"The education and well-being of the current generation of children and young people should be the highest priority in any national strategy to reopen society."
Children have been spared the worst of disease from the pandemic, even considering the extremely rare post-COVID-19 hyperinflammatory syndrome
But school closures have been harming children, so the question regarding their role in transmission has loomed large
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A new study from brings us a step closer to understanding
In a meta analysis of contact tracing studies, children acquire the infection less than adults. Looking at household transmission specifically, by less than half (OR 0.41, 95%CI 0.22 - 0.76)
Differences much stronger for young children (<12-14y) than older teens
This is supported by seroprevalence data which have generally found lower levels of infection in children (especially in the largest, population representative studies)
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Assessing infectivity has been difficult, as has assessing direction of transmission in studies within schools
Thankfully, the vast majority of studies of COVID-19 within schools have found very limited evidence of transmission, with most cases remaining isolated
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Importantly - the time has come to put polarisation and reductionism of the debate aside
Our children's futures are too precious for them to be used as a political football
Decisions on precise actions taken to make schooling happen need to consider a number of things
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-Community transmission rates
-Resources available for infection prevention
-Social/cultural acceptability of different interventions
-Needs and viewpoints of the CHILDREN and their families whose futures may be irreparably damaged by long term school absence
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It's not as simple as "Kids don't transmit", or, "Schools will propagate a second wave"
They can't be opened with impunity with high prevalence, or remained closed indefinitely
But children MUST be at the forefront of all national strategies to reopen society
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Vinay points correctly to the bias prone endpoint of self reported URTI symptoms and implies the entire difference between groups could be due to “the placebo effect”
The problem is, this is almost
certainly not a result of placebo
It’s detection or ascertainment bias
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Vinay describes as much in his piece, when he mentions different interpretations of vague symptoms between people with or without masks depending on their beliefs
Wear a mask and wake up tired? Probably nothing
Not been wearing a mask? Could be the start of something…
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The rationale behind this is that some have postulated PASC could be due to viral persistence - SARS-CoV-2 hanging around when it should have been cleared
Anti-virals might help clear the virus and resolve symptoms
2/
The evidence base behind this theory is far from clear, but given the general mess of evidence in the field this seemed like a reasonable trial
It could also serve as possible therapeutic diagnosis (if it works, it gives evidence towards the possible cause)
3/