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The children of the pandemic

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In politics, nothing happens by accident. If it happens, you can bet it was planned that way.

Franklin D. Roosevelt

Never let a good crisis go to waste.

Winston Churchill

On 12 March, compulsory masking for all pupils from Cycle 2 onwards was enshrined in law[1]. In the school year 2020/2021, it was de facto implemented in secondary education from autumn onwards, at that time still without a legal basis. From the Easter holidays onwards, voluntary self-tests were added in schools, initially once a week, then increased to 2 weekly tests from the Whitsun holidays onwards.

We would like to examine the circumstances under which these measures were introduced. To do this, we first look at the chronology of key events in this context.

A chronology

2 January 2021 Despite the restriction of flights from the UK, the British mutant was detected in first samples in Luxembourg [2].

6 January The possibility that children could be affected to a greater extent by the new variant is being addressed in the local media[3].

12 January Santé director Dr Schmit warns: the new variant poses a danger if it spreads, more restrictive measures may be necessary[4].

19 January The COVID-19 Task Force speaks out[5]:

An do ass et sou, datt vill méi detailléiert Analysen noutwendeg sinn. An do gehéieren och d’Masken an de Schoulen, mee och eenzelen anere Secteuren dobäi. Déi nei Varianten kéinten nämlech och bei jonke Leit oder Kanner méi schlëmm verlafen.

(More precise analyses are thus necessary. And this also includes the compulsory use of masks in schools and other areas.)

28 January Education Minister Meisch issues a first warning[6]. The warning emphasizes that it is the British variant that is causing most concern. This represented a paradigm shift, since until now the scientific consensus had been that schoolchildren were not themselves at risk from Covid-19, nor could there be any significant contagions in schools.

4 February After a slight increase in the incidence in schools during the month of January, lessons in the week before the carnival holidays (week 6) take place in homeschooling “as a precaution”. The headlines in the media leave no doubt that this is due to the new virus variants: Les variants mettent K.-O. le milieu scolaire [7] or Back to homeschooling / school closures: Virus Variants Cause Serious Concern[8].

12 February A press conference on 12 February by the Ministry of Education [9] analyses the development of new infections in schools. Increased clusters were found, which could be related to the new virus variants. As a result, the existing measures would have to be adapted to the new situation. The Minister of Education, Meisch, then also announced that masks would be compulsory after the carnival holidays [10]:

Et hätten donieft och vill méi Clustere ginn an deenen déi brittesch Variant vum Virus massiv present wier. All dat féiert dozou, datt d’Schoule just ënner verstäerkte sanitäre Mesuren kéinten opgoen. Heescht: Vum 22. Februar u gëllt iwwerall eng Maskeflicht an de Schoulen an och Maison relaisen, an dat vum Cycle 2 un.

(There had been a sharp increase in the number of infection clusters where high levels of involvement of the British variant had been found. All this means that schools can only reopen under stricter sanitary measures. This means that from 22 February, schools and day-care centres will be required to wear masks from Cycle 2 onwards).

12 March On 12 March, the compulsory wearing of masks in schools is enshrined in law[1].

19 April After a short pilot phase, the rapid tests were introduced in schools after the Easter holidays[11]. The 120,000 pupils and school staff can test themselves once a week on a voluntary basis.

31 May After the Whitsun holidays, there will be two tests per week.

The data

The evolution of positive cases among Enseignement fondamental and secondaire pupils from week 42/2020 (12 October) to week 23/2021 (7 June) is shown in the following graph:

The definitions of the different scenarios can be found in the weekly reports of the Ministry of Education [12] and are as follows:

  • Scenario 1: a single case in a class where it is assumed that he/she has been infected outside school.
  • Scenario 2: 2 positive cases in one class, without differentiation of the source of infection
  • Scenario 3: 3 – 5 positive cases in one class
  • Scenario 4: several cases where it is assumed that the infection took place within the school community. This is the case when there are more than 5 people who tested positive in one or more classes of a school institution. This is called a “cluster”.

In the press conference of 12 February, the introduction of compulsory masks in schools is essentially justified by the 3 following reasons:

  1. A higher positive rate in the age groups “0 to 9” and “10 to 19 years” compared to the rest of the population.
  2. An increase in the number of positive cases among Enseignement Fondamental pupils from 25 January.
  3. A higher incidence of clusters involving the British variant.

1. Positivity rate

The following graph was shown at the press conference. The increased values for the age groups “0 to 9” and “10 to 19 years” in calendar weeks 2 to 5 were highlighted in red.

As we have described in detail in a previous article [13], the positive rates (proportion of positive tests per total number) in the different test frameworks “Diagnostic”, “Contact tracing” and “Large Scale Test (LST)” differ, sometimes substantially. For example, while the professional age groups are usually tested for the most part in the LST, which has a very small positive rate, children tend to be tested more specifically, for example if they are symptomatic or have had contact with a person who has tested positive. It is thus obvious that these age groups can differ in their respective positive rates, without this having any significance for the actual incidence of infection in this category. A report from the MEN [14] of 12 November comes to the same conclusion:

Dans les semaines après le retour à l’école, le Contact tracing (CT) a joué un rôle majeur dans la stratégie du testing. (…) Ceci est une information à prendre en compte pour les analyses, car nous nous attendons à ce que les tests qui sont demandés par le CT produisent un taux de cas positifs plus élevé. Les tests qui proviennent du CT ou d’une ordonnance médicale sont en effet plus ciblés, car ils sont effectués sur une population pour laquelle une suspicion de contamination est présente.

(In the weeks after the start of school, contact tracing (CT) played a major role in the testing strategy. (…) This must be taken into account in the analyses, as we expect a higher positive rate for the tests carried out in the CT. The tests in the CT or on a doctor’s prescription are carried out in a more targeted manner, as they are used in people where there is a suspicion of an infection).

Nevertheless, it is precisely this positive rate that is used to compare the different age groups with each other!

Furthermore, if we look at the positive rates for the 0-9 and 10-19 age groups over the period from October 2020 to June 2021, we can immediately see that a sharp increase in these measures has already occurred at other times (week 43/2020 and 15/2021) without the need to adjust the measures here.

If one wants to compare the incidence of infection in different age groups, one should directly look at the cases per number of persons in the respective age category.

The claim that the British variant is more prevalent among the younger population can be clearly contradicted:

  • It can be clearly seen that in the age group “10-19 years”, the proportion of people tested positive was already very high compared to the other age groups. This could be explained by the fact that this part of the population probably has the most social contacts, and thus the incidence of infection is highest in this group. The proportion of people testing positive in this group reached a maximum of 0.35% in week 12, not even half of the highest value of 0.76% in week 46.
  • In the category “0-9 years”, the values are also above those of the other age groups from January onwards only in weeks 5 and 6 and then stabilise in the midfield compared to the other categories. As in the previous case, the values are below those measured from November to December. The maxima of the 2nd and 3rd wave are 0.47 % (week 48) and 0.27 % (week 5).

This is also the conclusion of the Ministry of Education in a publication of 15 April [15]:

… nous ne sommes pas encore en mesure de nous exprimer quant à une éventuelle susceptibilité accrue des plus jeunes aux nouveaux variants.

(… we do not yet see ourselves in a position to pronounce on an increased susceptibility of the youngest to the new variants).

In this context, the positive rate is therefore not suitable for comparing the incidence of infection in the different age groups.

Increase in positive cases from 25 January

In the press conference of 12 February, only the period from 4 January 2021 is considered for the evaluation of the development of positive cases.

Viewed in a broader time frame, however, this increase is relativized significantly.

We look at the number of positive cases in the different age categories over the entire interval from October 2020 to June 2021. The time interval in the previous graph (week 1 to 6) is outlined in red.

Apart from the fact that the number of positive cases was significantly higher in the months of October to December, without the need to introduce the mask requirement, it is very clear that the trend shows the same tendency in all age categories, which is confirmed in retrospect by the report already cited [15]:

… les taux d’incidence dans les établissements scolaires reflètent les taux d’incidence dans la société …

(…the incidences in the school institutions reflect the incidences in the population …)

The temporary sharp increase in calendar weeks 4 and 5, on the other hand, could be explained by the targeted testing of the “équipes mobiles”, which are always deployed when there is an accumulation of those testing positive in a school. Given the size of Luxembourg, even a few clusters can significantly influence the total number of positive cases. This circumstance would also explain the high positive rates at that time.

3rd Cluster

The classification into different scenarios with the respective specifications would in itself require a scientific justification. Why are 6 cases in a class or a school (regardless of the total number of pupils in the respective institution) already epidemiologically relevant in a “Scenario 4”, which is classified as a cluster? Why not only 10?

We are not even talking here about the peculiarity of the PCR test to show a positive result even months after an infection[16]. Thus, the simultaneous occurrence of several positive test persons at the same location does not at all result in a causal relationship. However, this arbitrary definition of a cluster gives it a (psychological) significance for the evaluation of the situation, which does not correspond to it per se.

The argumentation on the part of the ministry is then essentially exhausted in a listing of scenarios 3 and 4 that occurred in weeks 4 and 5 (25 January to 7 February):

– As examples of a Scenario 4, 2 schools and 2 day-care centres are mentioned where between 14 and 50 people tested positive.

According to Edustat [17], there are currently 181 schools in the Enseignement Fondamental with around 57,000 pupils in an estimated 3,800 classes (at 15 pupils per class). The figures mentioned thus represent a vanishingly small proportion.

Finally, it should also be mentioned that a number of the positive cases that occurred only became a Scénario 4 through subsequent testing (see appendix of the publication already mentioned [15]). Testing means the testing of the entire school class by a mobile team after the occurrence of a single case (Scénario 1). It is therefore understood to be the testing of asymptomatic persons, in which the principle of “he who seeks, finds” applies.

Depending on how consistently one implements this measure, one will logically find more or less clusters. The evil in the eyes of the beholder…

Harm-benefit analysis

A corresponding harm-benefit analysis on the wearing of masks in the school context was not considered by the responsible persons at any time. An open letter from 120 teachers and educators, which received a lot of public attention, as well as 6 further letters from the subsequently founded “FAIR Movement” [18] to the responsible minister, which, among other things, demanded a public debate on the proportionality of the mask obligation, remained unanswered.

The benefit

The masking requirement applied from week 8. Regardless of whether one looks at the number of positive cases in the school setting, the positive rate of the tests, or the proportion of cases in the respective age group, no measurable effect can be identified. Even the already cited publication of the MEN [15] cannot say with certainty whether this measure had an influence and comes to the conclusion:

L’introduction du port obligatoire du masque à partir du cycle 2 semble avoir contribué à détendre la situation au sein des classes de l’enseignement fondamental.

(The introduction of compulsory masks from “Cycle 2” onwards seems to have contributed to easing the situation in the classes of the Enseignement fondamental).

The numbers also increased after the introduction of mandatory masks and followed the general trend in the overall population independently of this. An article on Swiss Policy Research [19] lists 10 studies that found no or only weak efficacy with regard to the containment of masks on the incidence of infection.

The harm

In politics as well as in public opinion, the prevailing opinion seems to be that mask-wearing represents negligible harm to physical and mental health, and can therefore still be justified as a precautionary measure, even if possibly not necessary.

We would like to counter this with our concerns by addressing only a small selection of the harmful effects:

  • A study published in the renowned journal International Journal of Environmental Research and Public Health by 8 scientists [20] has shown that the mask has a significant influence on breathing resistance and dead space volume, which in turn reduces the oxygen content in the blood. This leads to stress and exhaustion in the short term and may even cause damage to the immune system or increase the risk of developing cancer in the long term.
  • The masks are an ideal environment for pathogens. On masks worn by children, a laboratory found bacteria, parasites and fungi, including some that can cause pneumonia [21].
  • Mental health problems among children and adolescents have increased significantly as a result of the Corona measures and manifest themselves, among other things, in suicidality, anxiety, depression and self-injurious behaviour [22]. Obviously, the wearing of the masks plays a non-negligible role here [23].

Similarly, the self-tests introduced after the Easter holidays are by no means unproblematic in terms of potential harm to health. Apart from the fact that the epidemiological benefit can be fundamentally questioned [24], there are justified concerns about the chemicals used in the buffer solution [25], the sterilization with ethylene oxide (EO) of the swab [26] and its irritation of the nasal mucosa [27].

It is therefore incomprehensible why a harm-benefit analysis has not been carried out so far.

A bitter aftertaste

The arguments put forward for the introduction of mandatory masks are tenuous at best. The less science is made up for by more buzzwords like “cluster” and “dangerous variant”.

A discussion about the harm and benefit of the masks is obviously not desired. In the meantime, the question of the proportionality of the measures alone is equated in the public with the denial of the pandemic, as the shitstorm in the (social) media after the publication of the “open letter of the 120” showed.

Although it had been clear since 15 April at the latest[15] that the feared increased infectivity of the British variant had not been confirmed in children and adolescents, and the efficiency of the compulsory masking could not be proven with certainty, it was nevertheless maintained until the end of the school year. This seems all the more incomprehensible since at that time the self-tests had been introduced in the schools and there was no mask obligation in the indoor area of the Horeca.

A closer look at the chronology given at the beginning of this article leads to the temptation of not being able to exclude a certain media production: The chronically cloudy crystal ball of the task force suddenly anticipates political decisions [5], the specific danger to children posed by the British variant as well as the closure of schools in week 6 are generously staged [3,6,7,8]. In the end, compulsory masks appear as the only possible answer to the impending danger.

However, the main problem, in our view, lies in the way political decisions are made in the current crisis. Ultimately, the assessment of the epidemiological situation is in the hands of a small group of people who are not democratically elected and are not subject to any external control. If policymakers rely solely on this expertise, they will also fail to do justice to their task of balancing competing urgencies, in this case infection control vs. human needs and mental health.

The marriage of politics and science reduces political decisions to specific scientific findings. Once made, the former can no longer be reversed, the latter can no longer be revised. Science mutates into dogmatism, democracy into technocracy.

In this context, we recommend reading “The Open Society and its New Enemies” by philosopher of science Prof. Esfeld [28]. Since 2009 a member of the Leopoldina, the National Academy of Sciences of the FRG, he gained media attention through an open letter to its president Prof. Haug, in which he criticized that a Leopoldina statement not written according to scientific standards had been used as legitimization for political decisions [29].

In conclusion, we must unfortunately note a general tendency that the dignity and well-being of (also) children has only played a subordinate role for politics since the beginning of the pandemic[30]. This is impressively demonstrated, for example, by the fact that the Covid vaccination of children is solely about herd immunity. Luxembourg is no exception, as the answer of the Minister of Health to parliamentary question no. 3976 [31] showed:

Et ass bewisen, dass Kanner a Jugendlecher sech mat SARS-CoV-2 ustieche kënnen, an esou och zur Verbreedung vum Virus an der Bevëlkerung baidroen. Et war also logesch, och déi Jugendlech ze impfen, wann den lmpfstoff dann zougelooss ass. Dëst géif sécher zur Herdenimmunitéit baidroen…

(It has been proven that children and adolescents can become infected with the SARS-CoV-2 virus and thus also contribute to its spread in the population. It would therefore be logical to vaccinate adolescents as well, once the vaccine has received approval. This would certainly contribute to herd immunity… )

Does this not correspond exactly to the definition of instrumentalisation[32]?

Sources

[1] Loi du 12 mars 2021 portant modification de la loi modifiée du 17 juillet 2020 sur les mesures de lutte contre la pandémie Covid-19. http://legilux.public.lu/eli/etat/leg/loi/2021/03/12/a193/jo

[2] Wort (02.01.2021): Le variant du covid-19 détecté au Luxembourg https://www.wort.lu/fr/luxembourg/le-variant-du-covid-19-detecte-au-luxembourg-5ff0aca1de135b92363df62c

[3] Wort (06.01.2021): Les enfants plus touchés par la variante du covid? https://www.wort.lu/fr/luxembourg/les-enfants-plus-touches-par-la-variante-du-covid-5ff5901cde135b92363b773b

[4] RTL (12.01.20121): 6 Fäll vu brittescher Corona-Mutatioun zu Lëtzebuerg detektéiert https://www.rtl.lu/news/national/a/1644375.html

[5] RTL (19.01.20121): Rapport Covid-19-Task-Force: “Mir rutschen an eng nei Well!” https://www.rtl.lu/radio/thema-vum-dag/s/3446370.html

[6] RTL (28.01.20121): “Mir mussen extrem virsiichteg sinn!”, sou de Claude Meisch https://www.rtl.lu/news/national/a/1662470.html

[7] Wort (04.02.2021): Les variants mettent K.-O. le milieu scolaire https://www.wort.lu/fr/luxembourg/les-variants-mettent-k-o-le-milieu-scolaire-601c12e2de135b9236c10c7d

[8] Tageblatt (05.02.2021): Zurück ins Homeschooling / Schulschließungen: Virusvarianten bereiten ernsthafte Sorgen https://www.tageblatt.lu/?post_type=post&p=895771

[9] MEN (12.02.2021): Dispositif sanitaire à l’Éducation nationale dans le contexte de la crise COVID-19 https://gouvernement.lu/dam-assets/documents/actualites/2021/02-fevrier/12-reouverture-ecoles.pdf

[10] RTL (12.02.2021): Verschäerfte Mesuren an de Schoulen, dorënner Maskeflicht
https://www.rtl.lu/news/national/a/1671078.html

[11] RTL (15.03.2021): No der Ouschtervakanz kommen d’Schnelltester an de Schoulen https://www.rtl.lu/news/national/a/1687992.html

[12] Men.lu: Covid19, État hebdomadaire de la situation dans les écoles luxembourgeoises https://men.public.lu/fr/support/coronavirus.html

[13] Expressis Verbis: Invasion der Mutanten https://www.expressis-verbis.lu/2021/06/26/invasion-der-mutanten/

[14] men.lu (12.11.2020): Rapport d’analyse sur la situation de la COVID-19 dans les établissements scolaires du 15 septembre au 1er novembre 2020 https://men.public.lu/dam-assets/catalogue-publications/sante-bien-etre/covid19/2011-rapport-covid-etablissements-scolaires.pdf

[15] men.lu (15.04.2021): Rapport d’analyse sur la situation de la COVID-19 dans les établissements scolaires du 4 janvier au 4 avril 2021 https://men.public.lu/dam-assets/catalogue-publications/sante-bien-etre/covid19/RAPPORT-COVID-AVRIL-2021.pdf

[16] RKI: Grafik Erregernachweis https://www.rki.de/SharedDocs/Bilder/InfAZ/neuartiges_Coronavirus/Grafik_Erregernachweis.png

[17] Edustat: L’enseignement au Luxembourg en chiffres https://edustat.script.lu/fr/public-data/key-figure

[18] FAIR Beweegung https://fairbeweegung.lu/

[19] Swiss Policy Research: Are Face Masks Effective? The Evidence. https://swprs.org/face-masks-evidence/

[20] Is a Mask That Covers the Mouth and Nose Free from Undesirable Side Effects in Everyday Use and Free of Potential Hazards? https://www.mdpi.com/1660-4601/18/8/4344/htm

[21] Uncut.news: Eine Gruppe von Eltern schickte die Gesichtsmasken ihrer Kinder zur Analyse in ein Labor. https://uncutnews.ch/eine-gruppe-von-eltern-schickte-die-gesichtsmasken-ihrer-kinder-zur-analyse-in-ein-labor-hier-ist-was-sie-gefunden-haben/

[22] Question parlementaire n° 2957 https://chd.lu/wps/portal/public/Accueil/TravailALaChambre/Recherche/RoleDesAffaires?action=doQuestpaDetails&id=19930

[23] Quelles conséquences psychologiques du port du masque chez les enfants ? https://www.youtube.com/watch?v=q-9dXJbESNI

[24] Deutsche Gesellschaft für Krankenhaushygiene e.V. : Hygieniker warnen vor zu hohen Erwartungen an Schnellteste https://www.krankenhaushygiene.de/informationen/817

[25] Prof. Dr. Werner Bergholz: Gefährdungsanalyse Durchführung von Covid-19-Schnelltests durch Laien
https://corona-transition.org/IMG/pdf/gefahrdungsanalyse_schnelltest_2021_04_16.pdf

[26] Health Hazards Associated With Ethylene Oxide https://obpmedical.com/the-dangers-of-ethylene-oxide-gas-sterilization-for-medical-devices/

[27] PCR-Teststäbchen-Partikel können wie Asbest im Körper wirken https://2020news.de/pcr-teststaebchen-partikel-wirken-wie-asbest-im-koerper/

[28] Club der klaren Worte: Die offene Gesellschaft und ihre neuen Feinde https://clubderklarenworte.de/von-prof-michael-esfeld/

[29] MDR (19.02.2021): Wird die Leopoldina politisch instrumentalisiert? https://www.mdr.de/wissen/leopoldina-politisch-instrumentalisiert-100.html

[30] NachDenkSeiten: Kinder in der Pandemie: „Instrumentalisierung pur!“ https://www.nachdenkseiten.de/?p=74455

[31] Question parlementaire n°3976 https://www.chd.lu/wps/portal/public/Accueil/TravailALaChambre/Recherche/RoleDesAffaires?action=doQuestpaDetails&id=21231

[32] Deutsches Referenzzentrum für Ethik in den biomedizinischen Wissenschaften: Instrumentalisierung https://www.drze.de/im-blickpunkt/pid/module/instrumentalisierung

Photo: Demo in Luxemburg-Stadt. Mit freundlicher Genehmigung von Julia.