (c). emotional needs (e.g. a ‘buddy’ system)”

Now it was quite late to be saying this, some will argue. But SAGE was also saying this back in early September in this paper. However the advice on students needing food, support, etc etc never made it into DfE’s advice back out to the sector.

Meanwhile SAGE also evaluated planned, short, stay-at-home orders of say a couple of weeks. If you lump together some of the “soft lockdowns” being thrown at students with some of the “failed householding” in large halls, this is where many students are trapped at.

The paper warns of a:

Negative impact on health due to mental health impacts on adults and children; domestic abuse prevalence. Key workers, low income groups have to continue to go to work. Mental health impact may begin prior to implementation, knowing there are upcoming periods of isolation”

It also says there is a need for:

Substantial support (financial, social, informational, emotional) needed for people with limited support networks, low financial resources / precarious employment and other needs e.g. IT equipment to minimise exacerbation of educational inequality.

And without the support:

Adherence, health and trust will suffer if people are not given the resources they need to adhere safely.

So a solution would be:

Community-level co-production of support measures can support adherence, and financial support for mutual aid organisations from central government is necessary.

None of this seems to have happened for students, other than “urging universities to do more” and the repeated claim that this year’s student premium funding might be redirected towards this. Arguably, we went on fail to provide support. Has it led to to distress, poor adherence and loss of trust? The signs are there.

Finally, a quick thing on risks in halls. I’ve a confession on this one – I missed a SAGE paper on “preventing outbreaks in institutional settings” that went to SAGE 39. In my defence, it was never indexed here where it should have been.

I should have spotted that it was missing off the back of the SAGE 39 minutes that discussed “institutional settings”, but we are where we are. Anyway, I found it buried on gov.uk – just not indexed alongside the SAGE 39 papers.

This remember is from May – four full months before the great migration back. It covers institutional settings – various care/homeless/criminal justice settings plus barracks, boarding schools, ships (naval, merchant and leisure) and of course halls of residence.

Such settings, says the paper, have the potential to “act as reservoirs of infection – making local elimination challenging”. They can “act as amplifiers of infection” and “have weak data connection / traditional surveillance schemes” – in other words it’s often hard for authorities to know what’s going on inside them unless you take specific action to fix that.

So how do you fix that? Well, the paper says that you need active surveillance that’s linked to support, mandated where possible and with the data feeding into PHE Regional Centres. You need to know if residents have been ill, know if anyone needs testing, and need to know if anyone who is symptomatic is unable to self isolate.

The paper notes that these settings are “insulated from general population” but both amplifiers and “reservoirs of infection”. And in these settings there are limitations to measures used with the general population measures e.g. contact tracing, and as such they need a balance between responsive testing and regular screening.

It’s a paper that paints a picture of needing to recognise that these types of settings are high risk, and need additional coordination, funding and different prevention/testing/tracing/outbreak/support strategies than other settings.

After the meeting the minutes say that the paper was circulated to DfE. But there’s very little evidence that that advice was meaningfully acted on and implemented beyond some sketchy paragraphs on “householding” in the DfE guidance.

And look at what happened next.

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