Thread by @phenomstruck

Been meaning to write a thread about this pre-print (literature review, opinion piece) on #COVID19, children and #schools. (Very likely I am replicating somebody's efforts already). A lot of it in there made sense to a lay-person like me so here it is:
mja.com.au/journal/2020/c…

Are children less susceptible to infection? Research is ongoing and no definitive evidence either way yet.
From 61K people in #Spain, 3.4% of children and teenagers had antibodies against SARS-CoV-2 (point-of-care test) vs 4.4-6.0% of adults.

In the same study, in a subset of 52K people with immunoassay testing, the children-adult "gap" narrowed to 3.8% vs 4.5-5.0%. T
Are children less susceptible to infection than adults, or does it reflect shielding? Schools closed in March and haven't opened as of early August.

Do children play a substantial role in transmission?
Experts on #epitwitter could weigh in.
In as tudy of symptomatic people with mild to moderate COVID-19, the amount of viral RNA detected in the nasopharyngeal swabs of children aged 5-17 years was similar to that of adults.

Young children (<5 years) had levels 10 to 100 times higher. Does that indicate a potential to be substantial drivers of spreading, given large number of contacts children have in close-contact in schools?
Ref- jamanetwork.com/journals/jamap…

Contact-tracing study of ~6K index cases, ~59K contacts in #SouthKorea: Non-household contacts of child index cases were as likely to be infected as contacts of adult cases.
Ref: wwwnc.cdc.gov/eid/article/26…

Attack rate for the contacts of older children/teenagers was higher than any other group.
Ref: wwwnc.cdc.gov/eid/article/26…
In #Italy, contacts of children<15 years were more likely to be infected than those of adults.
Ref: medrxiv.org/content/10.110…

#Israel-Schools closure mid-March. Reopening on 17 May. First outbreak occurred on 27 May.
2 cases without an epidemiological link were detected in students; mass testing followed.
153 students (AR: 13.2%) and 25 staff members (AR: 16.6%) tested positive.

Further 87 cases among close contacts detected mid-June, including siblings attending other schools, parents, and the family members of staff.
Outbreak coincided with an extreme heatwave during which students were exempted from wearing face masks and air conditioning was used.

In #Chile 9.9% of students, 6.6% of staff seropositive. Students from pre-school to middle school most affected. 18% of staff and 40% of students were asymptomatic, indicating the potential for silent spread among children.
Refs:
eurosurveillance.org/content/10.280…

Evidence generated to date has limitations, likely explaining a clear trend :
- Conducted during lockdowns/low community transmission
- Cases rapidly isolated further limiting spread to children
- Testing excluded those not fitting clinical criteria

-> Schools neither inherently "safe"/ "unsafe".
-> Risk associated with schools depends on levels of community transmission.
"As a minimum, interventions should include wearing of face masks by staff and students, increasing ventilation and indoor air quality. "

Evidence that children/schools are at risk -> "wider implications for the community".
Q. Can we afford to overlook the role of children here?
Q. Should we conduct social experiments by reopening schools in absence of any interventions?
Q. Shouldn't we be better safe than sorry?

Rant over. Critical remarks and question always appreciated. Apologies for any typos.
@C19RedTeam @MinVWS @MinPres @rivm
#covid19NL #covid19

@ginnymooy @edwinveldhuizen @Wim_Schellekens perhaps some issues to consider moving forward with the decision makers and decision influencers?