Headlines - COVID-19 and Children: The Role of Schools in Virus Transmission

Santé publique France presents the main findings of the report published in August 2020 by the European Centre for Disease Prevention and Control (ECDC) on SARS-CoV-2 infection in children and the role of schools in virus transmission. The objective of this report is to provide:

• an overview of the epidemiology and characteristics of COVID-19 in children (ages 0–18) in the countries of the European Union, the European Economic Area, and the United Kingdom;

• an assessment of the role of schools and childcare facilities in the transmission of SARS-CoV-2.

Key takeaways:

• A small proportion (<5%) of all reported COVID-19 cases in the EU/EEA and the United Kingdom involve children (people aged 18 and under). If diagnosed with COVID-19, children are much less likely to be hospitalized or to die than adults.

• In children, the infection is generally milder or asymptomatic, meaning that the infection may go unnoticed or undiagnosed.

• When they do have symptoms, children shed the same amount of virus as adults and are therefore just as contagious as adults. The infectiousness of asymptomatic children is unknown.

• Although very few clusters of COVID-19 in school settings have been documented, they do occur and can be difficult to detect due to the lack of symptoms in infected children.

• Most countries report a slightly lower seroprevalence among children than among adults, but these differences remain to be confirmed. More targeted studies on children are needed to better understand the dynamics of infection and antibody production.

• Investigations of cases in school settings suggest that child-to-child transmission in schools is rare and is not the primary cause of SARS-CoV-2 infection among children whose infection coincides with their time in school, particularly in preschool and elementary schools.

• If physical distancing and hygiene measures are implemented, it is unlikely that schools constitute environments more conducive to virus spread than workplaces or recreational settings with similar population densities

• The impact of school closures and reopenings on community transmission levels is the subject of conflicting reports. However, contact tracing around a case in schools and data from a number of EU countries suggest that school reopening has not been associated with an increase in community transmission.

• Available data also indicate that the closure of childcare facilities and schools alone is unlikely to be an effective control measure for limiting community transmission of COVID-19. Such closures are unlikely to increase protection for children, as most develop only very mild symptoms of COVID-19, or none at all.

• Decisions regarding the implementation of control measures in schools and the closure or reopening of these facilities must be consistent with other physical distancing and public health decisions within the community.