Wat studies over Corona en scholen/kinderen…

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. 
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 [46]. Contact-tracing studies conducted in schools and educational settings in Australia, Singapore and Ireland found a low rate of, or even no, secondary cases [79]. 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

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)


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.


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.


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.

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

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