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


COVID-19 in children and the role of school settings in transmission - second update. Stockholm: ECDC; 2021.

The latest considerations from ECDC on this topic can be found in the news item from 25 August linked below.

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, focusing in particular on the experience in EU/EEA countries since the beginning of the pandemic. This document also addresses transmission to and from staff in school settings, school-related mitigation measures including risk communication, testing, contact tracing, and the effectiveness and impacts of school closures. This document draws upon and updates evidence presented in the previous reports from ECDC on this topic, which were published in August 2020 and December 2020. 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.

Executive summary

Key messages

  • Increased transmissibility across all age groups has been reported for SARS-CoV-2 variants of concern (VOCs), most notably for the Delta variant. In regions where an increasing percentage of adults are fully vaccinated against COVID-19 but where children are not vaccinated, it may be anticipated that in the coming months increasingly greater proportions of reported SARS-CoV-2 cases will be among children.
  • The majority of the studies referred to in this report were conducted prior to the emergence and widespread circulation of the Delta variant. This should be taken into account when interpreting reported study results.
  • Children of all ages are susceptible to and can transmit SARS-CoV-2. Cases of SARS-CoV-2 in younger children appear to lead to onward transmission less frequently than cases in older children and adults. Recent increases in the share of reported cases among children probably represents increased case ascertainment of mild cases. Children aged between 1-18 years have much lower rates of hospitalisation, severe disease requiring intensive hospital care, and death than all other age groups, according to surveillance data. The exact burden of COVID-19 and its long-term consequences in the paediatric population is still to be determined and is a priority for further research.
  • The general consensus remains that the decision to close schools to control the COVID-19 pandemic should be used as a last resort. The negative physical, mental and educational impacts of proactive school closures on children, as well as the economic impact on society more broadly, would likely outweigh the benefits. Given the likely continued risk of transmission among unvaccinated children, it is imperative that there is a high level of preparedness in the educational system for the 2021/2022 school year.
  • In light of circulating SARS-CoV-2 VOCs, including Delta, combinations of non-pharmaceutical interventions (NPIs) in the form of physical distancing that prevent crowding as well as hygiene and other measures to reduce transmission risks will continue to be essential to prevent transmission in school settings. Measures should be adapted to levels of community SARS-CoV-2 transmission as well as to the educational setting and age group. Implementation of measures should consider the need to provide children with an optimal learning and social environment while also reducing transmission risks.
  • It is important that testing strategies for educational settings aiming at timely testing of symptomatic cases are established to ensure isolation of cases and tracing and quarantine of their contacts. When positive cases are identified, the school should be informed, contact tracing should be initiated according to local guidelines, and communication to and the testing of close contacts, ideally with rapid diagnostic tests, should be considered.
  • While a measure of last resort, school closures can contribute to a reduction in SARS-CoV-2 transmission, but are by themselves insufficient to prevent community transmission of COVID-19 in the absence of other nonpharmaceutical interventions and the expansion of vaccination coverage. The effectiveness of school closures appears to have declined in the second wave as compared to the first wave of the COVID-19 pandemic, possibly in part due to better hygiene measures in school settings.

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