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Hiqa review Covid masks ruled out for primary schoolchildren but not for secondary students

Experts express doubts about use of rapid antigen tests for asymptomatic people

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The wearing of face masks in secondary school looks set to remain compulsory for now although they have been ruled out for primary school pupils.

The benefits of primary schoolchildren wearing face masks as a Covid-19 protection measure are likely to be small, according to a Hiqa review which looked at their use in under 13-year-olds, the current cut-off point.

Nphet has since accepted the advice but its expert advisory committee said it was “premature” to consider revising the wearing of masks in secondary school which is currently is mandatory.

The use of masks in under-13s is to be reviewed again six to eight weeks after schools reopen.

Dr Conor Teljeur, Hiqa’s chief scientist said: “The use of layered mitigation measures in schools and childcare facilities, such as physical distancing, hand hygiene, cough etiquette, increased ventilation, and, most importantly, not attending when you have symptoms of Covid-19, reduces the risk of transmission of SARS-CoV-2.

“National and international evidence suggests that when these mitigation measures are fully implemented, schools become low risk environments.”

Dr Teljeur added: “As there are currently high rates of infection in the community, we encourage parents and children to continue to observe public health guidance before, during and after school activities. We also recommend that anyone who has the opportunity to avail of the Covid-19 vaccine does so.”

Hiqa also reviewed the use of rapid antigen testing in real-world settings for screening or surveillance of asymptomatic individuals-those who have no known or suspected exposure to Covid-19 -to limit transmission of the virus.

It comes as the phased return to the workplace started today.

It said that on the current evidence, there is uncertainty regarding the effectiveness of rapid antigen testing for screening of asymptomatic individuals with the aim of limiting transmission of the virus.

There are also significant resource, implementation, regulatory, ethical and social considerations associated with the widespread use of rapid antigen detection tests (RADTs) in asymptomatic populations.

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Hiqa has advised that RADTs may have a role in limiting transmission in certain circumstances, but only as an additional public health measure, rather than a replacement for known mitigation measures.

Dr Teljeur said: “A negative antigen test in an asymptomatic person should not be viewed as a ‘green light’ to engage in activities that would be otherwise considered as high risk for transmission.

"Also, the introduction of routine and widespread rapid antigen testing in asymptomatic populations would require a significant investment. Any decision to use RADTs for screening in asymptomatic populations should consider a variety of factors including the prevalence of Covid-19 the proportion of the population who have adequate immunity and the vulnerability of the population involved.”

Sixteen relevant studies were identified that provided evidence regarding the effectiveness of RADTs for screening of asymptomatic individuals to limit transmission of SARS-CoV-2.

Eight examined the effectiveness of RADTs for mass testing, four for pre-event screening and four for serial testing in different settings (high school students, prison inmates and staff, students and staff of a university sports programme, and staff in care homes).

No evidence was found regarding the use of RADTs for surveillance of asymptomatic individuals.

Overall, there is uncertainty regarding the effectiveness of rapid antigen testing for screening of asymptomatic individuals at limiting the transmission of SARS-CoV-2. This uncertainty is due to the relatively low number of studies identified, the predominantly observational and/or uncontrolled study designs used, and concerns regarding the methodological quality of these studies.

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