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Coronavirus: What are the risks for children? Coronavirus: What are the risks of opening schools?
(2 months later)
Some children in England will be going back to school from Monday 1 June. The current plan is to have most children back in school across the UK by September.
Following a heated debate, the government published the advice it received from scientists on what is known about the impact of more children returning to the classroom. But, with winter and fears of a resurgence of the virus approaching, what role could this play in spreading coronavirus?
How dangerous is coronavirus for children?How dangerous is coronavirus for children?
Children are at extremely low risk of becoming ill from the virus. Children are at extremely low risk of becoming ill from the virus themselves.
Adults - and particularly older adults - are far more likely to be seriously ill and die from complications of the virus. Adults - and particularly older adults - are far more likely to be seriously ill and die from complications.
Across the UK, 0.01% of deaths were people under 15, 1% were aged 15-44 and about 75% were over 75. A study of more than 55,000 hospitalised coronavirus patients found that only 0.8% were under the age of 19.
Half of all the people with confirmed coronavirus who were admitted to critical care units in England, Wales and Northern Ireland were 60 as at 15 May, and half were younger, according to a research charity. More than three-quarters of all the people with confirmed coronavirus who were admitted to critical care units in England, Wales and Northern Ireland were 50 or older as of 31 July, according to a research charity. And fewer than 10% were younger than 40.
But the majority were over 50 and fewer than 10% were younger than 40.
Children have so far only accounted for between 1% and 5% of all diagnosed cases, according to Prof Adilia Warris, a paediatric infectious diseases specialist at the University of Exeter.
They often have "milder disease than adults," she says, pointing out that deaths have been rare.
There have been some extremely rare cases of children developing an inflammatory syndrome similar to Kawasaki disease, and scientists are exploring a possible delayed immune response to coronavirus.There have been some extremely rare cases of children developing an inflammatory syndrome similar to Kawasaki disease, and scientists are exploring a possible delayed immune response to coronavirus.
Can children pass on coronavirus to others?Can children pass on coronavirus to others?
This is one of the missing pieces of the puzzle about coronavirus and how it spreads. A review of global studies by University College London (UCL) and the London School of Hygiene and Tropical Medicine found children were about half as likely to catch coronavirus as adults, meaning they would be less likely to pass it on.
It is still not clear how infectious anyone with very mild symptoms or no symptoms at all is - at any age. To understand this we would need widespread antibody testing to identify who has had the virus across the whole population, and work out how they might have caught it. The team reviewed more than 6,000 studies from around the world but found only 18 had good enough data.
A University College London review of the evidence, based on studies using contact tracing and population screening, suggested children were half as likely as adults to catch the virus. Even the useable studies mostly took place during lockdowns when schools were not running at full capacity.
The government's Scientific Advisory Group for Emergencies (Sage) said the "balance of evidence" suggested children might be both less likely to catch it and, if they do catch it, less likely to pass it on. But the "evidence remains inconclusive," it said. The Department for Education says an as-yet unpublished study of pupils and teachers at 100 schools in England will provide little evidence that the virus is transmitted in schools.
One study looking at cases in Shenzhen in China at the beginning of the year suggested that children were just as likely to catch the virus, raising the fear that they could be transmitting it without showing any symptoms. But research carried out since then has been more reassuring. Public Health England, which ran the study due to be published later in the year, said coronavirus infections and outbreaks were "uncommon in educational settings during the first month after the easing of national lockdown".
Studies of clusters of infections in family groups across China have concluded - based on contact tracing - that none of the infections were likely to have been introduced by children. Both government and the researchers hailed this as a positive sign for schools returning in September.
A study of a cluster of infections in the French Alps found that a child who tested positive for the virus did not pass it on to any of the more than 100 people they had contact with during the time they had symptoms. The study is based on data from a time when schools have been less than 10% full, though. They don't give a picture of the risks of much fuller classrooms.
Community studies in Iceland, South Korea, the Netherlands and Italy all found evidence children were less likely to have - or have had - the virus than adults. The Italian region studied tested 70% of its population. The government's Scientific Advisory Group for Emergencies (Sage) said in countries where schools have reopened, data suggests it has made "little difference to community transmission".
Teams of researchers around the world have tried to estimate how often children catch coronavirus and how often they are the first case which starts an outbreak.
Studies of clusters of infections in family groups across China, and cases in the French Alps, have concluded - based on contact tracing - that none of the infections were likely to have been introduced by children.
Community studies in Iceland, South Korea, Netherlands and Italy all found evidence children were less likely to have - or have had - the virus than adults. The Italian region tested 70% of its population.
A review of the evidence by a global team of researchers concluded: "The role of children in transmission is unclear, but consistent evidence is demonstrating a lower likelihood of acquiring infection, and lower rates of children bringing infections into households."A review of the evidence by a global team of researchers concluded: "The role of children in transmission is unclear, but consistent evidence is demonstrating a lower likelihood of acquiring infection, and lower rates of children bringing infections into households."
One theory for why children generally have no symptoms or milder ones is that their lungs might contain fewer of the receptors that coronavirus uses to infect cells. But experts say there is not yet any good evidence to support this.
What about the risks to staff?What about the risks to staff?
More children in schools means more teachers working, and more parents at the school gates, and it's not yet clear how those extra contacts might affect the spread of infection.More children in schools means more teachers working, and more parents at the school gates, and it's not yet clear how those extra contacts might affect the spread of infection.
As the Sage report says, "It is important to understand the other types of social distancing measures that staff, parents, and students are engaging in beyond the boundaries of the school." A study by UCL and the London School of Hygiene and Tropical Medicine suggested without adequate contact-tracing, reopening schools would contribute to a second wave of infection larger than the first.
The group of scientists modelled nine different "return to school" scenarios. They assumed children were half as infectious as adults, but they also used computer models to see how more parents returning to work or resuming other activities would affect the spread of the virus.
On 16 May, Deputy Chief Medical Officer for England Dr Jenny Harries said the government had opted for the one estimated to give the smallest increase in the R number - the measure of how fast the disease is spreading - while still bringing significant numbers of children back to school. What if you don't send schoolchildren back?
It was reported that in 22 European Union countries where schools were partially reopened, there hadn't been a significant increase in cases, including among staff. These countries all opened up schools to different extents. Opening schools involves some risk of spreading infection, but not opening schools also involves risk - just of a different kind.
France did report a small uptick in cases after partially re-opening schools. Sage says school closures risked children's educational outcomes, which in turn could impact their psychological wellbeing and long-term development. This is likely to hit the most vulnerable children the hardest.
But World Health Organization (WHO) chief scientist Dr Soumya Swaminathan agrees that children are "less capable" of spreading the virus, and are at "very low risk" of getting ill from the disease. When some schoolchildren returned earlier in the summer, younger year groups and those with exams coming up were generally prioritised.
"What we have seen in countries where schools have remained open is that there have not been big outbreaks in schools." This is because they have the most important educational needs and, for younger children, they may be less able to learn well at home.
Why send primary school children back first?
Government guidelines say it wants to start with Reception, Year 1 and Year 6 children in England because:
The government says secondary schools in England will be able to reopen to Year 10 and Year 12 from Monday 15 June.
But only a quarter of pupils from those years will be allowed in school at any one time
The schools minister Nick Gibbs told MPs there is still no decision about the government's ambition to send all primary children in England back before the summer break.
What do I need to know about the coronavirus?What do I need to know about the coronavirus?