#15,402
Going into this fall there is probably no greater hot-button issue than deciding how and when schools should be reopened during our ongoing COVID-19 pandemic.
- Proponents of re-opening point out that kids tend to be less seriously affected by SARS-CoV-2, and that keeping schools closed is not only bad for kids, it is a barrier to economic recovery - particularly for families where both parents work.
- Opponents point out that opening schools not only put kids at risk, but also their teachers and other school personnel, and carries the very real danger of bringing the virus home to infect older, more vulnerable family members.
Adding to the concern, seven months into this pandemic we are still learning how the virus spreads in the community, along with its immediate and long-term health consequences.
Saying that kids are `less affected' by the virus sounds reassuring, unless it happens to be your kid that is seriously ill (see COCA Call - Multisystem Inflammatory Syndrome in Children (MIS-C). And over the past couple of months early assumptions about low infection rates, transmission, and viral loads in children have been replaced by new research showing quite the opposite.
MMWR: SARS=CoV-2 Transmission At A Summer Day Camp - Georgia, June 2020
JAMA PEDS: Nasopharyngeal Viral RNA Higher In Young Children Than Adults
Yesterday the ECDC published a technical report on COVID-19's impact on children and the role of school attendance in its transmission. The full 31-page PDF is well worth reading, but I've posted the key messages below.
I'll have a brief postscript when you return.
COVID-19 in children and the role of school settings in COVID-19 transmission
Technical report
6 Aug 2020
The aim of this document is to provide an overview of the epidemiology and disease characteristics of COVID-19 in children (0-18 years) in EU/EEA countries and the United Kingdom (UK), and an assessment of the role of childcare (preschools; ages 0-<5 years) and educational (primary and secondary schools; ages 5-18 years) settings in COVID-19 transmission.
Executive summary
Key messages
- A small proportion (<5%) of overall COVID-19 cases reported in the EU/EEA and the UK are among children (those aged 18 years and under). When diagnosed with COVID-19, children are much less likely to be hospitalised or have fatal outcomes than adults.
- Children are more likely to have a mild or asymptomatic infection, meaning that the infection may go undetected or undiagnosed.
- When symptomatic, children shed virus in similar quantities to adults and can infect others in a similar way to adults. It is unknown how infectious asymptomatic children are.
- While very few significant outbreaks of COVID-19 in schools have been documented, they do occur, and may be difficult to detect due to the relative lack of symptoms in children.
- In general, the majority of countries report slightly lower seroprevalence in children than in adult groups, however these differences are small and uncertain. More specialised studies need to be performed with the focus on children to better understand infection and antibody dynamics.
- Investigations of cases identified in school settings suggest that child to child transmission in schools is uncommon and not the primary cause of SARS-CoV-2 infection in children whose onset of infection coincides with the period during which they are attending school, particularly in preschools and primary schools.
- If appropriate physical distancing and hygiene measures are applied, schools are unlikely to be more effective propagating environments than other occupational or leisure settings with similar densities of people.
- There is conflicting published evidence on the impact of school closure/re-opening on community transmission levels, although the evidence from contact tracing in schools, and observational data from a number of EU countries suggest that re-opening schools has not been associated with significant increases in community transmission.
- Available evidence also indicates that closures of childcare and educational institutions are unlikely to be an effective single control measure for community transmission of COVID-19 and such closures would be unlikely to provide significant additional protection of children’s health, since most develop a very mild form of COVID-19, if any.
- Decisions on control measures in schools and school closures/openings should be consistent with decisions on other physical distancing and public health response measures within the community.
COVID-19 in children and the role of school settings in COVID-19 transmission - EN - [PDF-1.75 MB]
While this report acknowledges `. . . . . the role of children in SARS-CoV-2 transmission remains unclear, especially in the context of educational settings.', their overriding message appears to be that closing schools provides limited benefits in curbing community transmission or protecting children's health.
And that may be absolutely true.
But during the short history of this pandemic we've seen a lot of well-meaning experts underestimate this novel virus; dismissing early concerns over potential aerosol spread or the role of asymptomatic transmission of SARS-CoV-2, and discounting the value of universal masking in public.
Opening schools during a pandemic carries with it enough unknowns to make the outcomes unpredictable. It may go well in some places, and not so well in others. And those results may vary widely depending upon a variety of factors (NPI compliance, level of community transmission, etc.).Which is why I'm less than sanguine when it comes to assuming the best case scenario.
Sending kids back to school this fall may succeed in some places, but it remains very much a gamble in others. And that worries me, because - while I've never been much of a gambler - I do know the one cardinal rule.
Never wager anything you can't afford to lose.
