COVID-19 in children and the effect of schools reopening on potential transmission to household members

Abstract

Aim: The effect of reopening schools on children's contribution to SARS-CoV-2 transmission, especially within households, remains controversial. This study describes the clinical presentation of a large ambulatory COVID-19 paediatric cohort and evaluates the role of children in household transmission prior to and following school reopening.

Methods: A retrospective database cohort study was conducted in a large Health Maintenance Organization in Israel. Data of all paediatric, laboratory-confirmed Coronavirus cases between 28/2/2020 and 20/6/2020 were extracted. All cases were analysed for household contacts and primary cases within each family cluster.

Results: A total of 1,032 cases under 18 years old (median age 12 years) were included. Of these cases, 432 (41.9%) were asymptomatic; 122 (11.8%) cases acquired the infection at school, and 45 of them were part of two school clusters; 846 children had at least one positive household contact, in 498 family clusters, and among them, 293 primary cases were identified. Only 27 (9.2%) primary cases were under 18 years of age and six (2%) were below 10. The proportion of primary cases did not change after the re-opening of educational facilities.

Conclusion: Children, particularly under 10 years of age, are less likely to be the vector for SARS-CoV-2 infection within household settings. Opening educational facilities did not change transmission dynamics.

Keywords: COVID-19; children; household; school; transmission; ultra-orthodox.

FIGURE 1

Epidemic curve of children Infected with SARS‐CoV‐2 at school settings. School settings—Day care (3–35 months old, n = 2), Preschool (3–6 years old, n = 12), Elementary school (1^st–6^th grade, n = 47), High school (7^th–12^th grade, n = 61). May 3^rd—The date of school settings gradual reopening

FIGURE 2

Number of primary and secondary infected cases identified within a household according to age groups. Primary case—The first person with a confirmed diagnosis of SARS‐CoV‐2 infection in the household. A primary case is the presumed source of secondary infection within the household. A minimum of 3 days interval between the primary and successive cases was defined