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1.5 billion children have been out of schools with consequences from nutrition to mental health and social development. A thread on SARS-CoV2, children and school in India in response to FAQs from many journalists. Incomplete, but helpful (I hope). 1/14
Younger children are less likely to get infected than adolescents. 2/14
COVID-19 Trends Among School-Aged Children ... https://www.cdc.gov/mmwr/volumes/69/wr/mm6939e2.htm?s_cid=mm6939e2_w via @CDCgov
COVID-19 Trends Among School-Aged Children ... https://www.cdc.gov/mmwr/volumes/69/wr/mm6939e2.htm?s_cid=mm6939e2_w via @CDCgov
Protection from infection might be because they are more likely than adults to have seasonal coronavirus infections and hence antibodies. 3/14
Preexisting and de novo humoral immunity to SARS-CoV-2 in humans https://science.sciencemag.org/content/early/2020/11/05/science.abe1107
Preexisting and de novo humoral immunity to SARS-CoV-2 in humans https://science.sciencemag.org/content/early/2020/11/05/science.abe1107
When infected, most children clear infection quickly, and perhaps because the virus spends less time in the body, less neutralizing antibodies are made. 4/14
https://rdcu.be/cbLZ7
https://rdcu.be/cbLZ7
Rarely, children may have serious disease or multi-system inflammatory syndrome (also being reported in adults). 5/14
Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated Wi… https://pubmed.ncbi.nlm.nih.gov/32511692/
Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated Wi… https://pubmed.ncbi.nlm.nih.gov/32511692/
Relationship of MIS-C & S-COV2 unclear as not all kids test +ve. Tests, esp rapid antigen tests, may not work well 6/14
Field evaluation of a rapid antigen test (Panbio™ COVID-19 Ag Rapid Test Device) for COVID-19 diagnosis in primary healthcare centres https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(20)30697-2/fulltext#.X8y4TAKjJoM.twitter
Field evaluation of a rapid antigen test (Panbio™ COVID-19 Ag Rapid Test Device) for COVID-19 diagnosis in primary healthcare centres https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(20)30697-2/fulltext#.X8y4TAKjJoM.twitter
With these complexities, given that children have been out of school for a long time, & we know impact is worst on the poorest children, how should we think about this? Here is great advice from WHO. 7/14
https://www.who.int/docs/default-source/coronaviruse/risk-comms-updates/update39-covid-and-schools.pdf?sfvrsn=320db233_2
https://www.who.int/docs/default-source/coronaviruse/risk-comms-updates/update39-covid-and-schools.pdf?sfvrsn=320db233_2
Key take-aways. Schools reflect the community, but risks low in young children & infections in schools come from adults and older kids. Better for kids to be in school if community transmission low (no defined level yet but many countries have kept their schools open). 8/14
Essentially, the goal in sending children safely to school is to minimise risk. It is impossible to completely eliminate it. Appropriate planning, based on clear concepts of transmission and risk, data-informed decision making and rapid response capacity must be developed. 9/14
What is needed?
Education-virus, spread, precautions
Hand hygiene, and a cleaning schedule
Masking
Ventilation
Physical distancing
Cohorting of classes, smaller groups
Outdoor classes, when possible
Limit visitors to schools
No sharing of difficult to clean items
Contd 10/14
Education-virus, spread, precautions
Hand hygiene, and a cleaning schedule
Masking
Ventilation
Physical distancing
Cohorting of classes, smaller groups
Outdoor classes, when possible
Limit visitors to schools
No sharing of difficult to clean items
Contd 10/14
Staggered class timings
Exercises and games that permit physical distancing and preferably outdoors
Avoid singing (except maybe outdoors & at a distance)
Staggered eating times in sub-class groups
Assigned seating
One way traffic as far as possible (labs do this)11/14
Exercises and games that permit physical distancing and preferably outdoors
Avoid singing (except maybe outdoors & at a distance)
Staggered eating times in sub-class groups
Assigned seating
One way traffic as far as possible (labs do this)11/14
And if anyone is ill, or reports illness at home
Low bar for testing in cohort of children and teachers (caveat about rapid antigen tests in children, if used must confirm with RT-PCR)
Permit return according to local isolation requirements 12/14
Low bar for testing in cohort of children and teachers (caveat about rapid antigen tests in children, if used must confirm with RT-PCR)
Permit return according to local isolation requirements 12/14
Given all that has happened, any schools that can, should add or increase counselling support for students, staff & teachers. Mental health is ignored at our peril as a society. 13/14
Much more detail in guidance from WHO and several governments. I find the more detailed the guidance, the easier to implement or identify why implementation is not possible and consequently potential increased risk. 14/14
