In autumn 2021, a landmark study was launched into the feasibility of using air cleaners to reduce the spread of Covid-19 in schools. The £1.85mn trial, which took place in 30 primary schools in Bradford, was run by the University of Leeds, funded by the Department for Health and Social Care, and overseen by the UK Health and Security Agency. Yet almost two years later the full results of this major study remain unpublished.
In a tantalising peek, a report prepared for the Child of the North All-Party Parliamentary Group (APPG) in September 2023 shared the headline findings of the randomised trial. They show significant implications for our children’s future health, so why are the full results and recommendations still not in the public domain?
Clean air in schools
Speaking at the launch of the aptly named Class-ACT study, lead scientist Professor Mark Mon-Williams of the University of Leeds said: “There is an urgent need to identify technologies that could be adopted by schools to try and stop the spread of Covid-19. We know that good ventilation can help disperse the aerosols that can cause infection, but in a busy classroom ventilation alone will not be enough.”
The location of the trial was chosen because of the hugely successful Born in Bradford model, where schools, the council, health professionals and academic researchers work together to investigate ways of promoting the health and wellbeing of children. Most importantly, through Bradford’s pioneering work on linking datasets, infections and school absence data could be accurately correlated – giving the trial a very high level of scientific credibility.
Amazing headline results
Details of the main findings have just emerged via the APPG’s report, Addressing Education and Health Inequity: Perspectives from the North of England. The report also cites other related research studies to give some clear messages:
- The circumstantial evidence linking good ventilation to reduced transmission of airborne illnesses in schools is substantial, yet the pandemic highlighted many problems with school building infrastructure and the difficulty in ensuring classrooms are adequately ventilated.
- The extent of natural ventilation in a classroom affects the level of illness and “provides support for the frequent reports of schools acting as ‘super-spreader’ sites for illness”.
- Unhealthy school environments “mean that children and young people are more likely to be absent from school (with all the educational and safeguarding issues this entails) and teachers are more likely to be off ill”.
- The study provides direct evidence of significant reductions in Covid-19 illness absences when schools were fitted with air cleaners.
- The study also found that schools fitted with these relatively low-cost air-cleaning technologies showed significantly lower absence rates overall.
- Moreover, the perception of schools as hubs of illness transmission has the potential to contribute towards the growing trend of “school hesitancy”.
Further significant details emerged last week at the World Health Organization’s Europe Indoor Air Conference. Professor Cath Noakes, lead author of the Class-ACT study, reported finding that classrooms with air cleaners had over 20% fewer student absences than those without.
In the context of continuing political and public discussion on the high-profile issue of school absences, this is very powerful evidence of a relatively cheap technology that could have a significant impact on improving children’s health and access to education. But when will it be acted on?
Where’s the full report?
The APPG appendix references only the abstract of the Class-ACT report, as – unlike the hundreds of other references given – the final paper is not yet published. Many are keen to know why, including local MPs who have approached both the Secretaries of State for Health and Care and for Education for answers. The response given is that the paper is still undergoing peer review – that is, evaluation by people with similar competencies as its producers.
But nearly two years after the results were expected, could it be political expediency rather than the peer review process that is causing the delay?
These results are being hailed as very significant by organisations campaigning for clean air in schools, such as the Corsi-Rosenthal Foundation. The organisation is calling for the full report to be released, claiming that even better results are possible at a lower cost, with the cheaper and more powerful air cleaners now available.
The full results are equally important to ‘Long Covid Kids’, an organisation that champions children adversely affected by Covid-19 infections. It said on X (formerly known as Twitter): “We remain eager to see the full report, and children adequately protected. It is long overdue. Avoiding Covid is the only way to be assured of avoiding Long Covid.”
Many other countries are investing in clean air technology for classrooms. Unlike the UK, the US government has provided hundreds of billions of dollars to improve indoor air quality, including $122bn for schools, with many states rolling out mass deployment of air cleaners. For example, Illinois recently started installing 60,000 air cleaners in classrooms across the state.
So how does it make sense for a government already under intense public scrutiny for lack of investment in school infrastructure not to publish or publicise such significant results? And whilst peer review is recognised as an important process that takes time, the authors of the APPG report clearly have confidence in the results – otherwise, they would not have quoted them so extensively. So when will the Department of Health and Social Care publish the research in full?
Every week that passes means more infection, especially in schools – the emergence of a new variant, coupled with a limited vaccine offer, surely means that the UK Government needs to expand its strategy for safely “living with Covid-19”?
With the Class-ACT study, we have yet another randomised trial showing the multiple benefits to children of “the provision of ‘air cleaning technologies’ that remove particles from the circulating air” and go beyond Covid-19 to protect against other illnesses like flu, asthma and hay fever.
There are understandable concerns about challenges to implementation, such as finding space in classrooms and ensuring teachers understand the importance of keeping the cleaners switched on at all times.
Nevertheless, the world-leading scientists who led the Class-ACT study have concluded that while air cleaners are “not a panacea”, they “could help schools [ … ] become healthier environments”.
So when will the Government share in full the findings of its own research and act on its own recommendations to improve the health of our children?