I have seen some repeated assertions about the evidence on #COVID19, children and schools recently which sound convincing, but unfortunately are false

It is a sensitive and important topic, which is important to get right

Shall we bust some myths? 💥

Let's go!

Myth 1. Evidence suggesting limited transmission within schools is based on flawed evidence as only children with symptoms were tested ❌

There are many studies drawn on symptom based testing, there are MANY which are not, and all find the same thing

Here's just a few...

Myth 2. Long COVID affects 13% of infected children ❌

This is based on an incorrect interpretation of some ONS based data on symptoms in children, with NO control group

For why this is a *major issue*, read this excellent article


We certainly need more data on long covid in children (studies are underway), but given infection in children is predominantly mild or asymptomatic, prolonged, severe symptoms are unlikely to be common

Myth 3. International modelling shows schools drive transmission, and are less biased

That was not the finding of this systematic review of these studies


Nor was it the finding of this modelling study from the US which determined children played a relatively minor role and young adults were the driving factor (which is what has been observed internationally)

Models have their uses, but are subject to the limitations of the data and assumptions put into them

Modelling of school closures relies heavily on data from Spring 2020, when accompanied by near simultaneous implementation of other interventions. This bias is baked in.

Myth 4. Primary schools play just as important a role in transmission as secondary

I've heard people quote the number of outbreaks being the same from PHE data as evidence

Not untrue, but ignores the fact there are nearly FIVE TIMES MORE primary than secondary schools

Not only this, but data from a survey from the first half term in autumn showed the *majority* of cases in primary school outbreaks were in staff, not children

Also, random, in school sampling by ONS found lower prevalence in primary than secondary schools

Does this mean transmission doesn't happen in schools? No

Does it mean we can open schools willy nilly? No

Does it mean the consensus of the EU and US CDC that transmission within schools is relatively low and not the driving factor in community transmission is sound? Yes

For the excellent review document from @ECDC_EU see link


And from @CDCgov see link


Myths busted!


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More from @apsmunro

5 Feb
You may have seen this headline today

It may even have been accompanied by scary emojis ⚠️ 🚨 💥 😱

The reality is much less scary (as is the article compared to the headline)


These numbers are roughly accurate, but do not reflect anything like a comparable scenario to spring

These children are MUCH less unwell, due to a combination of recognising less severe cases, early management, and perhaps a degree of over diagnosis to be on the safe side

Only a couple of patients per day are even unwell enough to be enrolled in the worlds only clinical trial for this condition, the RECOVERY trial

Very few cases of coronary artery aneurysms, which even after spring resolved for most children over follow up

Read 4 tweets
4 Feb
I don't put too much stock in ecological modelling studies, but I understand that some others do

A new study from the USA looks at which age groups appear to drive transmission trends

It has some interesting findings


They use age specific mortality data to eliminate bias from undertesting of cases, alongside mobility and contact data

They found adults age 20 - 49 are the origins of most infections

This did not change over time, nor with school reopenings

"This study provides evidence that the resurgent COVID-19 epidemics in the US in 2020 have been driven by adults aged 20-49, and in particular adults aged 35-49, before and after school reopening."

Read 5 tweets
29 Jan
I've seen suggestions that the idea younger children might be less susceptible to infection with #COVID19 is a "myth", based on children just not being tested enough

That is untrue!

Whilst it's true children are under tested, this is not where this idea came from!

It comes from household contact tracing studies

When someone in a home is identified as being infected, the other members of the house are tested to see if they are infected

It's a useful experiment as everyone at home gets very similar exposure

Some early studies did only test contacts with symptoms, but actually most large studies since then have tested ALL close contacts REGARDLESS of symptoms

Here are just a handful




Read 8 tweets
9 Jan
I think people find it hard to understand the deal with kids reduced susceptibility to #COVID19 and what it means for schools etc

I thought I’d share a little analogy which helps me conceptualise it

Let’s imagine #COVID19 is rain... 🌧

Everyone wants to stop getting wet

Adults are just dressed normally 👦

Teens have a little hat on 🧢

Younger kids have got an umbrella ☂

When there is very little rain, you won’t notice much difference between how wet everyone is

When it starts raining a bit, you’ll notice the younger kids are less wet than adults

The teens may be just as wet as they spend more time out in the rain

Read 8 tweets
3 Jan
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

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

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

Read 9 tweets
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?

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...

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


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


Read 8 tweets

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