An absolute smorgasbord of data around children, schools and #COVID19 this week

We've got @PHE_uk , the @ONS survey, REACT study, and a new SAGE report!

Lets take a birds eye view of the key findings 🧵

1/17
First in @PHE_uk

Cases flattening in secondary age children after a sharp rise, rates still much lower in primary age

School outbreaks flat/declining (half term will have played a role here)

assets.publishing.service.gov.uk/government/upl…

2/17
Of course these tests are symptom based, and may miss cases due to lower symptom burden in children

Let's look at the UK's 2 big, random sample studies which overcome this issue!

3/17
First @ONS survey

Cases rose fast in secondary age children behind young adults, but appears to now be flat or falling in both

ons.gov.uk/peoplepopulati…

4/17
On the other hand, in primary school aged children cases crept up behind, and now are lowest other than adults >50yrs and flat for a few weeks

Big difference in prevalence between age groups of "children" - very important

ons.gov.uk/peoplepopulati…

5/17
Next the REACT study

This shows more or less the same, but with a decrease in prevalence in primary aged children in the most recent data

spiral.imperial.ac.uk/bitstream/1004…

6/17
Interestingly, in the adjusted model primary aged children have the lowest odds for testing positive in all periods

Secondary age children the second highest in most

Combination of biology and exposure/behaviour (contacts)

spiral.imperial.ac.uk/bitstream/1004…

7/17
Now the SAGE report. Some repetition here so I've just picked out some of the most interesting things (please read it all!)

First, reassuringly reiterating no evidence so far of increased risks to teachers compared to other professions

gov.uk/government/pub…

8/17
They note cases in children did increase after school openings, but that this followed behind increases in other age groups and that R was rising well before schools opened

This is consistent with experience in other countries

9/17
I'm intrigued by the ONS household contact data, suggesting:

-rate of children bringing infection into homes increased
-children much less susceptible to catching infection

I'm sure both are true, but the effect sizes seem implausible; likely some misclassification bias

10/17
On the above point, I'm disappointed there is no methodology for the data provided as we have seen household contact data is strikingly difficult to interpret

Hopefully it will be forthcoming and provide further insight

11/17
They wisely mention the difficulty separating risks of being *in school* from the end to end activities related (including transport), and mixing which occurs outside of school

12/17
It goes on to review school studies in more detail (largely done during periods of much lower prevalence, which is less relevant to today)

I have covered most of this previously so won't do so again now

I will however look at one last thing

13/17
We've seen big, age related differences in rates of infection

It shouldn't be a surprise as we've seen it before, however some proposed it was merely due to school closures

Schools are fully open, and there's still big differences between younger children and adolescents

14/17
Looking at contact rates between age groups, there is no real difference

The most likely explanation, as previously suggested, is reduced susceptibility to infection of younger children (for example, under 12y) which increases with age

gov.uk/government/pub…

15/17
Some concluding thoughts:

-Children are clearly susceptible to infection and can transmit
-In periods of high prevalence, teenagers are a much bigger transmission risk than younger children
-Schools will contribute to some degree, but it is unclear to what extent

16/17
-Harms of school closure are huge and should be a last resort
-Infection prevention measures can be increased if needed (e.g. masks now used in secondary schools)
-Interventions in primary schools likely low yield and more harmful

17/17

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More from @apsmunro

10 Nov
This is a phenomenal statement from @ADPHUK

One disheartening thing about some of the scientific communications during the pandemic has been a painfully narrow view

None of that here

A holistic, considered and progressive approach to management of the pandemic

1/5
First, focus on a combination strategy

Stop focussing on silver bullets or game changers and start getting the basics right. Promote good public health messages. Support test/trace/isolate.

Complex problems don't have simple one stop solutions

2/5
Second, win HEARTS and MINDS

Foster trust, goodwill and collaboration (hint; this is NOT achieved by punishment, shaming and fearmongering, no matter how many ❤️🔁 it gets)

**Protect communities**

Amazing document outlining these strategies here

adph.org.uk/wp-content/upl…

3/5
Read 5 tweets
9 Nov
This potentially incredibly good news

Twitter is about to be full of articles about "herd immunity" again, but now with words laced in honey rather than shouting and hissing

Some things we now need to consider...

1/6

statnews.com/2020/11/09/cov…
We need to see the data

I note it is a difference between arms of *symptomatic* infection - this might mean reduction in disease severity, but we need to know about transmission

Why is that important?

2/6
With only ~90 events there's no way we'll be able to see efficacy in the highest risk groups who we are trying to protect (and who we're most worried won't mount an effective immune response)

Nice to turn COVID into a cold for younger people, but not what we're aiming for

3/6
Read 6 tweets
6 Nov
A criticism of the data regarding children and #COVID19 from the first surge is that it was acquired with schools closed

Its now surge 2 and they're open

Let's look at the up to date info from @PHE_uk and @ONS infection survey and see what is going on

#schoolsreopening

1/10
After an initial surge, in the recent weeks of @PHE_uk data we have seen a decline in cases in the 10 - 19y age group

Otherwise lowest cases remain in the 0 - 10y ages, although still trending up

assets.publishing.service.gov.uk/government/upl…

2/10
What about school outbreaks?

They've been flat for the past several weeks despite rising prevalence in the community

Unfortunately doesn't tell us about how many cases involved or whether it's children or staff/teachers

assets.publishing.service.gov.uk/government/upl…

3/10
Read 10 tweets
13 Oct
Quick thread on latest @ONS infection survey data, which is very informative!

FYI: the survey involves mass random population testing for #COVID19 in England and Wales, so is not biased by symptoms/test seeking - so very useful indeed!

1/7
I can't go any further without pointing out the massive regional disparities between the north and south of England

Whilst not completely straight forward, this is likely in part due to socioeconomic differences which we know influence effects of disease transmission

2/7
But of course, I'm interested in the KIDS!

Schools open for nearly 6 weeks with fairly limited infection mitigation, and cases rising exponentially across the country

What's happening with primary school age kids?

Not much at all

Even I am surprised about that

3/7
Read 7 tweets
1 Oct
"If there's one thing we learn from history, it's that we don't learn from history"

A new study from India looks at #COVID19 contact tracing

And now reported, "[children] transmitted the virus at rates similar to the rest of the population"

🤔

latimes.com/world-nation/s…

1/10
There is SO much to dig in to here because these findings are complex - but we'll stick with the major issues for now

Child index cases were found to have a high proportion of positive contact of the same age

They must infect them easily, right?

science.sciencemag.org/content/early/…

2/10
The first caveat, is that to be defined as a index case, the child was almost certainly symptomatic

Symptomatic people seem to be much more infectious than asymptomatic

A large proportion of children seem asymptomatic (~50%) so findings are not generalisable

But wait...

3/10
Read 10 tweets
25 Sep
🔥Hot off the press🔥

New article in @JAMAPediatrics from me and @SaulFaust

"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."

jamanetwork.com/journals/jamap…

1/8
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

2/8
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)

jamanetwork.com/journals/jamap…

3/8
Read 8 tweets

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