The current issue of #schoolclosures is so complex I am loathed to add my opinion to the twitter soup

Massive uncertainties✅
High stakes✅
Huge health trade offs✅
Opposing opinions ✅
Easy answers 🚫

I'll just add a few simple thoughts

1/9
Firstly, don't be fooled by twitter

It has the most shouty and polarised opinions only, the moderates have been largely hounded out

Both public and scientific opinion is almost certainly much more nuanced and balanced than this platform would fool you into believing

2/9
Next, advocating for widespread closure is a legitimate opinion in the current environment

Massive, uncontrolled community transmission and looming hospital capacity issues, with high prevalence of infections among children (esp teens) are a bad mix

3/9
BUT, this would be be associated with massive, lifelong harms to children, who have already missed months of school due to the pandemic

BUT, trying to run schools with frequent, large scale closures/isolations/staff sickness may be a losing game, esp for secondary schools

4/9
I can understand the government wanting to keep them open, and I 100% believe they should be the absolute priority: Last to close, First to open

Have we reached a stage where the risks of opening now outweigh the harms of closure?

I don't know the answer

5/9
IF closures occur, it is not so simple as open/closed

We must consider many things (which sadly I hear little about); This list is vital

-If closed, for how long? Closing much easier than reopening (ask the USA)

-Can we buy back closure time from Easter/Summer holidays?

6/9
-Can we mitigate educational/social inequity for the disadvantaged? (tuition, free meals, social care support)

-Can we maximise the benefit of this harmful intervention (if schools closed, everything else should be)

-Can we stagger closure/reopening (prioritise primary)

7/9
If you hear people talking about whether open schools is "safe", or "unsafe", sadly this is basically meaningless

Children themselves have little to fear, but there are wider harms to consider

There is no safe or unsafe, only balance of risks, harms and benefits

8/9
The relative increased transmissibility of the new variant seems to impact both children and adults

At such high rates of prevalence trade offs are now more difficult

Nothing is simple, we can only shift harms from some onto others and try to minimise total damage done

9/9

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More from @apsmunro

18 Dec 20
New findings from Swiss seroprevalence and an good opportunity to learn some more infectious disease epidemiology!

A similar prevalence in children aged 6 - 18 y (23%) than the adult population (~27%)

Lower in kids <6y (~15%) and over 65y (<15%)

What can we learn?

1/8
First, another lesson in age binning for kids (will we ever learn?)

6 - 18y is a weird age bin which I would not recommend

It hides big epidemiological differences

In fact, we have seen it in related data before...

2/8
The pre print of the first study from this team used age bin 5-19 y and reported no statistically different prevalence vs adults

medrxiv.org/content/10.110…

They changed for publication and found significantly lower prevalence in children <10y

thelancet.com/journals/lance…

3/8
Read 8 tweets
15 Dec 20
Here is a good lesson in basic epidemiology

This data is difficult to interpret in a number of ways:
1. There is no denominator, either of institutions or populations
2. It counts the number of outbreaks, not cases
3. It doesn't tell you who had the infections

This matters

1/5
An extreme example of why this is important from earlier this year

After lots of excitement about outbreaks in schools it turned out the median number of children involved was...

Zero

2/5
For some denominator context there are:

- 24,000 schools (9 million pupils) not inc. university
- 11,000 care homes (410,000 residents)
- 117 prisons (79,000 prisoners)
- 26,000 restaurants (many not/partially open)

We are comparing apples and oranges

Epidemiology 101

3/5
Read 5 tweets
11 Dec 20
It's time to clarify some things about children, schools and #COVID19 🧵

Summary: Young children seem significantly less susceptible, probably less likely to transmit. Less clear for teens. Schools mainly follow community trends, but secondary much higher risk than primary

1
The best way to determine susceptibility is through household contact tracing, as it controls for *exposure* - everyone gets more or less the same

There are many of these. Results vary, which we expect because infection is complicated

That's why we need to combine results

2
Here's 4 meta analyses; all find young children are much less susceptible than adults. Some that teens are too

Zhu (RR 0.6)
academic.oup.com/cid/advance-ar…

Goldstein (RR~0.5)
dx.doi.org/10.1093/infdis…

Viner (OR 0.41)
jamanetwork.com/journals/jamap…

Maidwell (RR ~0.5)
medrxiv.org/content/10.110…

3
Read 24 tweets
27 Nov 20
Really interesting pre print looking at school transmission in Northern Italy during the second surge

Suggests huge age dependant differences in risk of transmission in children in these settings (who would have guessed?!)

Let's take a look...

doi.org/10.1101/2020.1…

1/8
Detailed contact tracing of 43 cases
- 5 teachers
- 38 children

Whole classes tested regardless of symptoms, and swabbed a second time 10-14d later if the first was within 6 days of exposure

How much onward transmission?

2/8
Pre school (6 kids, 2 teachers) - 0/156 (0%)
Primary school (14 kids) - 1/266 (0.44%)
Secondary school (23 kids, 5 teachers) - 38/572 (6.64%)

Notice a pattern here?

3/8
Read 8 tweets
26 Nov 20
Some people are *still* lumping "children" all together in talking about transmission, schools etc

That is a dumb thing to do

It doesn't take a paediatrician to tell you a 2yr old is different from a 17yr old

Case study using data from the @ONS

ons.gov.uk/peoplepopulati…

1/8
The @ONS performs large scale, *random* population testing via rt-PCR

People often complain test data in children is biased by lower symptom burden - that is not the case for this data

Hence, it is very informative (why aren't more countries doing this?!)

2/8
Here is a graph of the last few weeks modelled incidence by age group

Huge initial spike in 17 - 24yr olds
Up behind then followed 12 - 16yr olds
Then 25 - 34yr olds
Then 35 - 49yr olds
Then 50 - 69yr olds

Eventually the 2 - 11yr olds get dragged up behind

3/8
Read 8 tweets
23 Nov 20
IT WORKS 🥳🎉

Great news from the Oxford/AZ vaccine phase III interim analysis today!

ovg.ox.ac.uk/news/oxford-un…

But if you thought you had questions after previous vaccine announcements, boy oh boy does this leave us wanting more!

Quick thread...

1/6
What are the interim results?

-131 cases in Brazil and the UK
-Overall efficacy 70% for the Oxford vaccine compare to control (MenACYW vaccine)
-No safety concerns identified

BUT

Split by dosing regime:
-2x high dose 62% effective
-Low dose then high dose 90% effective

2/6
That is a truly intriguing finding, and we'll need to see the breakdown of the data to understand the uncertainty around those estimates

I'll leave it for clever immunologists to theorise why a lower dose priming shot might be more effective

But wait, there's more...

3/6
Read 6 tweets

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