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Covid-19 HSE Clinical Guidance and Evidence

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HSE Frameworks and Operational Pathways of Care

Interim HSE advice in relation to return to school and at risk groups

HSE advice in relation to school attendance and at risk groups (CD19-193-001 / 13.04.21)

NPHET, HSE, Department of Health and Department of Education and Skills advice

This guidance is subject to the overarching advice of the National Public Health Emergency Team (NPHET), the HSE, the Dept of Health and the Dept of Education and Skills. Information is available at:


  • This document summarises guidance relating to school attendance for those who have underlying conditions which may put them at increased risk of severe illness from COVID-19. It considers advice relating to pupils, members of their household and adults working in the school environment.
  • It is intended for the general public, those in the educational sector and healthcare professionals.
  • Note that for adults, the HSE has classified those at possible increased risk as:
    • High risk or
    • Very high risk (also termed ‘extremely medically vulnerable’)
  • Information for the public on high risk groups is available here: 
    and for pregnant women here:  


Information on COVID-19 and children
  • Children are more likely than adults to have no symptoms or to have mild disease. Symptoms in children include new onset cough, deterioration of existing respiratory condition, fever and changes in sense of smell.  Children, particularly young children, are infrequently the source of COVID-19 infection into a household.
  • School-aged children are not more likely than adults to spread infection to other people.
  • Evidence from contact tracing and testing within the school setting in Ireland is consistent with international findings of school as a low risk setting for transmission.
  • The virus that causes COVID-19 may very rarely trigger an inflammatory disease called PIMS (Paediatric Inflammatory Multisystem Syndrome) in children.(2)


Pupils with underlying conditions
  • Given current knowledge about COVID-19 disease in children, it is now difficult to justify cocooning in most children with underlying conditions. Long-term cocooning of children with complex medical needs is likely to adversely affect them (3) and may outweigh the potential risk of infection. For all children, care should continue to be taken to reduce transmission through the measures promoted by HPSC including hand washing and social distancing by all household members etc.
  • For the vast majority of children with cystic fibrosis, the National Clinical Programme for Cystic Fibrosis recommended a full return to school in line with the guidance from the Department of Education. Children with cystic fibrosis should continue to follow standard public health advice in relation to social distancing, hand hygiene and respiratory etiquette. (4) The exception are those with cystic fibrosis whose disease is unstable or severe (e.g. patients awaiting transplantation). 
  • Children with diabetes are also advised to return to school and to follow general infection control and public health guidance on reducing transmission.
  • For children with profound immunodeficiency/immunosuppression (e.g. due to ongoing or recent cancer treatment or a recent transplant), their individual risk should be assessed by their treating team and consideration given to the possible necessity of avoiding school. (5)


School workforce
  • It is acknowledged in Dept. of Education and Skills guidance that there are some school staff who may be unable to return to school.(6)
  • As with all decisions re suitability for attendance in the workplace, consideration will be given to the individual’s health and risk factors, the risk associated with the particular work and workplace and the precautions available to mitigate that risk. School occupation health services should be consulted to support an individual risk assessment.

(a) Very high risk conditions

  • ​​​Adults who have a condition considered very high risk are generally advised to continue working remotely where possible and should discuss this with their occupational health department.
  • As we learn more about COVID-19 disease, those groups classified as ‘very high risk’ will be further revised. The detailed clinical guidance on this group is available on the HSE COVID-19 clinical guidance repository. Note that only those medications currently listed in the very high risk category in the guidance, available at are considered sufficiently immunosuppressing to require the additional precautions for very high risk groups.
  • Certain individuals who have a very high risk condition may, following consultation with their specialist team, be considered suitable for return to the workplace.
  • In addition, some people are advised to follow cocooning advice prior to certain treatments/surgical procedures (typically for two weeks) or following a treatment/procedure. Patients will generally be advised to work remotely during such a cocooning period, depending on their work environment. Patients should be advised by their healthcare team at the end of treatment or post-operatively as to how long they should continue to follow cocooning recommendations/be excluded from the workplace.

(b) High risk conditions

  • Those who work in a school setting and have a condition listed as high risk are generally advised that it is safe for them to return to the workplace and to continue to carefully follow infection control and public health guidance in relation to hand hygiene, etc.
  • The detailed clinical guidance on this group is available on the HSE COVID-19 clinical guidance repository at
Family members with underlying conditions
  • Children with immediate family members, including parents, in both the ‘high risk’ and ‘very high risk’ categories, can attend school and it is important for the child’s overall well-being.
  • This is consistent with public health advice internationally in relation to at-risk family members.(7) The priority is that the household continues to follow all current advice on how to minimise the risk of coronavirus, through regular hand washing, etc. (See the HSE website) More detailed advice on specific measures within a household are included in HPSC COVID-19 Guidance for Older People and Others at Risk of Severe Disease on Reducing Risk of COVID-19 Infection . (8)
  • In terms of reassurance from what we know to date on children and COVID-19, children, particularly young children, are infrequently the source of COVID-19 infection into a household. School aged children are not more likely than adults to spread infection to other people. Evidence from contact tracing and testing within the school setting in Ireland is consistent with international findings of school as a low risk setting for transmission.
  • Schools have put measures in place to reduce the risk of coronavirus being transmitted to/within the school, such as hand hygiene regimes and cleaning measures within the school, reduced mixing between children and less objects going in and out of school.
  • It remains important for all parents/family members, particularly those at high-risk and very high risk, to ensure that they continue to socially distance from other adults, e.g. at school pick-up times, to minimise their likelihood of possible exposure.
  • Similarly, children and young people who live with someone who is pregnant can attend school and early years’ settings. Again, when taking children to school/nursery, it is important to practice social distancing – staying two metres away from teachers/carers and other parents and not going inside the building.
  • Abigail Collins (Public Health), Ellen Crushell (Paediatrics), Ciara Kirke (Medication Safety), Triona McCarthy (Public Health), Augustine Pereira (Public Health)
  • With contributors: Jim Egan (Transplant Medicine), Alan Irvine (Dermatology), Peter McKenna (Obstetrics & Gynaecology), Siobhan Ni Bhriain (Integrated Care), Colm O Morain (Gastroenterology), Muriel Pate (Medication Safety), Lynda Sisson (Occupational Health)
  • Authors of update 02/04/2021: Abigail Collins (Public Health), Ellen Crushell (Paediatrics), Triona McCarthy (Public Health), Lynda Sisson (Occupational Health)


  1. COVID-19 Schools and childcare facilities mass testing reports, HSE, Available at
  2. Royal College of Paediatrics and Child Health information available at:
  3. National Clinical Review on the Impact of COVID-19 Restrictions on Children and Guidance on Reopening of Schools and the Normalisation of Paediatric Healthcare Services in Ireland. August 2020. Available at:   
  4. NCPCF advice: Return to school for children with Cystic Fibrosis in light of COVID-19 (NCD19-030 / 31.08.20) available at:
  5. Interim Guidance on Medically Vulnerable Children during the Coronavirus (COVID-19) pandemic (CD19-191 / 06.08.20), available at:
  6. Roadmap for the full return to school  Department of Education Published on
  7. Protective measures for groups vulnerable to COVID-19  HIQA First published June 2020,  Available at 
  8. People at increased risk of severe illness , HPSC, Available at

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