THREAD: "COVID-19 in children and the role of school settings in transmission - first update" (December 23, 2020)

"There is a general consensus that the decision to close schools to control the COVID-19 pandemic should be used as a last resort."
https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-in-children-and-the-role-of-school-settings-in-transmission-first-update_0.pdf https://twitter.com/ajlamesa/status/1342315728230215680

"The negative physical, mental health and educational impact of proactive school closures on children, as well as the economic impact on society more broadly, would likely outweigh the benefits."

In other words, school closures do a lot of damage and provide very little benefit.

"In surveillance data, among childhood COVID-19 cases, children between 1-18 years of age have lower rates of hospitalisation, severe hospitalisation and death than do all other age groups."

"Younger children appear to be less susceptible to infection, and when infected, less often lead to onward transmission than older children and adults."

"The return to school of children around mid-August 2020 coincided with a general relaxation of other NPI measures in many countries and does not appear to have been a driving force in the upsurge in cases observed in many EU Member States from October 2020."

"Where epidemiological investigation has occurred, transmission in schools has accounted for a minority of all COVID-19 cases in each [ @ECDC_EU member] country."

"Educational staff and adults within the school setting are generally not seen to be at a higher risk of infection than other occupations, although educational roles that put one in contact with older children and/or many adults may be associated with a higher risk."

"[Non-pharmaceutical interventions in school settings] must be adapted to the setting and age group and consider the need to prevent transmission as well as to provide children with an optimal learning and social environment."

The latter is *really important*!

"Children aged 1-11 years are under-represented among cases compared with the general population, whereas the proportion of cases aged 12-18 years is broadly in line with the population distribution."

In other words, PRIMARY SCHOOLS! PRIMARY SCHOOLS! Open them safely and soon.

"Finally, in multiple countries that did not respond to the survey, the media reported on clusters of COVID-19 in educational settings [45-48]. However, it is not always known whether these cases have been fully investigated."

Media *assuming* infections occur at school sites.

This section on "COVID-19 among educational staff" is very good!
https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-in-children-and-the-role-of-school-settings-in-transmission-first-update_0.pdf

"Transmission of SARS-CoV-2 within the workplace is difficult to assess, especially when there is ongoing transmission within the community, given that adults may become infected outside of the workplace."

"[The] @WHO finds that staff-to-staff transmission was the most common and that in school outbreaks, the virus is most likely introduced by adult personnel."

"Data from the Public Health Agency of Sweden linked case-based data for the period 15 March-19 October with occupational registries and found that...teachers were not at an increased risk of being diagnosed with COVID-19 compared with other occupational groups."

"Data from the 2 September (the start of the school year) to 16 October 2020 from England found no differences in COVID-19 positivity rates between primary and secondary school teachers and other professions."

"A similar trend was seen when including household members of teachers, where no evidence of difference in positivity rates was noted."

"[Analysis] of national data on occupation and COVID-19 infection and hospitalisation risk through 20 October 2020, from the Norwegian Institute of Public Health, found that when data were adjusted by age, sex and country of birth, teachers were not at significantly higher risk."

"National data from Denmark also indicates that COVID-19 infection rates in persons within the teaching sector do not differ from those of other working adults."

"France reported 0.09% (1,020/1,162,850) of teaching personnel tested positive for SARS-CoV-2 on 27 November 2020 and Austria reported 0.6% test positivity in teachers from a sample of 10,000 gargle tests taken from students and staff in educational settings between Sept and Oct"

"[School mitigation] measures should be implemented taking into consideration the age groups and the measures’ impact on learning and psychosocial development."
https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-in-children-and-the-role-of-school-settings-in-transmission-first-update_0.pdf

Few European countries appear to be closing playgrounds or reducing class sizes as interventions at schools. This may come as a surprise to some Americans!
https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-in-children-and-the-role-of-school-settings-in-transmission-first-update_0.pdf

European countries have reported they're doing the "basics" (see first paragraph), but "rarely implemented" measures include: temp screening, allowing virtual learning when schools are open -- in-person learning is generally mandatory! -- and mass testing.
https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-in-children-and-the-role-of-school-settings-in-transmission-first-update_0.pdf

"Schools are important venues for science education and learning good health practice such as handwashing. Further, through education students can become advocates for disease prevention and control in their homes, the school and the community at large."
https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-in-children-and-the-role-of-school-settings-in-transmission-first-update_0.pdf

"ECDC recommends that testing efforts, in community settings generally and in educational settings specifically, are maximised with the aim of offering timely testing to all symptomatic cases in order to ensure isolation of cases and tracing and quarantine of their contacts."

"When there are clusters of pupils with confirmed COVID-19, a school-wide testing approach may be considered, on the condition that clear objectives for the testing activity are determined and there is an agreed plan of action, following the test results."
https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-in-children-and-the-role-of-school-settings-in-transmission-first-update_0.pdf

Contrast @ECDC_EU guidance -- focusing testing on symptomatic cases and only school-wide testing when clusters are identified -- with @JoeBiden's proposal to spend tens of billions of dollars testing every teacher, staff member, and student once a week!
https://www.politico.com/news/2020/12/23/biden-frequent-testing-reopen-schools-coronavirus-450280

School closures impose extraordinary costs on students, families, and societies.

"School closures are associated with substantial adverse physical and mental health and educational impacts in children."

"They can also exacerbate existing inequalities in a society..."

"[School closures] can also exacerbate existing inequalities in a society, by having a disproportionate impact on more vulnerable children, caregivers, families and communities."

"The economic costs of school closures due to COVID-19 are estimated to be high and include direct learning lost, labour lost from working parents as well as long term consequences such as lower skills in the labour force and less productivity."

"Given the severe consequences of school closures on children and their communities, this measure should be employed as a last resort for disease control and, even then, should be time-limited, with close attention paid to mitigating the impacts of the closure on children..."

It's so important for Americans to take note of the @ECDC_EU saying that school closures "should be employed as a last resort for disease control" and "SHOULD BE TIME-LIMITED." (emphasis added).

Cities like Los Angeles have *indefinite school closures.*
https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-in-children-and-the-role-of-school-settings-in-transmission-first-update_0.pdf

The @ECDC_EU notes that remote learning is only "theoretically" -- yes, they're using this word -- "full-time" learning.

Love the honesty!
https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-in-children-and-the-role-of-school-settings-in-transmission-first-update_0.pdf

When the @CDCgov document on reopening schools was released, we were told that the emphasis on mental health was "because Donald Trump," so I invite Americans to read the @ECDC_EU's words about the impact of closures on child mental health, well-being, and domestic violence risk.

"In addition, it is not certain that older children, such as 16-18-year olds, have decreased social interactions when schools are closed or switch to remote learning."
https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-in-children-and-the-role-of-school-settings-in-transmission-first-update_0.pdf

Reopening schools -- in countries across the globe -- hasn't contributed to a significant number of new outbreaks when responsibly done.

Note that the infamous "Israel issue" is addressed at the end of this paragraph.
https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-in-children-and-the-role-of-school-settings-in-transmission-first-update_0.pdf

"Aside from very rare instances, COVID-19 poses relatively little direct severe health risk to children."
https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-in-children-and-the-role-of-school-settings-in-transmission-first-update_0.pdf