Last reviewed 10 January 2022

Last year, typical levels of winter illnesses were not seen in schools due to Covid-19 restrictions. This winter more exposure to common viral infections means increased risk of outbreaks of the four major illnesses likely to affect school-age children: respiratory syncytial virus (RSV) Influenza or flu, Norovirus, and Covid-19.

Higher frequency of infections with more serious symptoms were anticipated this winter and Public Health England (PHE) surveillance recently revealed that numbers presenting with RSV and other respiratory infections continue to rise, especially amongst under-15s.

Why are increases in winter illnesses being seen?

Contact with viral pathogens usually occurs regularly and while this does not always lead to illness, occasional exposure to the viruses, particularly in winter, usually tops up immunity. Last year, wearing masks and other measures to prevent Covid-19 meant different viruses were temporarily pushed to the background, resulting in one less year of building immunity.

Respiratory illnesses including Respiratory Syncytial Virus (RSV)

Respiratory syncytial virus (RSV) is one of the pneumoviruses that commonly cause viral coughs and colds in winter. Though generally mild, it may be severe in those with asthma.

Younger children, in particular, would not have developed immunity to RSV last winter so it is currently more prevalent.

Covid-19, Colds, and Influenza

UK researchers advise that up to 50% of those who currently have cold type symptoms such as sneezing, headache, sore throat, fatigue, or a runny nose may have the Covid-19 Omicron variant, even if they are fully vaccinated, so they should get tested and follow current guidance.

The Influenza or flu virus is variable and each year there are different strains. Often called seasonal flu, occurring between December and February, it is highly contagious and can lead to extreme inflammatory responses and worsening of chronic conditions. Symptoms tend to start suddenly, are more severe, last longer and most infectious from onset of symptoms and a further three to seven days. Children and those with weaker immune systems may remain infectious for longer.

Flu and the common cold are caused by different viruses. According to the NHS, differences in colds and flu symptoms include:

Colds

Flu

Appears gradually

Appears swiftly, within a few hours

Affects mainly nose and throat

Affects more than just nose and throat

Makes you feel unwell but able to go to school as usual

Makes you exhausted and too unwell to carry on as normal

It is very easy to become infected by someone, especially if in a crowded indoor space as Covid-19, colds and flu are all highly contagious and spread via respiratory droplets. Individuals can contract Covid-19 and flu at the same time and are likely to be seriously ill.

Norovirus

Known as the winter vomiting bug, Norovirus is extremely infectious with at least 25 different strains. There is no cure, and with so many strains we do not develop immunity. Norovirus was also at lower levels throughout the Covid-19 pandemic but as restrictions eased, cases across all age groups increased.

Just a few particles of material contaminated by stool or vomit from an infected person spreads Norovirus, as viral particles are suspended in the air, contaminating the environment, remaining infectious on surfaces for several days, resistant to disinfection, heat and cold.

The incubation period is 10–48 hours and individuals can pass on the Norovirus or shed the virus onto surfaces and objects during this time but are most infectious whilst symptomatic with: watery diarrhoea, vomiting (often projectile), a high temperature, headache and aching arms and legs.

Those involved in food preparation may contaminate food, especially if they do not wash their hands regularly or wear gloves.

Although unpleasant it generally clears up after a few days of rest and fluids to avoid dehydration, but for vulnerable individuals it can be more serious.

How to prevent spread of Norovirus in schools

  1. Ensure infection control policies are up to date and accessible for all staff.

  2. Remind parents to exclude their child from school if they have diarrhoea and/or vomiting.

  3. Ensure plans are in place for transporting pupils home who normally use the school bus or public transport.

  4. Symptomatic individuals must not undertake food preparation or handling of foods.

  5. Spread is primarily via hand contamination so effective hand washing with soap and water is essential as hand sanitisers or antibacterial gels are not effective at killing this virus.

  6. Ensure liquid soap and disposable paper hand towels are available in all toilets and classrooms where there are handwashing facilities and encourage frequent, thorough handwashing.

  7. Increase frequency of toilet cleaning, including floors and shared common areas.

  8. Ensure foot-operated bins are in use and in working order.

  9. Use Personal protective Equipment (PPE) for contact/ cleaning activities and ensure:

    1. prompt cleaning of vomit and faecal spillages

    2. appropriate disinfectant or a bleach-based cleaning agent to disinfect other surfaces including desks, door handles, light switches, and handrails

    3. contaminated carpets and soft furnishings cleaned with hot water and detergent, or steam cleaned.

Public Health England have produced a leaflet which can be downloaded.

What to do if staff or pupils become unwell at school?

Staff and pupils should go straight home as soon as symptoms begin.

Procedures for isolating pupils with appropriate supervision should be followed, and use of separate toilet facilities, until parents can collect them.

The isolation room should be thoroughly cleaned after use.

While Norovirus symptoms persist, individuals must remain off school until 48 hours after their last symptom, even if feeling well.

Teachers and pupils may feel under pressure to return to school sooner but may remain contagious.

For more information, see the NHS website.

When should schools declare an outbreak?

PHE guidance specifies an outbreak as two or more cases of diarrhoea or vomiting in the same classroom, shared communal areas, or taking part in the same activities.

The headteacher should contact the local health protection team (HPT) to discuss the situation and actions required and will need to report:

  • number/s affected

  • symptoms

  • the date(s) symptoms began

  • number of classes affected.

In the event of any outbreak, precise record keeping should be maintained to help with investigations.

Sickness policy

Schools’ sickness policies must be enforced and any recently updated policies or guidance should be shared with staff, parents, guardians and pupils.

Vaccination

Teachers and pupils eligible for a flu vaccination or a Covid-19 vaccination/booster should be encouraged to access these as an effective way to boost natural immunity, protect others and reduce school absenteeism. It is safe to have the Covid-19 and flu vaccines at the same time.

Each year the flu vaccine is made to give the best protection against the strains of flu expected to circulate in the coming season. The flu vaccination programme for the 2021/22 season was expanded to include pupils in years 7 to 11, as well as primary schools. Guidance can be found here.

Second doses of Covid-19 vaccines are to be offered to pupils aged 12–15 in schools from 10 January 2022 or they can access them in vaccination, walk-in centres or pharmacies. Those yet to have a first dose may still access this.

Cleaning and PPE

Cleaning is recommended twice daily as a minimum in an outbreak and adequate levels of cleaning materials should be stocked, such as disposable cloths, detergent and PPE, in anticipation of increased cleaning.

Toilets should be cleaned more frequently, bins emptied, door handles, classroom tables and other surfaces such as computer keyboards thoroughly cleaned.

Sufficient stock levels of liquid soap and disposable paper hand towels should also be maintained.

Generic prevention measures

Winter illnesses in semi-enclosed school environments can be difficult to control, and as school buildings vary, precautions need to reflect local infrastructure.

For most pupils and teachers, whilst unpleasant, most winter illnesses are unlikely to be too serious. However, it is essential to minimise opportunities to spread them and protect those at increased risk.

Prevention measures include:

  • being prepared

  • being vigilant, recognising and reporting outbreaks

  • reminding parents to exclude their child from school if symptomatic of Covid-19, flu, diarrhoea and/or vomiting

  • testing routinely for Covid-19 and if experiencing symptoms

  • re-iterating Catch it, kill it, bin it

  • ensuring disposable tissues are readily available and encouraging pupils to cover their mouth and nose with a tissue when coughing or sneezing, then immediately disposing of this before washing hands

  • making sure liquid soap and disposable paper hand towels available in all toilets and classrooms where there are handwashing facilities, encouraging hand washing for at least 20 seconds with warm running water

  • safe use of hand sanitiser if soap is not available or the situation makes using soap less feasible, bearing in mind this is ineffective against Norovirus

  • staying home if unwell and keeping away from others who are ill

  • increasing fresh air and ventilation

  • wearing face masks/coverings as per guidance

  • ensuring schools’ bodily fluid hygiene policy is up to date and PPE readily available

  • making sure PPE is used and disposed of properly; guidance can be found here

  • encouraging vaccination for Covid-19 and flu.

Summary

  • Covid-19, flu, RSV and Norovirus are likely to pose an increased risk to school-age children.

  • Staff or pupils should go home immediately when symptoms begin.

  • The school’s sickness policy should be clearly communicated and enforced.

  • Vaccination should be encouraged.

  • Cleaning is recommended at least twice daily during an outbreak.