Yesterday I attended a WHO convened meeting on COVID in children and adolescents it’s made me think / feel differently about school closures and the difficulties of home schooling. In case this helps anyone else here are some of the take home messages. 1) The graphs we see all

the time (UK test and trace) are based on symptomatic testing, this is not the same as infection levels. When you look at asymptomatic household testing you see much higher infection levels in children and adolescents and there are cases where children clear the infection so

quickly they are never positive (this may be due to differences in innate immunity). 2) What happens in school is essentially a reflection of what is happening in the local community. 3) With the arrival of the new variant what worked to drive down numbers I.e Tier 3 (economic

closure, schools opened) no longer worked. Analysis showed increased infection in children, in particular secondary school aged, who were bringing infection into households at 2x the rate of adults for primary and 7-8x the rate of adults for secondary age. 4) Schools had to close

to drive down transmission even though this will impact in the long-term on skill development, physical fitness, mental health and ultimately life expectancy (UNICEF) exacerbating inequality and increasing risks for the most vulnerable. Many children have also faced

Interruption to the services that support their health and wellbeing beyond school. However 5) this does not argue for a quick release of all restrictions once those most vulnerable to death have been vaccinated. Death rates are horrendous but they are not the only impact of this

disease, we need to be talking about #LongCovid which is why we must reduce the spread for many months to come. We will have to make choices about what normal things are and aren’t possible. 6) Many impacts of the disease are being hidden in the poorest countries, MSF discussed

what happens when the only doctor in the hospital gets sick with COVID, newborn mortality is increasing where people cannot access hospital care taken up by COVID. Children are not being vaccinated leaving them susceptible to other diseases e.g. measles.

The broader impacts of this pandemic must begin to be discussed, we shouldn’t just measure death and symptomatic infection, the long term consequences also need to be understood.