Studies conducted before mass vaccination campaigns began have reported proper and consistent facemasking by students and staff in school settings are associated with reduced incidence of school-associated transmission or seropositivity.
Fewer studies have reported efficacy of facemasking in the post-mass vaccination period in school settings. The studies available report, however, school-associated transmission were lower, less than 1% secondary attack rate in schools.
Studies of school-associated COVID-19 cases find community exposure to SARS-CoV-2 and/or noncompliance with multiple mitigation measures (e.g. facemask policies, distancing, non-isolation, etc) are key factors of clusters and outbreaks in children.
Badea, A; Groot, G; Muhajarine, N; Howell-Spooner, B; Young, C. What is the evidence for the effectiveness of universal mask use in the pediatric population? 2021 Sep 30, Document no.: EOC210901 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 14 p. (CEST rapid review report).
Pediatric cases of COVID-19 constitute between 1% to 10% of all confirmed cases of COVID-19; variation exists by jurisdiction.
Few case reports exist of confirmed child-to-other transmission. Contact tracing studies suggest that children are unlikely to be transmitters of the disease. Households are the most likely environments for transmission.
A recent large South Korean contact tracing study however (in pre-print) found that household COVID-19 transmission rates for children age 10-19 were significantly higher than in adults; transmission rates for children age 0-9 were relatively low.
AUGUST 7th, 2020 UPDATE: No new studies examining secondary attack rates of pediatric index cases were found. Studies continue to suggest low transmission from pediatric cases, and high proportion of pediatric cases being asymptomatic to mildly symptomatic.
MARCH 9th, 2021 UPDATE: Variants of Concerns are an emerging threat, but literature on pediatric prevalence and transmissibility is sparse. The British variant seems more transmissible (secondary attack rate higher) but follows the same age-related distribution of cases seen earlier in the pandemic.
Sulaiman, F; Coomaran, V; Muhajarine, N; Dalidowicz, M; Miller, L. What are the effects of the new COVID variants on transmission and school reopenings in pediatric populations? 2021 Mar 30; Document no.: PH030801 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 14p. (CEST rapid review report)
· Temperature screening has not yet been demonstrated to reduce COVID-19 spread or accurately identify COVID-19 cases in schools. This did not prove to be a useful strategy when implemented in Singapore during the 2003 SARS epidemic.
· 14% to 19% of children with COVID-19 have an asymptomatic presentation and fever only develops in less than half of symptomatic pediatric cases. Fever is also a common presentation of childhood illnesses unrelated to COVID-19.
· Chemical and plastic-strip thermometers are considered unreliable in pediatric clinical settings and there is also an element of user error with any thermometer type.
Radu, L; Groot, G; Badea, A; Mueller, M; Young, C. Is the use of thermometers an effective screening strategy for students in schools during COVID-19? 2020 Sep 4; Document no.: EOC090201 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 13 p. (CEST rapid review report)
Based on a rapid review performed by the Public Health Agency of Canada and an updated literature search found herein, there is limited evidence of SARS-CoV-2 viral transmission through heating, ventilation, and air conditioning (HVAC) systems.
Schools are encouraged to ensure their HVAC systems are functioning properly in order to further mitigate risk of viral spread via this method.
Recommendations for optimal HVAC system settings are published, but schools should follow local guidelines with the help of HVAC professionals.
Vanstone, J; Asamoah, G; Muhajarine, N; Reeder. B; Dalidowicz, M; Young, C. What role do ventilation systems play in the prevention and spread of COVID-19 and other respiratory diseases in non-clinical buildings? 2020 Sep 4; Document no.: EOC082501 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 7 p. (CEST rapid review report)
· The CDC does not recommend universal symptom screening (all students in K-12 grades) to be done by schools prior to entry
· Schools/districts should individually work with public health officials to determine the necessity and details of implementing any testing strategies
· European CDC recommends that all symptomatic individuals and asymptomatic high-risk close contacts should be referred for testing – fast and effective contact tracing following testing is key
· Large scale universal testing in school settings has not been studied and it’s efficacy compared to implementation of other infection prevention control measures is unknown
· Large scale testing in school settings to date has largely been done in response to an outbreak, not as routine surveillance
Badea, A; Muhajarine, N; Howell-Spooner, B; Mueller, M. What laboratory surveillance testing strategies are effective for COVID-19 in school settings? 2020 Aug 27; Document no.: PH082501 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 23 p. (CEST rapid review report)
· Potential impact on reproductive rate (R) of the seven “returning to school” scenarios that were modeled by SAGE exhibited an increase in R due to reopening of school. The scale of increase depended on current value of R within each community and mitigation plans within the community, especially the adherence to social distancing measures. · CDC recommended using additional indicators such as healthcare capacity, new cases, and percent of positive cases to decide school operations along with community spread levels: none-to-minimal, minimal-to-moderate, substantial-controlled, and substantial-uncontrolled. · Combination of strategies such as mask usage, physical distancing, hygiene measures, classroom cohorting, symptomatic screening, testing and tracing of students, staff and teachers along with low levels of community transmission can aid in maintaining low level of R. · Increasing testing and contract tracing can impede an epidemic rebound. · Intersectoral partnerships with local authorities, dedicated personnel (such as coordinators) for testing and tracing along with appropriate communication with parents, teachers and staff should be followed to open schools safely.
Pisolkar, V; McRae, D; Muhajarine, N; Dalidowicz, M; Ellsworth, C. What COVID community transmission indicators are used in school reopening plans? 2020 Aug 26; Document no.: EOC081201 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 23 p. (CEST rapid review report)
A number of jurisdictions have re-opened schools successfully without a spike in COVID-19 cases, eg. Japan, Germany, France, Finland, Denmark, Austria, Norway
Most school plans indicate that staff/students/visitors who are sick or have had exposure to COVID-19 in the past 14 days should not attend school, and those that become symptomatic at school should be isolated and removed from the premises as soon as possible, with thorough cleaning thereafter
In Alberta, if two or more members of a cohort are found to be COVID-19 positive, schools should follow the outbreak procedures which are under review until September
In Nova Scotia, one confirmed case of COVID-19 in a school would be considered an outbreak
In Germany, classmates and teachers of an infected student are sent home for two weeks but other classes continue
Taiwan (based on the H1N1 response) suspends the class which had a confirmed case identified, for 14 days. With two or more cases the whole school must close. When 1/3 of the schools in a district are closed, all schools in the district must close.
In Israel, schools closed after a single case was identified , and following mass outbreaks in schools at least 355 schools had closed with over 2,026 students and staff testing positive and over 28,000 students in quarantine due to possible exposure
Badea, A; Muhajarine, N; Reeder, B; Miller, L; Mueller, M. What is the evidence and rationale describing the key public health principles to consider for school re-openings and precautions regarding school closures during COVID-19? 2020 Aug 17; Document no.: EOC070901 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 22 p. (CEST rapid review report)