1. Forbes, H., , Morton, C.E., Bacon, S., McDonald, H.I., Minassian C., Brown, J.P., Christopher T Rentsch, Rohini Mathur, Anna Schultze, Nicholas J DeVito, Brian MacKenna, William J Hulme, Richard Croker, Alex J Walker, Elizabeth J Williamson, Chris Bates, Amir Mehrkar, Helen J Curtis, David Evans, Kevin Wing, Peter Inglesby, Henry Drysdale, Angel YS Wong, Jonathan Cockburn, Robert McManus, John Parry, Frank Hester, Sam Harper, Ian J Douglas, Liam Smeeth, Stephen JW Evans, Krishnan Bhaskaran, Rosalind M Eggo, Ben Goldacre, Laurie A Tomlinson (2021). Association between living with children and outcomes from COVID-19: an OpenSAFELY cohort study of 12 million adults in England. British Medical Journal, 372, n628. https://doi.org/10.1136/bmj.n628.
In contrast to wave 1, evidence existed of increased risk of reported SARS-CoV-2 infection and covid-19 outcomes among adults living with children during wave 2. However, this did not translate into a materially increased risk of covid-19 mortality, and absolute increases in risk were small.
2. Lewis, SJ.J., Munro, A.P.S., Smith, G.D., Pollock, A.M. (2021). Closing schools is not evidence based and harms children. British Medical Journal, 372, 521 doi: https://doi.org/10.1136/bmj.n521 (Published 23 February 2021)
In the absence of strong evidence for benefits of school closures, the precautionary principle would be to keep schools open to prevent catastrophic harms to children.
3. O’Leary, S.T. (2021). To Spread or Not to Spread SARS-CoV-2-Is That the Question? JAMA Pediatrics. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2775655
With this large seroprevalence study demonstrating yet again what we have suspected for several months, the answer to that question could not be clearer: we must prioritize the reopening of childcare facilities and elementary schools to full time, in-person learning without exception.
4. Tönshoff B, Müller B, Elling R, et al. (2021). Prevalence of SARS-CoV-2 infection in children and their parents in southwest Germany. JAMA Pediatrics. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2775656
The low seroprevalence of SARS-CoV-2 antibodies in young children in this study may indicate that they do not play a key role in SARS-CoV-2 spreading during the current pandemic.
5. Somekh et al. (2021). Reopening Schools and the Dynamics of SARS-CoV-2 Infections in Israel: A Nationwide Study. Clinical Infectious Diseases. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciab035/6103916
This analysis does not support a major role of school reopening in the resurgence of the COVID-19 curve in Israel. Easing restrictions on large scale gatherings was the major influence on this resurgence.
6. Ingelbeen, B., Peckeu, L., Laga, M., Hendrix, I., Neven, I., van der Sande, M.A.B., van Kleef, E. (2020). Reducing contacts to stop SARS-CoV-2 transmission during the second pandemic wave in Brussels, Belgium. https://t.co/LAagJYe0Wf?amp=1
Het effect van de scholen op besmettingen is heel beperkt in vergelijking met een situatie waarin de scholen gesloten blijven.
7. Hershow RB, Wu K, Lewis NM, et al. Low SARS-CoV-2 Transmission in Elementary Schools — Salt Lake County, Utah, December 3, 2020–January 31, 2021. Morbidity and Mortality Weekly Report, ePub: 19 March 2021. DOI: http://dx.doi.org/10.15585/mmwr.mm7012e3
These findings add to evidence that in-person elementary schools can be opened safely with minimal in-school transmission when critical prevention strategies including mask use are implemented, even though maintaining ≥6 ft between students’ seats might not be possible.
8. Honein, M.A., Barrios, L.C., Brooks, J.T. Data and Policy to Guide Opening Schools Safely to Limit the Spread of SARS-CoV-2 Infection. JAMA. 26 january 2021. https://jamanetwork.com/journals/jama/fullarticle/2775875
The COVID-19 pandemic has greatly affected K-12 schools across the US. Accumulating data now suggest a path forward to maintain or return primarily or fully to in-person instructional delivery… but there has been little evidence that schools have contributed meaningfully to increased community transmission.
9. Zimmerman KO, Akinboyo IC, Brookhart MA, et al. (2021). Incidence and secondary transmission of SARS-CoV-2 infections in schools. Pediatrics. https://pediatrics.aappublications.org/content/early/2021/01/06/peds.2020-048090
We examined 11 school districts with nearly 100,000 students/staff open for 9 weeks of in-person instruction, tracking secondary transmission of SARS-CoV-2; within-school infections were extremely rare.
10. Sciensano (2021). Schoolsurveillance in België in het kader van de COVID-19 Epidemie. https://www.sciensano.be/nl/pershoek/covid-19-belgische-scholen
Volgens de verzamelde gegevens op school, werden leerkrachten en ander schoolpersoneel vanaf september 2020 tot het begin van de herfstvakantie vermoedelijk vooral geïnfecteerd door collega’s en minder door leerlingen. Voor de periode nadien zijn er onvoldoende gegevens om hierover uitspraken te doen. Uit de gegevens blijkt verder dat minder dan één op vijf van de gerapporteerde besmettingen waarschijnlijk op school plaatsvond.
11. Buonsenso D, De Rose C, Moroni R, Valentini P. (2021). SARS-CoV-2 Infections in Italian Schools: Preliminary Findings After 1 Month of School Opening During the Second Wave of the Pandemic. Frontiers in Pediatrics, 14 januari 2021. https://www.frontiersin.org/articles/10.3389/fped.2020.615894/full
Importantly, national schools reported only 1 infection in more than 90% of cases, and only in one high school a cluster of more than 10 cases has been described (P = 0.015). These findings would suggest that, when proper preventive measures are respected, the intraclass transmission of the virus is low. This is in agreement with recent studies suggesting that children have lower susceptibility to SARS-CoV-2, compared with adults… The available studies suggest children and adolescents play a lesser role in transmission of SARS-CoV-2, which is in marked contrast to influenza (7).
12. Yung CF, Kam KQ, Nadua KD, Chong CY, Tan NWH, Li J, et al. (2020). Novel coronavirus 2019 transmission risk in educational settings. Clinical Infectious Diseases. ciaa794. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa794/5862649
Our investigations, especially in preschools, could not detect SARS-CoV-2 transmission despite screening of symptomatic and asymptomatic children. The data suggest that children are not the primary drivers of SARS-CoV-2 transmission in schools and could help inform exit strategies for lifting of lockdowns.
13. E. Lavezzo, E. Franchin, C. Ciavarella, G. Cuomo-Dannenburg, L. Barzon, C. Del Vecchio, et al. (2020). Suppression of a SARS-CoV-2 outbreak in the Italian municipality of Vo. Nature , 584, pages425–429. https://www.nature.com/articles/s41586-020-2488-1
Recent studies have found that the clinical progression of infection in children is generally milder than in adults14,15,16. We found that none of the children under 10 years of age who took part in the study tested positive for SARS-CoV-2 infection at either survey, despite at least 13 of them living together with infected family members (Extended Data Table 3). This agrees with a recent study conducted in Iceland13 and is particularly intriguing given the very high observed odds ratio for adults to become infected when living together with family members who are positive for SARS-CoV-2.
14. Ismail SA, Saliba C, Lopez Bernal JA, Ramsay ME, Ladhani SN. SARS-CoV-2 infection and transmission in educational settings: a prospective, cross-sectional analysis of infection clusters and outbreaks in England. The Lancet Infectious Diseases, 8 december 2020. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30882-3/fulltextSARS-CoV-2
Infections and outbreaks were uncommon in educational settings during the summer half-term in England. The strong association with regional COVID-19 incidence emphasises the importance of controlling community transmission to protect educational settings. Interventions should focus on reducing transmission in and among staff.
15. Kim J, Choe YJ, Lee J, et al. (2020). Role of children in household transmission of COVID-19. Archives of Disease in Childhood. 2020;archdischild-2020-319910. https://adc.bmj.com/content/early/2020/08/06/archdischild-2020-319910
In this context, our data may provide important baseline information on the role of children in COVID-19 household transmission dynamics in the setting of social distancing, suggesting that children are mainly infected inside household clusters, with limited transmission to household members.
16. Yoon Y, Kim KR, Park H, Kim SY, Kim YJ. Stepwise School Opening and an Impact on the Epidemiology of COVID-19 in the Children. Journal of Korean Medical Science, 30;35(46):e414; https://pubmed.ncbi.nlm.nih.gov/33258334/
There was no sudden increase in pediatric cases after the school opening, and the proportion of pediatric cases among total confirmed cases in the nation around 7.0%. … Korea had a successful transition from school closure to online and off-line school opening, which did not cause significant school-related outbreak among the pediatric population.
17. Ehrhardt J, Ekinci A, Krehl H, Meincke M, Finci I, Klein J, et al. (2020). Transmission of SARS-CoV-2 in children aged 0 to 19 years in childcare facilities and schools after their reopening in May 2020, Baden-Württemberg, Germany. Euro Surveillance, 25(36):2001587.
https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.36.2001587
Our investigation suggests that child-to-child transmission in schools and childcare facilities is uncommon and not the primary cause of SARS-CoV-2 infection in children.
18. Ludvigsson JF. Children are unlikely to be the main drivers of the COVID-19 pandemic – A systematic review. (2020). Acta Paediatrica 2020;109(8):1525-30. https://onlinelibrary.wiley.com/doi/full/10.1111/apa.15371
Children accounted for a small fraction of COVID‐19 cases and mostly had social contacts with peers or parents, rather than older people at risk of severe disease. Data on viral loads were scarce, but indicated that children may have lower levels than adults, partly because they often have fewer symptoms, and this should decrease the transmission risk. Household transmission studies showed that children were rarely the index case and case studies suggested that children with COVID‐19 seldom caused outbreaks. However, it is highly likely that children can transmit the SARS‐COV‐2 virus, which causes COVID‐19, and even asymptomatic children can have viral loads.
19. Dyani Lewis. Why schools probably aren’t COVID hotspots (2020). https://www.nature.com/articles/d41586-020-02973-3
Data gathered worldwide are increasingly suggesting that schools are not hot spots for coronavirus infections. Despite fears, COVID-19 infections did not surge when schools and day-care centres reopened after pandemic lockdowns eased. And when outbreaks do occur, they mostly result in only a small number of people becoming ill.
20. Viner RM, Mytton OT, Bonell C, et al. Susceptibility to SARS-CoV-2 infection among children and adolescents compared with adults: a systematic review and meta-analysis. (2020) JAMA Pediatr. Published online September 25. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2771181
Conclusions and Relevance In this meta-analysis, there is preliminary evidence that children and adolescents have lower susceptibility to SARS-CoV-2, with an odds ratio of 0.56 for being an infected contact compared with adults. There is weak evidence that children and adolescents play a lesser role than adults in transmission of SARS-CoV-2 at a population level.
21. Munro APS, Faust SN. . Children are not COVID-19 super spreaders: time to go back to school. (2020) Archives of Disease in Childhood, 105, 618-619. http://dx.doi.org/10.1136/archdischild-2020-319474
At the current time, children do not appear to be super spreaders… Governments worldwide should allow all children back to school regardless of comorbidities.
22. Heavey L, Casey G, Kelly C, Kelly D, McDarby G. (2020). No evidence of secondary transmission of COVID-19 from children attending school in Ireland, 2020. Euro Surveillance, 25(21):2000903. https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.21.2000903
The results moreover echo the experience of other countries, where children are not emerging as considerable drivers of transmission of COVID-19… These findings suggest that schools are not a high risk setting for transmission of COVID-19 between pupils or between staff and pupils.
23. Davies NG , Klepac P , Liu Y , et al. (2020) Age-dependent effects in the transmission and control of COVID-19 epidemics. Nature Medicine, 26, 1205-1211. https://www.nature.com/articles/s41591-020-0962-9
Accordingly, we find that interventions aimed at children might have a relatively small impact on reducing SARS-CoV-2 transmission, particularly if the transmissibility of subclinical infections is low.
24. Davies NG , Kucharski AJ , Eggo RM , et al . (2020). Effects of non-pharmaceutical interventions on COVID-19 cases, deaths, and demand for hospital services in the UK: a modelling study. Lancet Public Health :e375-e385. https://www.sciencedirect.com/science/article/pii/S246826672030133X
We estimated that neither school closures, physical distancing, shielding of older people, nor self-isolation alone would reduce R0 enough to bring about a sustained decline in the incidence of new infections… In particular, school closures had little effect in our projections, despite our model accounting for substantial asymptomatic transmission among children.
25. Larosa E, Djuric O, Cassinadri M, et al. (2020). Secondary transmission of COVID-19 in preschool and school settings in northern Italy after their reopening in September 2020: a population-based study. Eurosurveillance 25:2001911. https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.49.2001911
Previous studies measuring incidence in school-aged children and adolescents before and during school closures suggested limited transmission in schools [4–6]. Contact-tracing studies conducted in schools and educational settings in Australia, Singapore and Ireland found a low rate of, or even no, secondary cases [7–9]. One study reporting results of screening at the reopening of kindergartens in Korea found only one possible secondary case among 45 cases identified when attending the school [10]. Similarly, a low transmission from student to student was found in the United Kingdom when analysing predominantly primary and preschools [11] and in Germany for all ages [12]. These findings are in line with our report in terms of transmission in preschools and elementary schools, but not with our results for secondary schools.
26. Gudbjartsson DF, Helgason A, Jonsson H, Magnusson OT, Melsted P, Norddahl GL, et al. (2020). Spread of SARS-CoV-2 in the Icelandic Population. The New England Journal of Medicine, 382(24):2302-2315
https://pubmed.ncbi.nlm.nih.gov/32289214/
In a population-based study in Iceland, children under 10 years of age and females had a lower incidence of SARS-CoV-2 infection than adolescents or adults and males.
27. Hobbs CV, Martin LM, Kim SS, et al. (2020). CDC COVID-19 Response Team. Factors associated with positive SARS-CoV-2 test results in outpatient health facilities and emergency departments among children and adolescents aged <18 years—Mississippi, September-November 2020. Morbidity and Mortality Weekly Report, 69(50):1925-1929. https://www.cdc.gov/mmwr/volumes/70/wr/mm7004e3.htm?s_cid=mm7004e3_w
In a setting of widespread community SARS-CoV-2 transmission, few instances of in-school transmission were identified among students and staff members, with limited spread among children within their cohorts and no documented transmission to or from staff members. With masking requirements and student cohorting, transmission risk within schools appeared low, suggesting that schools might be able to safely open with appropriate mitigation efforts in place.
28. Falk A, Benda A, Falk P, et al. (2021). COVID-19 cases and transmission in 17 K-12 schools—Wood County, Wisconsin, August 31-November 29, 2020. Morbidity and Mortality Weekly Report.
With masking requirements and student cohorting, transmission risk within schools appeared low… Among 5,530 students and staff members, 191 COVID-19 cases were reported. Only seven (3.7%) of these cases were associated with in-school transmission, all in students. Despite widespread community transmission, COVID-19 incidence in schools conducting in-person instruction was 37% lower than that in the surrounding community… the absence of identified child-to-staff member transmission during the 13-week study period suggests in-school spread was uncommon. This apparent lack of transmission is consistent with recent research
29. Vlachos J, Hertegård E, B Svaleryd H. (2021). The effects of school closures on SARS-CoV-2 among parents and teachers. Proceedings of the National Academicy of Sciences 2021;118:e2020834118. doi: 10.1073/pnas.2020834118. pmid: 33574041
The results for parents indicate that keeping lower-secondary schools open had minor consequences for the overall transmission of SARS-CoV-2 in society. The results for teachers suggest that measures to protect teachers could be considered.
30. (niet gepubliceerd in wetenschappelijk tijdschrift maar dicht bij huis, Luxemburg): https://covid19.public.lu/fr/actualite-covid-19/communiques/2021/01/15-situation-ecoles.html
le virus ne s’est pas propagé à l’intérieur de l’école grâce aux mesures de protection mises en place et les élèves ont pu continuer de fréquenter l’école. Dans 15 à 22% des cas, une infection à l’intérieur de l’école semble probable.
31. (niet gepubliceerd in wetenschappelijk tijdschrift maar dicht bij huis, Nederland, RIVM): https://www.rivm.nl/coronavirus-covid-19/kinderen
Vanaf 31 augustus 2020 tot en met 10 januari 2021 zijn ruim 390.000 mensen die werkzaam zijn in het onderwijs of kinderopvang getest. Van deze testen was 9% positief. Dit percentage is lager dan het totaal van 14% bij de ruim 3,7 miljoen volwassenen getest in de teststraten in deze periode.
32. (niet gepubliceerd in wetenschappelijk tijdschrift maar dicht bij huis, Vlaamse data, Sciensano)
Els Duysburgh; Joanna Merckx; Milena Callies; Ines Kabouche; Melissa Vermeulen; Mathieu Roelants; Isabelle Desombere. (2021). PREVALENCE AND INCIDENCE OF ANTIBODIES AGAINST SARS-COV-2 IN CHILDREN AND SCHOOL STAFF MEASURED BETWEEN DECEMBER 2020 AND JUNE 2021: AN OBSERVATIONAL SERO-PREVALENCE PROSPECTIVE COHORT STUDY. Sciensano report.
This study provides a representative estimate of the prevalence of anti-SARS-CoV-2 antibodies among pupils and school staff in Belgian primary and secondary schools at the end of the second wave. The study found that schools providing face-to-face teaching did not result in disproportionate numbers of infected individuals. There are no important statistical or clinical differences in the sero-prevalence in primary and secondary school pupils and school staff on the one side and the broader community on the other side. Based on our study findings, schools do not appear places where the coronavirus is more widespread or more likely to spread than elsewhere in the community.
Rapport: https://www.sciensano.be/sites/default/files/seroprevalence_sars-cov-2_schools_march2021.pdf
Samenvatting op https://radio1.be/luister/select/de-ochtend/onderzoek-sciensano-scholen-niet-de-motor-van-de-pandemie
33. Gilbert T. Chua, MBBS, MRCPCH1; Joshua Sung Chih Wong, MBBS2; Ivan Lam, MBChB2; Polly Po Ki Ho, MPH3; Wai Hung Chan, MBChB, MRCP3; Felix Yat Sun Yau, MBChB, MRCPCH3; Jaime S. Rosa Duque, MD, PhD1; Alvin Chi Chung Ho, MBBS4; Ka Ka Siu, MBChB4; Tammy W.Y. Cheung, MBBS, MRCPCH5; David Shu Yan Lam, MRCP5; Victor Chi Man Chan, MBChB, MRCPCH6; Kwok Piu Lee, MBChB6; Kwing Wan Tsui, MBBS, MRCP7; Tak Wai Wong, MBBS, MRCP7; Man Mut Yau, MBBS8; Tsz Yan Yau, MBChB8; Kate Ching Ching Chan, MBChB9; Michelle Wai Ling Yu, MBChB9; Chit Kwong Chow, MBBS10; Wah Keung Chiu, MBBS, MRCPCH10; Kwok Chiu Chan, MBBS, MRCP7; Wilfred H.S. Wong, PhD1; Marco Hok Kung Ho, MD1; Winnie W.Y. Tso, MBBS, MRCPCH1; Keith T.S. Tung, MPH1; Christina S. Wong, MRCP11; Janette Kwok, PhD12; Wing Hang Leung, PhD1; Jason C. Yam, MBBS13; Ian C.K. Wong, PhD14,15; Paul Kwong Hang Tam, ChM16,17; Godfrey Chi Fung Chan, MD1; Chun Bong Chow, MD1; Kelvin K. W. To, MD18; Yu Lung Lau, MD1; Kwok Yung Yuen, MD18; Patrick Ip, MPH1; Mike Yat Wah Kwan, MSc, MRCPCH2 (2021). Clinical Characteristics and Transmission of COVID-19 in Children and Youths During 3 Waves of Outbreaks in Hong Kong. JAMA Network Open. 2021;4(5):e218824. doi:10.1001/jamanetworkopen.2021.8824.
This cross-sectional study found that nearly all children and youths with COVID-19 in Hong Kong had mild illness. These findings suggest that household transmission was the main source of infection for children and youths with domestic infections and that the risk of being infected at school was small.
34. Brandal LT, Ofitserova TS, Meijerink H et al. Minimal transmission of SARS‐CoV‐2 from paediatric COVID‐19 cases in primary schools, Norway, August to November. Euro Surveill. 2021; 26: 2002011.
https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.26.1.2002011
Systematic tracing and testing of school contacts of paediatric COVID-19 cases showed minimal child-to-child and child-to-adult transmission in primary schools with implemented IPC measures. The results obtained during low to medium community transmission demonstrate the limited role of children in transmission of SARS-CoV-2 in school settings. This is an important finding in view of the ongoing discussions on school closures and use of quarantine for a large number of children. Strengthening of IPC measures in schools when community transmission levels increase could be an option.
35. Varma JK, Thamkittikasem J, Whittemore K, et al. COVID-19 infections among students and staff in New York City public schools. Pediatrics 2021 Mar 9: e2021050605.
https://pediatrics.aappublications.org/content/147/5/e2021050605
To assess prevalence, we analyzed data from 234 132 persons tested for severe acute respiratory syndrome coronavirus 2 infection in 1594 NYC public schools during October 9 to December 18, 2020; 986 (0.4%) tested positive. COVID-19 prevalence in schools was similar to or less than estimates of prevalence in the community for all weeks. To assess cumulative incidence, we analyzed data for 2231 COVID-19 cases that occurred in students and staff compared with the 86 576 persons in NYC diagnosed with COVID-19 during the same period; the overall incidence was lower for persons in public schools compared with the general community. Of 36 423 school-based close contacts, 191 (0.5%) subsequently tested positive for COVID-19; the likely index case was an adult for 78.0% of secondary cases.
We found that in-person learning in NYC public schools was not associated with increased prevalence or incidence overall of COVID-19 infection compared with the general community.
36. Li X, Xu W, Dozier M, He Y, Kirolos A, Theodoratou E; UNCOVER. The role of children in transmission of SARS-CoV-2: A rapid review. J Glob Health. 2020 Jun;10(1):011101. doi: 10.7189/jogh.10.011101. PMID: 32612817; PMCID: PMC7323934.
https://pubmed.ncbi.nlm.nih.gov/32612817/
“Preliminary results from population-based and school-based studies suggest that children may be less frequently infected or infect others, however current evidence is limited.”
37. Shah K, Kandre Y, Mavalankar D. Secondary attack rate in household contacts of COVID-19 Paediatric index cases: a study from Western India. J Public Health (Oxf). 2021 Jun 7;43(2):243-245. doi: 10.1093/pubmed/fdaa269. PMID: 33454742; PMCID: PMC7928715.
https://pubmed.ncbi.nlm.nih.gov/33454742/
“Thee household SAR from pediatric patients is low”
38. Lee EJ, Kim DH, Chang SH, Suh SB, Lee J, Lee H, et al. Absence of SARS-CoV-2 transmission from children in isolation to guardians, South Korea. Emerg Infect Dis. 2021;27(1):308–10. https://doi.org/10.3201/eid2701.203450.
https://wwwnc.cdc.gov/eid/article/27/1/20-3450_article
“We found that, even with close frequent contact, guardians who used appropriate personal protective equipment were not infected by children with diagnosed coronavirus disease. “
39. Chaabane, S.; Doraiswamy, S.; Chaabna, K.; Mamtani, R.; Cheema, S. The Impact of COVID-19 School Closure on Child and Adolescent Health: A Rapid Systematic Review. Children 2021, 8, 415. https://doi.org/10.3390/children8050415
https://www.mdpi.com/2227-9067/8/5/415/htm
“Harms of school closure on child and adolescent health seem to exceed some indicators of positive health care system effects.”
40. Danis K, Epaulard O, Bénet T, Gaymard A, Campoy S, Botelho-Nevers E, Bouscambert-Duchamp M, Spaccaferri G, Ader F, Mailles A, Boudalaa Z, Tolsma V, Berra J, Vaux S, Forestier E, Landelle C, Fougere E, Thabuis A, Berthelot P, Veil R, Levy-Bruhl D, Chidiac C, Lina B, Coignard B, Saura C; Investigation Team. Cluster of Coronavirus Disease 2019 (COVID-19) in the French Alps, February 2020. Clin Infect Dis. 2020 Jul 28;71(15):825-832. doi: 10.1093/cid/ciaa424. PMID: 32277759; PMCID: PMC7184384.
https://pubmed.ncbi.nlm.nih.gov/32277759/
“The fact that an infected child did not transmit the disease despite close interactions within schools suggests potential different transmission dynamics in children. “
41. Rice K, Wynne B, Martin V, Ackland G J. Effect of school closures on mortality from coronavirus disease 2019: old and new predictions BMJ 2020; 371 :m3588 doi:10.1136/bmj.m3588
“We therefore conclude that the somewhat counterintuitive results that school closures lead to more deaths are a consequence of the addition of some interventions that suppress the first wave and failure to prioritise protection of the most vulnerable people. When the interventions are lifted, there is still a large population who are susceptible and a substantial number of people who are infected. This then leads to a second wave of infections that can result in more deaths, but later. Further lockdowns would lead to a repeating series of waves of infection unless herd immunity is achieved by vaccination, which is not considered in the model. A similar result is obtained in some of the scenarios involving general social distancing. For example, adding general social distancing to case isolation and household quarantine was also strongly associated with suppression of the infection during the intervention period, but then a second wave occurs that actually concerns a higher peak demand for ICU beds than for the equivalent scenario without general social distancing.”
https://www.bmj.com/content/371/bmj.m3588
42. Alexander, P.A. (2021). School Closure: A Careful Review of the Evidence. American Institute for Economic Research.
“Based on the existing reviewed evidence, the predominant finding is that children (particularly young children) are at very low risk of acquiring SARS-CoV-2 infection, and if they do become infected, are at very low risk of spreading it among themselves or to other children in the school setting, of spreading it to their teachers, or of spreading it to other adults or to their parents, or of taking it into the home setting; children typically become infected from the home setting/clusters and adults are typically the index case; children are at very low risk of severe illness or death from COVID-19 disease except in very rare circumstances; children do not drive SARS-CoV-2/COVID-19 as they do seasonal influenza; an age gradient as to susceptibility and transmission capacity exists whereby older children should not be treated the same as younger children in terms of ability to transmit e.g. a 6 year-old versus a 17 year-old (as such, public health measures would be different in an elementary school versus a high/secondary school); ‘very low risk’ can also be considered ‘very rare’ (not zero risk, but negligible, very rare); we argue that masking and social distancing for young children is unsound policy and not needed and if social distancing is to be used, that 3-feet is suitable over 6-feet and will address the space limitations in schools; we argue that we are well past the point where we must replace hysteria and fear with knowledge and fact. The schools must be immediately re-opened for in-person instruction as there is no reason to do otherwise.”
43. Heavey L, Casey G, Kelly C, et al. (2020)/ No evidence of secondary transmission of COVID-19 from children attending school in Ireland, 2020. Euro Surveill2020;25:2000903.doi:10.2807/1560-7917.ES.2020.25.21.2000903
https://brownstone.org/articles/75-studies-and-articles-against-covid-19-school-closures/
“Children are thought to be vectors for transmission of many respiratory diseases including influenza. It was assumed that this would be true for COVID-19 also. To date however, evidence of widespread paediatric transmission has failed to emerge. School closures create childcare issues for parents. This has an impact on the workforce, including the healthcare workforce. There are also concerns about the impact of school closures on children’s mental and physical health… examination of all Irish paediatric cases of COVID-19 attending school during the pre-symptomatic and symptomatic periods of infection (n = 3) identified no cases of onward transmission to other children or adults within the school and a variety of other settings. These included music lessons (woodwind instruments) and choir practice, both of which are high-risk activities for transmission. Furthermore, no onward transmission from the three identified adult cases to children was identified.”
44. W. Van Lancker, Z. Parolin. (2020). COVID-19, school closures, and child poverty: A social crisis in the making The Lancet Public Health, 2019 (20) (2020), pp. 2019-2020, 10.1016/s2468-2667(20)30084-0
https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30084-0/fulltext
““The UN Educational, Scientific and Cultural Organization estimates that 138 countries have closed schools nationwide, and several other countries have implemented regional or local closures. These school closures are affecting the education of 80% of children worldwide. Although scientific debate is ongoing with regard to the effectiveness of school closures on virus transmission, the fact that schools are closed for a long period of time could have detrimental social and health consequences for children living in poverty, and are likely to exacerbate existing inequalities.”
45. Bayham, J. & Fenichel, E. P. Impact of school closures for COVID-19 on the US health-care workforce and net mortality: a modelling study. Lancet Public Health 5, e271–e278 (2020).
https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30082-7/fulltext
“Between January, 2018, and January, 2020, the US Current Population Survey included information on more than 3·1 million individuals across 1·3 million households. We found that the US health-care sector has some of the highest child-care obligations in the USA, with 28·8% (95% CI 28·5–29·1) of the health-care workforce needing to provide care for children aged 3–12 years. Assuming non-working adults or a sibling aged 13 years or older can provide child care, 15·0% (14·8–15·2) of the health-care workforce would still be in need of child care during a school closure. We observed substantial variation within the health-care system. We estimated that, combined with reasonable parameters for COVID-19 such as a 15·0% case reduction from school closings and 2·0% baseline mortality rate, a 15·0% decrease in the health-care labour force would need to decrease the survival probability per percent health-care worker lost by 17·6% for a school closure to increase cumulative mortality. Our model estimates that if the infection mortality rate of COVID-19 increases from 2·00% to 2·35% when the health-care workforce declines by 15·0%, school closures could lead to a greater number of deaths than they prevent.”
46. Rajmil L. Role of children in the transmission of the COVID-19 pandemic: a rapid scoping review. BMJ Paediatr Open. 2020 Jun 21;4(1):e000722. doi: 10.1136/bmjpo-2020-000722. PMID: 32596514; PMCID: PMC7311007.
https://pubmed.ncbi.nlm.nih.gov/32596514/
Fourteen out of 1099 identified articles were finally included. Studies included cases from China (n=9 to 2143), China and Taiwan (n=536), Korea (n=1), Vietnam (n=1), Australia (n=9), Geneva (n=40), the Netherlands (n=116), Ireland (n=3) and Spain (population-based study of IgG, n=8243). Although no complete data were available, between 15% and 55%-60% were asymptomatic, and 75%-100% of cases were from family transmission. Studies analysing school transmission showed children as not a driver of transmission. Prevalence of COVID-19 IgG antibody in children <15 years was lower than the general population in the Spanish study.
Conclusions: Children are not transmitters to a greater extent than adults. There is a need to improve the validity of epidemiological surveillance to solve current uncertainties, and to take into account social determinants and child health inequalities during and after the current pandemic.
https://pubmed.ncbi.nlm.nih.gov/32758454/
47. Macartney K, Quinn HE, Pillsbury AJ, Koirala A, Deng L, Winkler N, Katelaris AL, O’Sullivan MVN, Dalton C, Wood N; NSW COVID-19 Schools Study Team. Transmission of SARS-CoV-2 in Australian educational settings: a prospective cohort study. Lancet Child Adolesc Health. 2020 Nov;4(11):807-816. doi: 10.1016/S2352-4642(20)30251-0. Epub 2020 Aug 3. PMID: 32758454; PMCID: PMC7398658.
“SARS-CoV-2 transmission rates were low in NSW educational settings during the first COVID-19 epidemic wave, consistent with mild infrequent disease in the 1·8 million child population.”
48. M. D. Snape, R. M. Viner, COVID-19 in children and young people. Science 370, 286–288 (2020).
https://www.science.org/doi/10.1126/science.abd6165
““The near-global closure of schools in response to the pandemic reflected the reasonable expectation from previous respiratory virus outbreaks that children would be a key component of the transmission chain. However, emerging evidence suggests that this is most likely not the case. A minority of children experience a postinfectious inflammatory syndrome, the pathology and long-term outcomes of which are poorly understood. However, relative to their risk of contracting disease, children and adolescents have been disproportionately affected by lockdown measures, and advocates of child health need to ensure that children’s rights to health and social care, mental health support, and education are protected throughout subsequent pandemic waves…There are many other areas of potential indirect harm to children, including an increase in home injuries (accidental and nonaccidental) when children have been less visible to social protection systems because of lockdowns. In Italy, hospitalizations for accidents at home increased markedly during the COVID-19 lockdown and potentially posed a higher threat to children’s health than COVID-19. UK pediatricians report that delay in presentations to hospital or disrupted services contributed to the deaths of equal numbers of children that were reported to have died with SARS-CoV-2 infection. Many countries are seeing evidence that mental health in young people has been adversely affected by school closures and lockdowns. For example, preliminary evidence suggests that deaths by suicide of young people under 18 years old increased during lockdown in England.””
49. Yang, H. (2020). The Dangers of Keeping the Schools Closed. American Institute for Economic Research.
““The data from a range of countries shows that children rarely, and in many countries never, have died from this infection. Children appear to get infected at a much lower rate than those who are older… there is no evidence that children are important in transmitting the disease…What we know about social distancing policies is based largely on models of influenza, where children are a vulnerable group. However, preliminary data on COVID-19 suggests that children are a small fraction of cases and may be less vulnerable than older adults.””
50. Yanshan Zhu, Conor J Bloxham, Katina D Hulme, Jane E Sinclair, Zhen Wei Marcus Tong, Lauren E Steele, Ellesandra C Noye, Jiahai Lu, Yao Xia, Keng Yih Chew, Janessa Pickering, Charles Gilks, Asha C Bowen, Kirsty R Short, A Meta-analysis on the Role of Children in Severe Acute Respiratory Syndrome Coronavirus 2 in Household Transmission Clusters, Clinical Infectious Diseases, Volume 72, Issue 12, 15 June 2021, Pages e1146–e1153,
https://academic.oup.com/cid/article/72/12/e1146/6024998
““Whilst SARS-CoV-2 can cause mild disease in children, the data available to date suggests that children have not played a substantive role in the intra-household transmission of SARS-CoV-2.””
51. Wei Li, Bo Zhang, Jianhua Lu, Shihua Liu, Zhiqiang Chang, Cao Peng, Xinghua Liu, Peng Zhang, Yan Ling, Kaixiong Tao, Jianying Chen, Characteristics of Household Transmission of COVID-19, Clinical Infectious Diseases, Volume 71, Issue 8, 15 October 2020, Pages 1943–1946, https://doi.org/10.1093/cid/ciaa450
https://academic.oup.com/cid/article/71/8/1943/5821281
““The secondary attack rate to children was 4% compared with 17.1% for adults.””
52. Betz, C. L. (2020). COVID‐19 and school return: The need and necessity. Journal of Pediatric Nursing, 54, A7–A9. 10.1016/j.pedn.2020.07.015
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7402268/
| “Of particular concern are the consequences for children who live in poverty. These children live in homes that have inadequate resources for virtual learning that will contribute to learning deficits, and thereby falling further behind with expected academic performance for grade level. Children from low-resourced homes are likely to have limited space for doing school work, inadequate temperature controls for heating and cooling and safe outdoor space for exercise (Van Lancker & Parolin, 2020). Furthermore, this group of children are at high risk for food insecurity as they may not have access to school lunches/breakfasts with school closures.” |
53. Puls HT, Hall M, Frazier T, Schultz K, Anderst JD. Association of routine school closures with child maltreatment reporting and substantiation in the United States; 2010-2017. Child Abuse Negl. 2021 Oct;120:105257. doi: 10.1016/j.chiabu.2021.105257. Epub 2021 Aug 11. PMID: 34391127.
https://pubmed.ncbi.nlm.nih.gov/34391127/
“Results suggest that the detection of child maltreatment may be diminished during periods of routine school closure.”
54. Madewell ZJ, Yang Y, Longini IM Jr, Halloran ME, Dean NE. Household Transmission of SARS-CoV-2: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020 Dec 1;3(12):e2031756. doi: 10.1001/jamanetworkopen.2020.31756. PMID: 33315116; PMCID: PMC7737089.
https://pubmed.ncbi.nlm.nih.gov/33315116/
““Household secondary attack rates were increased from symptomatic index cases (18.0%; 95% CI, 14.2%-22.1%) than from asymptomatic index cases (0.7%; 95% CI, 0%-4.9%), to adult contacts (28.3%; 95% CI, 20.2%-37.1%) than to child contacts (16.8%; 95% CI, 12.3%-21.7%).”
55. Chaya Pitman-Hunt, Jacqueline Leja, Zahra M Jiwani, Dominique Rondot, Jocelyn Ang, Nirupama Kannikeswaran, Severe Acute Respiratory Syndrome-Coronavirus-2 Transmission in an Urban Community: The Role of Children and Household Contacts, Journal of the Pediatric Infectious Diseases Society, Volume 10, Issue 9, September 2021, Pages 919–921, https://doi.org/10.1093/jpids/piaa158
https://academic.oup.com/jpids/article/10/9/919/6007439
“A household sick contact was identified in fewer than half (42%) of patients and no child-to-adult transmission was identified.”
Studies die pro sluiting scholen zijn
1. Hyde, Z. (2020). COVID-19, children, and schools: overlooked and at risk”.In:The Medical Journal of Australia, 213(10), pp. 444-446e. https://www.mja.com.au/journal/2020/covid-19-children-and-schools-overlooked-and-risk
There is clear evidence that children and schools are at risk, with wider implications for the community. Additionally, serious outcomes in children will become increasingly common — at least in absolute terms — if the virus is allowed to spread. We can no longer afford to overlook the role children play in transmission if we hope to contain the virus.
2. Auger KA, Shah SS, Richardson T, et al. Association Between Statewide School Closure and COVID-19 Incidence and Mortality in the US. JAMA. 2020;324(9):859. doi:10.1001/jama.2020.14348
There was a temporal association between statewide school closure and lower COVID-19 incidence and mortality, although some of the reductions may have been related to other concurrent nonpharmaceutical interventions.
3. Haug, N., Geyrhofer, L., Londei, A. et al. Ranking the effectiveness of worldwide COVID-19 government interventions. Nat Hum Behav 4, 1303–1312 (2020). https://doi.org/10.1038/s41562-020-01009-0
The most effective NPIs include curfews, lockdowns and closing and restricting places where people gather in smaller or large numbers for an extended period of time. This includes small gathering cancellations (closures of shops, restaurants, gatherings of 50 persons or fewer, mandatory home working and so on) and closure of educational institutions… However, such radical measures have adverse consequences. School closure interrupts learning and can lead to poor nutrition, stress and social isolation in children31,32,33. Home confinement has strongly increased the rate of domestic violence in many countries, with a huge impact on women and children34,35, while it has also limited the access to long-term care such as chemotherapy, with substantial impacts on patients’ health and survival chance36,37. Governments may have to look towards less stringent measures, encompassing maximum effective prevention but enabling an acceptable balance between benefits and drawbacks38.
Studies die onduidelijk zijn met veel exposure:
1. Flaxman, S. et al. Estimating the effects of non-pharmaceutical interventions on COVID-19 in Europe. Nature 584, 257–261 (2020).
Deze paper wordt op social media vaak geciteerd als evidentie voor het nut van schoolsluiting. In de paper zelf staat dat het effect van school closure niet betrouwbaar was: “Most interventions were implemented in rapid succession in many countries, and as such it is difficult to disentangle the individual effect sizes of each intervention. In our analysis, we find that only the effect of lockdown is identifiable, and that it has a substantial effect”
Ondertussen is ook een kritiek op deze paper gepubliceerd in Nature: Soltesz, K., Gustafsson, F., Timpka, T. et al. (2020). The effect of interventions on COVID-19. Nature 588, E26–E28. https://doi.org/10.1038/s41586-020-3025-y
