We have looked carefully at incidence of SARS-CoV-2 infection in children in recent weeks for any impact of the phased return to the classroom. The data, and thorough public health investigation, confirm that schools remain a low-risk environment. 1/16
Schools are low risk because of the mitigation and protection measures put in place by teachers, principals, families, general practitioners and public health doctors. 2/16
The data show a moderate and transient increase in cases of SARS-CoV-2 infection reported in children, not directly because of the return to in-person education, but due to increased detection, or case ascertainment, related to an increase in testing. 3/16
During a surge, incidence in children is generally lower than the population average, but towards the end of the surge it converges with the population average. There have been two recent increases in incidence in children, in early-February and mid-March. 4/16
Specifically, during a surge, we first see incidence rising in 19-24 yo, later and simultaneously in adults 25-64 yo and teenagers, and later again in children, slowly converging on the population average towards the end of the surge. 5/16
So what explains the recent changes in incidence in children? The first increase occurred in early February, just after we resumed testing of asymptomatic close contacts, which had been paused for most of January. 6/16
Children are more likely to be asymptomatic and the number of asymptomatic infections detected in children dropped sharply in January; so we had undetected cases in January, and the resumption of close contact testing led to an apparent increase in incidence in February. 7/16
The second increase occurred in mid-March, soon after the first phase of school reopening. It was associated with a very high level of referral for testing, as parents, schools and doctors were vigilant, seeking to protect schools by detecting any infections in children. 8/16
While the level of testing increased 5- to 10- fold, the increase in detected infections was much smaller (40-50%), suggesting that the increase in incidence is in significant part due to the increase in testing (increased case ascertainment). 9/16
This is reinforced by two observations. The second phase of school reopening, from 15 March, involved a similar number of students (over 300,000), yet was not followed by any detectable increase in incidence. 10/16
Incidence started to drop as soon as schools closed for Easter on 26 March. If transmission were occurring in schools, infections occurring in the last week of term would be detected 5-10 days later, during the break. 11/16
The decrease in the number of cases detected during the Easter break is more likely to be due to an immediate drop in the number of referrals of children for testing, as the level of concern (and vigilance) decreases when schools are closed. 12/16
We note also that school opening is associated with an increase in attendance at workplaces; this increase in social mixing amongst adults carries a risk of increased viral transmission between households. 13/16
There has been some concern that the opening of schools may have led to an increase in infection in young adults; there is no population-level signal that this has occurred, with no clear trend in incidence in adults. 14/16
What does this mean? It seems we can return safely to classrooms, with mitigation measures, provided we reduce other contacts, and ensure children who have symptoms, or household members with symptoms, stay out of school and seek medical advice. 15/16
My thanks to the many colleagues in public health, medical laboratory science, surveillance, epidemiology and biostatistics who support the collection and analysis of these data. 16/16

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More from @President_MU

12 Dec 20
Let’s protect the vulnerable. Keep your contacts to a minimum between now and Christmas and then celebrate with a small circle. Meet outdoors if you can. If indoors: limit numbers and duration, use masks and keep your distance, gentle natural ventilation. 1/5 Image
It’s good that numbers in hospital and ICU are falling. Behind each number is a human story of illness and loss. Hospitalisations lag behind cases, and sadly what we are seeing now is the impact on older and vulnerable people infected towards the end of the recent surge. 2/5 ImageImage
A semi-log plot clearly shows the delay between rising cases and rising hospitalisations, and equally the delay between the suppression of infections in the community and the decline in the number of severely ill people in hospital. 3/5 Image
Read 5 tweets
19 Oct 20
The move to Level 5 restrictions was a difficult decision for Government, and is very hard for people whose lives and livelihoods are most affected, but it was necessary to interrupt uncontrolled exponential growth of the pandemic. 1/5
We can, collectively, suppress transmission of the virus again, if we fully enter into the spirit of these measures, and eliminate, for the next six weeks, close contacts other than our household, ‘bubble’, school or college, or essential work. 2/5
Our modelling shows that to make a success of this, we need get viral transmission down to very low levels. A reproduction number of 0.9 or 0.7 won’t be enough, we need to aim for R = 0.5. 3/5
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16 Oct 20
We face difficult decisions if we are to suppress again the spread of SARS-CoV-2, and different voices should be heard. However, such contributions should be grounded in the facts, and public health expertise and experience. This article is neither. 1/12 irishtimes.com/opinion/jack-l…
A public health specialist would give you a much better critique than I could of the errors and misconceptions in the argument; I’ll confine myself to highlighting some factual inaccuracies. 2/12
The article states that “it is reasonable to make an educated assumption that tens of thousands of cases were circulating undiagnosed throughout the country” in March and April, implying that 500-1000 cases now is less of a problem than it seems. 3/12
Read 12 tweets
8 Oct 20
The exponential growth in SARS-CoV-2 infection in Ireland should make each and every one of us stop, think, and resolve again to do our part to suppress the virus, now and quickly. 1/7 Image
The call to action is the same as it has been for weeks, but much more urgent now: radically limit our discretionary social contacts, maintain physical distance and safe practices when we do meet, self-isolate and call for help with any symptoms of COVID-19. 2/7 Image
We have seen rising cases, now we are seeing rapid increases in the number of people admitted to hospital and ICU. 3/7 Image
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2 Oct 20
We should not ignore or dismiss the rising numbers of SARS-CoV-2 infections. We monitor hospitalisations, intensive care admissions, and with great sadness, deaths, and we know where these numbers will go if we do not suppress transmission of the virus. 1/9 Image
Case numbers have been growing exponentially, at approximately 4% per day, since late June. The daily average case count on 23 June was 9 cases. If you add 3.9% every day, you get 12 cases on 1 July, 40 cases on 1 August, 131 on 1 Sept, and 430 today. 2/9 Image
Hospitalisations are delayed, but now also growing at about 4% per day. The daily average number of people in hospital with confirmed SARS-CoV-2 infection on 3 August was 12; increase that number by 4% per day and you get 37 on 1 Sept, and 121 on 1 Oct. 3/9 Image
Read 9 tweets
2 Oct 20
We don’t have SARS-CoV-2 under control in Ireland. We need, as much as we ever did, to work together, with one voice and one intention, to suppress the virus. Let’s remember the fundamental protection: keep your distance. 1/6
We need and crave social contact, but the virus exploits the moments we come close as an opportunity to transmit. It’s spreading rapidly right now, between households, especially in young adults. 2/6
The message: mix with one other household, keep your distance when socializing (even in your own home), get outdoors, limit your social contacts to those that are really important to you, stay home and seek a test if you feel unwell. 3/6
Read 7 tweets

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