A letter from myself, @mugecevik and @AshaBowen about #COVID19 in children and #schoolsreopening in reply to an opinion piece in @theMJA

We've been following the literature since the beginning

Careful and weighted review is vital to inform policy

osf.io/49q5a/

1/8
School closures were one of the first non-pharmaceutical closures around the world, leaving 1.6bil children out of education

en.unesco.org/covid19/educat…

Their reopening has been the source of intense debate

To suggest they are overlooked is erroneous

2/8
Interpreting the evidence means not bundling "children" together as one group

There is a clear difference between young children (<10y) as compare to older adolescents/young adults in regards to susceptibility and transmission

medrxiv.org/content/10.110…

3/8
Despite claims that school closures made past evidence unreliable, the main source of the evidence is household contact tracing studies which are unaffected by school closure

If anything it would increase SAR for children by increasing exposure

medrxiv.org/content/10.110…

4/8
Opinions voiced in the original letter were supported by highly selective reporting of evidence, and do not represent the international consensus on this topic

ecdc.europa.eu/en/publication….

5/8
Many peoples prior beliefs on childrens role in transmission are predicated on influenza

The clinical phenotype of COVID-19 in adults compared to children is completely different than flu

Their reduced role in transmission however was observed for both SARS and MERS

6/8
Highlighting risks to children from the disease is misleading. In England only 4 children <15yrs died of COVID-19 despite >600,000 being infected

We see 15 - 20 deaths from flu annually for comparison

Harms of lack of education are far greater

adc.bmj.com/content/early/…

7/8
Discussion about schooling is complex and requires nuance, balance, and fair representation of the evidence

Importantly it must consider more than epidemiology

Public health, equality, wellbeing and social concerns must be addressed

osf.io/49q5a/

8/8

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More from @apsmunro

9 Sep
I have the great privilege of working on the Oxford #COVID19 vaccine trials

Safety is the top concern in all vaccine trials, and we go to great lengths to ensure the vaccine is safe to use, and to keep our trial participants safe

Here are some of the ways we do that

1/8
First we have a dedicated phone number our participants can phone 24hrs a day, 365 days a year with ANY medical concerns that gets them straight to a study doctor

We provide advice, direct them to appropriate care, and record ALL symptoms/events in our participants

2/8
All participants have symptom diaries they complete in the period following vaccination

We receive alerts if any serious symptoms are recorded so we can follow up with them, check they're OK, and review if they were related to the vaccine (some mild side effects are normal)

3/8
Read 8 tweets
7 Sep
I really don't find the term "long COVID" useful

I think it's confusing, particularly for the lay public - but if I'm honest even I'm not sure what it's referring to most of the time

1/7
Importantly, the term is misleading because it's NOT COVID; it's *post COVID-19* syndromes

This is not pedantic - I've seen people ask, "are you still infectious if you have long COVID?"

So what actually is "long COVID"?

As far as I can tell, its several distinct entities

2/7
First, prolonged symptoms of fatigue/breathlessness after severe illness which last for several weeks/months

This is not unique to COVID, as it's a well recognised after effect of pneumonia or severe infections in general

Eventually it improves

blf.org.uk/support-for-yo…

3/7
Read 7 tweets
27 Aug
People can't stop talking about schools and #COVID19

Here's a thread on school transmission studies!

Summary:
- If prevalence high in the community, it will be high in schools and some will transmit
- Isolated cases result in low transmission
- Infection prevention works

1/11
First, when it's gone not so well

A high prevalence area in France pre-lockdown had a secondary school with 40% seropositivity in staff and pupils; higher than in pupils households, suggesting school transmission

Almost all pupils 15y+

doi.org/10.1101/2020.0…

2/11
Famously, Israel had trouble after opening schools alongside everything else and experiencing a big surge in cases

This secondary school had 2 symptomatic cases, so everyone was tested. 13% of pupils and 16% of staff were positive.

eurosurveillance.org/content/10.280…

3/11
Read 11 tweets
23 Aug
New paper on #COVID19 contact tracing in the US, looking at household secondary attack rates (SAR)

doi.org/10.1093/cid/ci…

Abstract suggests equal SAR in children and adults - an unusual finding in these studies

As usual it's a bit more complicated than that...

1/6
First an important point:

Do not group all participants <18y together

We've seen big differences in children <10y compared to 15y+ in many other studies

Of course, it is no different here

2/6
What happens when we separate them out?

SAR 10 - 17y 58% (!)
SAR 0 - 10y 18% (!)

SAR for adults (spouses) 33%, so for young children a ratio ~ 0.5 - what we've seen in most other studies (inc. meta analyses

3/6
Read 6 tweets
10 Aug
A few weeks ago a study from SK got lots of attention for reportedly showed children aged 10 - 19 were just as, or more infectious than adults with #COVID19

But that was not the whole story

This study on the very same children shows why

adc.bmj.com/content/early/…

1/6
They took ALL children with #COVID19 in SK (107 of them, median age 15) and looked at how many secondary cases were associated

BUT - they removed cases with *shared exposure", who most likely got infected at the same time as the child

What did they find?

2/6
1 case of onward transmission from 248 household contacts (from a 16y old to their sibling, aged 14y)

A secondary attack rate of 0.5%

This is compared to a household SAR from adults of 7.6% using the same method of analysis

ophrp.org/journal/view.p…

3/6
Read 6 tweets
10 Aug
Cool study in @CDCMMWR about #MISC #PIMSTS in the US

cdc.gov/mmwr/volumes/6…

Taking 570 reported cases (med age 8y, 40% hispanic/latino, 33% black) they performed statistical analysis to break cases down into 3 categories

1/7
Using a method called latent class analysis (a supervised technique maximising differences between classes and minimising differences within classes) they created 3 gruops - the breakdown is interesting so lets take a look!

2/7
Group 1: "Classic" MISC/PIMSTS which is features of muti-organ involvement and shock with only 1/3 patients testing positive on rtPCR

Group 2: High respiratory involvement and vast majority testing positive for SARS-CoV-2 rt PCR

3/7
Read 8 tweets

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