Finding a path to reopen schools during the COVID-19 pandemic
2020; Elsevier BV; Volume: 4; Issue: 11 Linguagem: Inglês
10.1016/s2352-4642(20)30249-2
ISSN2352-4650
Autores Tópico(s)COVID-19 Pandemic Impacts
ResumoAs any parent knows, young children are extremely efficient at catching and passing on respiratory infections. This intuition is backed up by a raft of scientific evidence, which was greatly bolstered during the 2009 H1N1 influenza pandemic. Many studies demonstrated the crucial role that children played in the spread of this virus. When faced with the prospect of a devastating pandemic of COVID-19, it was natural that policy makers decided to close schools to try and slow or prevent transmission. UNESCO estimated that more than 60% of the world's students have had their education disrupted by national school closures during the COVID-19 pandemic.1UNESCOEducation: From disruption to recovery.https://en.unesco.org/covid19/educationresponseDate: 2020Date accessed: July 25, 2020Google Scholar These closures are likely to result in damage to children's social, psychological, and educational development, as well as lost income and productivity in adults who cannot work because of childcare responsibilities.1UNESCOEducation: From disruption to recovery.https://en.unesco.org/covid19/educationresponseDate: 2020Date accessed: July 25, 2020Google Scholar, 2Royal Society DELVE InitiativeBalancing the risks of pupils returning to schools.https://rs-delve.github.io/reports/2020/07/24/balancing-the-risk-of-pupils-returning-to-schools.htmlDate: 2020Date accessed: July 25, 2020Google Scholar It is likely that children from low-income backgrounds will probably be more adversely affected than children from high-income backgrounds.2Royal Society DELVE InitiativeBalancing the risks of pupils returning to schools.https://rs-delve.github.io/reports/2020/07/24/balancing-the-risk-of-pupils-returning-to-schools.htmlDate: 2020Date accessed: July 25, 2020Google Scholar As we have started to understand the clinical features and epidemiology of COVID-19, it has become increasingly apparent that, compared with influenza and most other respiratory infections, children seem to be largely spared. If infected, children typically have mild disease. This comparative lack of severe disease changes the benefit-to-cost ratio associated with closing schools: most children will only get very mild disease, if infected, but at the cost of all children suffering as a consequence of school closure. Yet at the population level, the benefits of closing schools might outweigh the costs if children play a key role in transmission to others. Two studies published in The Lancet Child & Adolescent Health seek to inform this debate. Kristine Macartney and colleagues3Macartney K Quinn HE Pillsbury AJ et al.Transmission of SARS-CoV-2 in Australian educational settings: a prospective cohort study.Lancet Child Adolesc Health. 2020; (published online Aug 3.)https://doi.org/10.1016/S2352-4642(20)30251-0Summary Full Text Full Text PDF PubMed Scopus (237) Google Scholar did a detailed study of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission in schools and early childhood education and care facilities in New South Wales, Australia, during the early part of the epidemic.3Macartney K Quinn HE Pillsbury AJ et al.Transmission of SARS-CoV-2 in Australian educational settings: a prospective cohort study.Lancet Child Adolesc Health. 2020; (published online Aug 3.)https://doi.org/10.1016/S2352-4642(20)30251-0Summary Full Text Full Text PDF PubMed Scopus (237) Google Scholar During much of this period, educational facilities were formally open, although attendance rates dropped precipitously in schools in mid to late March, 2020, when distance learning was implemented. Macartney and colleagues focused on the paediatric and adult population who had attended a school or early childhood education and care facility while infectious (defined as 24 h before symptom onset). 27 primary cases were identified (56% staff). 1448 close contacts were identified. Nearly half of these close contacts were tested virologically or serologically, yet only 18 secondary cases were identified. These very low rates of infection need to be interpreted with caution, because mitigation measures were in place: most educational facilities were closed briefly after case identification, and close contacts were expected to home quarantine for 14 days. Nevertheless, the result do align with findings from a similar study4Heavey L Casey G Kelly C Kelly D McDarby G No evidence of secondary transmission of COVID-19 from children attending school in Ireland, 2020.Euro Surveill. 2020; 252000903Crossref Scopus (172) Google Scholar from Ireland, also done during the early part of the epidemic, in which six confirmed cases (three adults and three children) attended schools. No secondary cases were documented as arising from the paediatric cases. A notable exception to the general pattern of very low attack rates in school settings occurred during an outbreak centred in a high school in northern France.5Fontanet A Tondeur L Madec Y et al.Cluster of COVID-19 in northern France: A retrospective cohort study.medRxiv. 2020; (published online April 23.) (preprint)https://doi.org/10.1101/2020.04.18.20071134Google Scholar Infection attack rates were high in students (aged 14–18 years) and staff (38% and 49%, respectively), and much lower among parents and siblings (11% and 10%, respectively) suggesting that infection was concentrated within the school environment. A follow-up study6Fontanet A Grant R Tondeur L et al.SARS-CoV-2 infection in primary schools in northern France: a retrospective cohort study in an area of high transmission.medRxiv. 2020; (published online June 29.) (preprint)https://doi.org/10.1101/2020.06.25.20140178Google Scholar in local primary schools revealed much lower infection rates (6–12%) among staff, students and family members, and no convincing evidence of any secondary transmission within schools. The contrast between the infection rates in the secondary and primary schools might turn out to be important. Contact tracing from South Korea suggests that rates of COVID-19 among household contacts of cases was lowest when the index case was younger than age 10 years (three [5%] of 57) and highest when the index case was aged 10–19 years (43 [19%] of 231).7Park YJ Choe YJ Park O et al.Contact tracing during coronavirus disease outbreak, South Korea, 2020.Emerg Infect Dis. 2020; (published online July 16.)https://doi:10.3201/eid2610.201315Crossref Google Scholar If young children are less infectious than adults, then there must be an age when they start to become as infectious as older individuals. The French and Korean studies suggest that this might occur during adolescence, which could have major implications when schools, colleges, and universities return fully, as they must do soon. The easing of restrictions and the reopening of schools is the focus of the study by Jasmina Panovska-Griffiths and colleagues also published in the journal.8Panovska-Griffiths J Kerr CC Stuart RM et al.Determining the optimal strategy for reopening schools, the impact of test and trace interventions, and the risk of occurrence of a second COVID-19 epidemic wave in the UK: a modelling study.Lancet Child Adolesc Health. 2020; (published online Aug 3.)https://doi.org/10.1016/S2352-4642(20)30250-9Summary Full Text Full Text PDF PubMed Scopus (202) Google Scholar They fitted an agent-based model to UK-specific data and assessed a number of policies for easing lockdown, including three different test, trace, and isolate (TTI) options and two ways to reopen schools in September; either fully or partially, in which half the children attend school on alternate weeks. Reopening of schools is assumed to increase work-related contacts in adults and is accompanied by an increase in other contacts because of wider lifting of restrictions. Panovska-Griffiths and colleagues found that reopening schools (even partially) and the accompanying return to more normal contacts is likely to lead to a second wave of infections, unless testing is scaled up significantly. Unfortunately, it is not clear from their analysis whether the increase in cases that occurs when schools are reopened in the model is due to increased contact between children or increased contact between adults who can now return to work and leisure activities. Both studies give potential options for keeping schools open and show the clear importance of adequate contact tracing and testing. Macartney and colleagues suggest that educational settings can remain open provided measures, such as contact tracing, quarantine, and even school closures, are in place to limit spread when cases occur. Panovska-Griffiths and colleagues suggest that the safe reopening of schools in the UK could occur if the TTI programme is greatly improved. However, many questions remain, including whether there are age-related differences in susceptibility and the likelihood of transmission between children and adolescents. We urgently need large-scale research programmes to carefully monitor the impact of schools reopening, as Public Health England's sKID study9Public Health EnglandCOVID-19 surveillance in children attending preschool, primary and secondary schools.https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/904207/sKIDS_protocol_v1.4.pdfDate: 2020Date accessed: July 25, 2020Google Scholar aims to do. Only in this way can we take the most appropriate measures to mitigate the risks and allow us to reassure parents, pupils, and teachers alike that schools are safe to attend. There are no quick fixes to this terrible pandemic. However, it is becoming increasingly clear that governments around the world need to find solutions that allow children and young adults to return to full-time education as safely and as quickly as possible. I am part funded by the Medical Research Council (grant number MC_PC 19065), the National Institute for Health Research (grant number PR-OD-1017–20002) and the European Union's Horizon 2020 Research and Innovations Programme—project EpiPose (grant number 101003688). The views expressed here are my own. Determining the optimal strategy for reopening schools, the impact of test and trace interventions, and the risk of occurrence of a second COVID-19 epidemic wave in the UK: a modelling studyTo prevent a second COVID-19 wave, relaxation of physical distancing, including reopening of schools, in the UK must be accompanied by large-scale, population-wide testing of symptomatic individuals and effective tracing of their contacts, followed by isolation of diagnosed individuals. Full-Text PDF Transmission of SARS-CoV-2 in Australian educational settings: a prospective cohort studySARS-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. With effective case-contact testing and epidemic management strategies and associated small numbers of attendances while infected, children and teachers did not contribute significantly to COVID-19 transmission via attendance in educational settings. These findings could be used to inform modelling and public health policy regarding school closures during the COVID-19 pandemic. Full-Text PDF
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