The Latest Research and Information on COVID-19: Children and Schools


​COVID-19, Children and Schools

This page is intended to serve as a resource compiling information known about SARS-CoV-2 and COVID-19 in children and in the context of schools. It is not intended to be an exhaustive systematic review, but rather a compilation of recent guidance and synthesis of the evidence to date.

GUIDANCE DOCUMENTS

SickKids updates guidance for schools during the pandemic

  • The updated report includes changes to testing recommendations, enhanced physical distancing and non-medical mask use, emphasis on cohorting and updates to the section on mental health and wellness.

CDC Information for pediatric healthcare providers

WHO checklist to support schools re-opening and preparation for COVID-19 resurgences or similar public health crises

  • The WHO has released a checklist to support compliance and adherence with public health measures in educational settings and schools with limited resources.

EVIDENCE REVIEWS

WHO Epidemiological update includes special section dedication to children and COVID-19

  • The January 19 Epidemiological Update highlights important findings from research to date on COVID-19 in children and the involvement of schools in transmission (pages 4-6). 
  • Globally, children and adolescents <18 represent 8% of cases, but comprise 29% of population.
    • They are more likely to have mild or asymptomatic infection; hospitalizations and deaths are uncommon.
  • Some evidence suggests differences in the transmission patterns of primary and secondary school-aged children.
    • Children <10 years appear less susceptible and less infectious; transmission in adolescents similar to adults.
    • More outbreaks have been reported in secondary/high schools than in primary/elementary schools.
  • Evidence for the involvement of school openings and closures on community transmission is mixed.
    • Several studies, including from the UK and South Korea, suggest school re-openings have not been associated with significant increases in community transmission or spikes in cases. Infection rates among students often reflect community transmission and contact tracing in some countries suggests that family members and not school are the source of infection.
    • Reports of superspreading events in schools have been rare and are associated with a lapse in mitigation measures (e.g., no mask use, recirculated air, crowded classrooms).
  • Preventive and protective measures in schools are essential to preventing transmission; stronger infection prevention and control may be particularly necessary among secondary/high school students.
  • The impact of emerging variants of SARS-CoV-2 on children requires additional analysis.
  • School closures have a negative effect on children beyond lost education and should be a temporary, last resort measure in areas with intense transmission.
    • Decisions to close, partially close or reopen schools should be guided by a risk-based approach to maximize the educational and health benefit for students, teachers, staff, and the wider community, and help prevent a new outbreak of COVID-19 in the community.

European CDC has released a technical report on COVID-19 in children and the role of schools in transmission

  • The European Centre for Disease Prevention and Control (ECDC) technical report updated on December 23, 2020 reviews the evidence surrounding the role of children in the transmission of SARS-CoV-2 and the role of schools during the pandemic based on the experience of EU countries from August to December 2020. Confidence ratings accompany the evidence and are based on the number of studies and the homogeneity of findings. Based on available evidence and the social and economic impact, the ECDC suggests that school closures should be an intervention of last resort.
    • Epidemiological data:
      • Children under 11 were under-represented in cases; all children under 18 were under-represented in cases with severe outcomes (i.e., hospitalizations, ICU admissions, respiratory support, death)
      • Start of the school year was not temporally associated with increased case rates in children; pattern of case rate in 16-18 year-olds similar to 19-39 age group.
    • Transmission in household/community settings:
      • Viral shedding in children is comparable to adults
      • Children are asymptomatic as least as often as adults, but estimating true rate of asymptomatic infection is difficult
      • Onward transmission by adolescents to household and community contacts is comparable to adults; the rate of secondary transmission in children is less clear
    • Transmission in schools:
      • Transmission in schools does occur and case clusters have been reported
      • Prevalence of cases in schools reflects community prevalence; school transmission appears to account for a minority of cases and evidence does not suggest that schools are driving community transmission
      • Closing schools has reduced community transmission, but it is difficult to establish the relative effectiveness of this intervention from others
    • Mitigation:
      • A number of measures can be implemented to reduce transmission risk: classroom distancing, staggered arrival times, cancellation of certain indoor activities, cleaning, ventilation, face masks in certain circumstances
      • Risk communication and community engagement are also essential to mitigate risk

Public Health Ontario Umbrella Review of COVID-19 in the pediatric population

  • Public Health Ontario released an umbrella review of COVID-19 in the pediatric population on November 4, 2020.
  • Forty-eight systematic reviews were included in the analysis and a comparison of the prevalence of COVID-19 in children in Ontario is made  with respect to other Canadian and international jurisdictions.

A living review of the role daycares and schools play in COVID-19 transmission

  • The National Collaborating Centre for Methods and Tools at McMaster University has released a living rapid review looking at the specific role of schools and daycares in the transmission of SARS-CoV-2.

WEBINARS

BMJ: COVID-19 and schools: #CovidUnknowns