Controversial two-week surgery quarantine stopped for children

Royal College of Paediatrics and Child Health has agreed the rule change with NHS England, Public Health England and other agencies, and it will begin to be introduced now.

The college has published 30 recommendations in total including that children may receive treatment in either “hot” or “cold” facilities — the former meaning there may be some spread of covid. There is growing evidence that children are very rarely seriously affected by the virus, and are not major spreaders of it.

More than 50,000 children in England have had surgery postponed between March and May and, with huge numbers of very-long waiters, and concerns about the total list ballooning, many in the health service are keen to resume as much surgery as possible. That is particularly the case in coming months before winter, which may see further severe contraints. There was concern the 14 day rule was putting families off booking surgery. 

There are also substantial concerns about the problems caused by the rule among adults, with reports of patients cancelling operations, whose slots cannot be filled at short notice due to the rule.

Sanjay Patel, a senior paediatrician who chaired the new guidance, said its conclusion could potentially be applied to adult surgery in places, particularly when operations are cancelled leaving empty slots.

He said: “I think the 14-day isolation is probably equally relevant to adults actually because it’s all to do with prevalence in the community. One of the issues that all surgical services are facing is if say a patient’s [procedure] is cancelled with 24 hours’ notice, you can’t just call up another patient and get them in at the moment because they need to be isolated for 14 days.

“The real strength of these recommendations, and I think that for me it’s something that could translate to adults, is that there is recognition as there is with the whole of covid, is that we need to be receptive and vigilant and data-based.”

Evidence in the guidance includes low mortality rates for children in the peri-operative period, low infection rates among children, the susceptibility to the disease within households and low community prevalence of coronavirus among children.

For adults, there is some evidence of very poor outcomes from surgery for those with covid.

In its recommendations regarding pre-operative isolation, the RCPH states that “children cannot isolate within a silo” and that there was still a risk of pre-operative sequential transmission days before a procedure.

It states: “PHE modelling data suggest that during periods of low community prevalence, isolation has very little impact on the risk of a child being infected at the time of admission to hospital.

“For this reason, the group agreed that during periods of low to moderate prevalence… the harms of pre-operative isolation (reduced access to education, impact on parental employment) outweigh the potential benefits in terms of reducing the risk of being infected with COVID-19 at the point of admission to hospital.”

It also points out that during higher-risk periods where only the most urgent procedures are performed, two-week isolation is still often not possible.

The guidance also gives flexibility to scaling back some of the freedoms suggested should the rates of infection rise.

Dr Patel said: ”The impact of some of these conditions will have a lifelong impact and psychological impact and it seems extremely likely that having children waiting for certain procedures will result in long-term issues, so the sooner we can get them done and restore them to health the better.”

The publication comes amid continuing anxiety both over the growing adult elective waiting list and reports that the self-isolation policy is causing significant and avoidable delays to the backlog.