I've almost given up on any balanced discourse about children, #COVID19 and schools, as everyone seems intent on either pretending children are not affected at all, or becoming borderline hysterical over the point

Case study: US daycares

1/6
This study from daycares in Utah has been amplified by high profile figures on twitter as a "big deal"

12 children infected (by staff) with 12 secondary cases, all in their homes, with no mention of transmission in the facility

A "big deal" 🤯

cdc.gov/mmwr/volumes/6…

2/6
That study is 3 days old and has an altmetric score of over 4000

That is insane

12 children with 12 secondary cases in over 3 months

How is this even newsworthy?

3/6
Oh look, another study of daycares in the US (Rhode Island)

In facilities catering for up to 19,000 children, 30 cases in children found

Of 20/29 facilities with cases, there were no secondary infections associated

Altmetric 640 🥱

cdc.gov/mmwr/volumes/6…

4/6
Both of these studies show basically the same thing; children can catch it and transmit, but the rate seems pretty low

The way they've been packaged is different: one is balanced and says, "with careful measures, this seems ok"

The other: "OMG CHILDREN TRANSMIT"

5/6
Children need us to move past this slightly hysterical, polarised way of talking about the risks of schooling, how we can mitigate against them, and how these are weighed up against the harms of lack of education. Particularly where it's become political

We can do better

6/6

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More from @apsmunro

15 Sep
There has never been more confusion about the role of children in transmission of #SARSCoV2 , and tensions are running high over implications for #schoolsreopening

Time for some clarity

@Damian_Roland and I review ALL the evidence on @DFTBubbles

dontforgetthebubbles.com/the-missing-li…

1/13
When considering transmission risk we must consider 2 classes of factors;

Non-modifiable: The biology of the host and pathogen

Modifiable: Behavioural or environmental influence

Since we can change the latter via policy/guidance etc, we'll focus on the former

2/13
How easily to children catch the virus?

Household contact tracing studies suggest less easily than adults; by about half given the same exposure, based on 4 reviews of all the evidence (links in next tweet)

3/13 ImageImageImageImage
Read 13 tweets
11 Sep
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
Read 8 tweets
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
4 Sep
Should GI symptoms (abdo pain, diarrhoea, vomiting) be included in the case definition for #COVID19 in children?

Lots of questions prompted by a new paper from my colleague Tom Waterfield et al.

If only there were simple answers....

medrxiv.org/content/10.110…

1/9
The question has come from this table, which found of children who tested positive vs negative for SARS-CoV-2 IgG, GI symptoms were associated with testing positive

You'll note the exact same is true of headache, which was just as common

2/9 Image
We've known for a long time COVID-19 can present with abdominal symptoms in both children and adults, although it may be slightly more common in children

Here only 20% of children with antibodies had GI symptoms; this is higher than cough (10%!) but lower than fever (31%)

3/9
Read 9 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

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