Policies on children and schools during the SARS-CoV-2 pandemic in Western Europe

Abstract

During the pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), mitigation policies for children have been a topic of considerable uncertainty and debate. Although some children have co-morbidities which increase their risk for severe coronavirus disease (COVID-19), and complications such as multisystem inflammatory syndrome and long COVID, most children only get mild COVID-19. On the other hand, consistent evidence shows that mass mitigation measures had enormous adverse impacts on children. A central question can thus be posed: What amount of mitigation should children bear, in response to a disease that is disproportionally affecting older people? In this review, we analyze the distinct child versus adult epidemiology, policies, mitigation trade-offs and outcomes in children in Western Europe. The highly heterogenous European policies applied to children compared to adults did not lead to significant measurable differences in outcomes. Remarkably, the relative epidemiological importance of transmission from school-age children to other age groups remains uncertain, with current evidence suggesting that schools often follow, rather than lead, community transmission. Important learning points for future pandemics are summarized.

Keywords: COVID-19; children; masks; mitigation; school closure; testing; vaccination; ventilation.

Figure 1

Percent of total COVID-19 registered deaths assigned to age groups, UNICEF/MPI DR COVerAGE database.

Figure 2

Closure of primary schools in European countries during the pandemic. The black line is showing the COVID-19 incidence per 10⁵ population for each country.

Figure 3

COVID vaccine doses per 100 children between 5 and 11 years of age (as per November 2022).