COVID-19 in children and the role of school settings in transmission - first update

Technical report
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COVID-19 in children and the role of school settings in transmission - first update. Stockholm: ECDC; 2020.

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The aim of this document is to provide an update on the knowledge surrounding the role of children in the transmission of SARS-CoV-2 and the role of schools in the COVID-19 pandemic, based on the experience in the EU from August–December, 2020. This document also addresses transmission to and from staff in school settings, school-related mitigation measures including risk communication, testing, contact tracing and the efficacy of partial and full school closures. This document draws upon and updates evidence presented in the previous report from ECDC on this topic, which was published on August 6, 2020 [4]. This report does not consider educational settings related to young adults or adults, such as universities or vocational schools or any school with overnight stays, such as boarding schools. This report does not consider the epidemiology of COVID-19 in relation to new variants of SARS-CoV-2, for which robust evidence on the potential impact in school settings is not yet available, such as one recently observed in the United Kingdom [2].

Executive summary

Key messages

  • There is a general consensus that the decision to close schools to control the COVID-19 pandemic should be used as a last resort. 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 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.
  • Children of all ages are susceptible to and can transmit SARS-CoV-2. Younger children appear to be less susceptible to infection, and when infected, less often lead to onward transmission than older children and adults.
  • This report does not consider the epidemiology of COVID-19 in relation to new variants of SARS-CoV-2, for which robust evidence on the potential impact in school settings is not yet available, such as one recently observed in the United Kingdom.
  • School closures can contribute to a reduction in SARS-CoV-2 transmission, but by themselves are insufficient to prevent community transmission of COVID-19 in the absence of other non-pharmaceutical interventions (NPIs) such as restrictions on mass gathering.
  • 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. Trends in case notification rates observed since August 2020 for children aged 16-18 years most closely resemble those of adults aged 19-39 years.
  • Transmission of SARS-CoV-2 can occur within school settings and clusters have been reported in preschools, primary and secondary schools. Incidence of COVID-19 in school settings appear to be impacted by levels of community transmission. Where epidemiological investigation has occurred, transmission in schools has accounted for a minority of all COVID-19 cases in each 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 in the form of physical distancing that prevent crowding as well as hygiene and safety measures are essential to preventing transmission. Measures 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.

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Questions and answers on COVID-19: Children aged 1 – 18 years and the role of school settings

How likely are children to catch and transmit the virus in school settings? When and how will schools be reopened?

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Infographic: COVID-19 in children and the role of schools

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This infographic is based on the ECDC technical report on COVID-19 in children and the role of school settings in COVID-19 transmission.