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COVID spread at primary schools may be underestimated

Primary school child walking to school holding mother's hand

Primary schools potentially contribute significantly to the spread of COVID-19, according to new research.

A Belgian study monitoring the incidence of COVID-19 in a primary school community found most infections linked back to the primary school, and children tested positive for the virus at similar rates to adults.

These findings disagree with previous data suggesting lower incidence of COVID among children, and indicate children may play a larger role in the transmission of SARS-CoV-2 than initially thought, the study published in JAMA Network Open says.

The cohort study of 63 children and 118 adults found children were significantly more often asymptomatic than adults, meaning they could be ‘silent carriers’.

They also tended to be sick for shorter periods of time.

“The possible role that children play in the transmission of SARS-CoV-2 and the rate of infection among children may be underestimated because children are more often asymptomatic,” the researchers say.

“A reconstruction of the outbreak revealed that most transmission events occurred between teachers and between children within the school. Of the observed household transmission events, most seemed to have originated from a child or teacher who acquired the infection at school,” they say.

The researchers say understanding the possible role of children in SARS-CoV-2 transmission is important in developing policies and procedures to reduce the spread of the virus while keeping schools open.

Study limitations

The study was small and observational so can’t prove cause and effect. It was also conducted prior to vaccination among adults being ubiquitous and the more transmissible Delta variant arriving in Europe.

Ways to mitigate the spread of COVID in schools

1. Vaccination

Vaccination is the most effective way to prevent infectious diseases, but in many countries primary school-aged children are not eligible. So, it’s important eligible adults and older children are vaccinated to reduce transmission. Transmission reduction through vaccination happens by reducing the number of people getting COVID in the first place and, if there are breakthrough infections, reducing the length of time they may be infectious for.

2. Masks

Many schools around the world encourage mask wearing or have mask mandates, where physical distancing isn’t possible. There is insufficient data on mask effectiveness in young children, but evidence shows they do reduce COVID cases and mortality in adults.

The World Health Organization recommends mask wearing in over five-year-olds, if there is intense community transmission.

3. Hygiene

Children and school staff need to keep up the basics of regular handwashing or sanitising, and coughing or sneezing into the crook of the arm. Daily cleaning and disinfection of the school environment and surfaces should also take place.

4. Staying home if you’re sick

Testing in various forms has become practise in different ways in schools around the world. The WHO recommends schools enforce students and staff staying home if they are unwell and ensure students who have been in contact with a COVID case stay home for 14 days.

5. Ventilation

Where feasible, children should be kept at least 1 metre apart in classrooms, the WHO says, and good ventilation is very important.

“Clean, natural ventilation (ie, opening windows) should be used inside buildings where possible, without re-circulating the air. If heating, ventilation and air conditioning systems are used they should be regularly inspected, maintained and cleaned.”

Article sources and references