Covid-19: Keeping schools as safe as possible

Effectiveness of BNT162b2 vaccine against SARS-CoV-2 Delta and Omicron infection in adolescents, Norway, August 2021 to January 2022

OBJECTIVES

We estimated the BNT162b2 vaccine effectiveness (VE) against any (symptomatic or not) SARS-CoV-2 Delta and Omicron infection among adolescents (12-17-years-old) in Norway from August 2021 to January 2022.

METHODS

We used Cox proportional hazard models, where vaccine status was included as a time-varying covariate and models were adjusted for age, sex, comorbidities, residence county, birth country, and living conditions.

RESULTS

VE against Delta infection peaked at 68% (95%CI:64-71%) and 62% (95%CI:57-66%) in days 21-48 after the first dose among 12-15-year-olds and 16-17-year-olds respectively. Among 16-17-year-olds that received two doses, VE against Delta infection peaked at 93% (95%CI:90-95%) in days 35-62 and decreased to 84% (95%CI:76-89%) in ≥63 days after vaccination. We did not observe a protective effect against Omicron infection after receiving one dose. Among 16-17-year-olds, VE against Omicron infection peaked at 53% (95%CI:43-62%) in 7-34 days after the second dose and decreased to 23% (95%CI:3-40%) in ≥63 days after vaccination.

CONCLUSIONS

We found reduced protection after two BNT162b2 vaccine doses against any Omicron infection compared to Delta. Effectiveness decreased with time from vaccination for both variants. The impact of vaccination among adolescents on reducing infection and thus transmission is limited during Omicron dominance.

Weighing policymaking: A narrative review of school closures as COVID-19 pandemic-mitigation strategies

INTRODUCTION

In the era of data-driven decision-making, unacceptable haziness, and inconsistency surrounds the yearlong scientific and public debate on the school closure policy in the coronavirus disease-2019 (COVID-19) pandemic mitigation efforts.

AIM

The present literature review stems out of the need for a clear scaffold collecting in one place all current evidence, as well as helping to organize incoming future evidence, concerning both the role of schools in driving the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) community spread and the cost-effectiveness of school closure in containing such spread.

METHODS

References for this review were initially identified through searches of PubMed, Scopus, and Cochrane Library for articles published from March 2020 to March 2021 by the use of key terms "Schools," "COVID-19," "pandemic," "clusters," "outbreak," and "seroprevalence," selecting all articles from 2020 to 2021 with full-text availability. A further search was undertaken by screening citations of articles found in the original search and through Google Scholar and ResearchGate.

RESULTS

Overall, evidence shows that opening schools and keeping them open in the context of the SARS-CoV-2 pandemic is possible, although behaviorally challenging and unfeasible if educational facilities or testing services are inadequate. Contrary to other respiratory viruses, children are not chief targets of SARS-CoV-2 infection, transmission, and disease. It also appears that the second wave of the SARS-CoV-2 virus spread in the WHO European region has been unrelated to school re-opening.

CONCLUSIONS

A fact-based understanding of what is currently known on such a consequential policy is required to provide a basis of evidence for advocacy of either school closure or school opening at times of high-intensity community transmission of SARS-CoV-2.

Adaptive school grounds design in response to COVID-19: Findings from six primary schools in South East England

The purpose of this research is to look at how primary schools in England have adapted their outdoor spaces in the context of COVID-19 rules and guidelines to meet the needs of students returning from school closures and national lockdown of Spring/Summer 2020, how that impacted play and learning value of their grounds, and to consider how these findings might inform future school grounds design. Thus, we used a mixed-method approach that included qualitative interviews with representatives from six primary schools (three in rural and three in urban areas), quantitative desk research, and in-person site surveys. We used literature-based scoring criteria to quantify changes in the playground before and after the implementation of COVID-19 measures. The research reveals that the zoning of play areas and other aspects of the school grounds may negatively affected the value of play and learning. We also found a substantial disparity in the amount of outside space per pupil (OSPP) available across schools. Those with the lowest OSPP also had the lowest outdoor and environmental learning provision, lacking the flexibility to accommodate this alongside other requirements of staggered play breaks and PE. The amount of outdoor space that a school has available per pupil averaged at 32 m2 for urban schools and 43 m2 for rural schools. Finally, we have explored how spatial layout and design elements may have supported or inhibited schools' abilities to respond to children's needs, and how this might inform adaptive school grounds design considerations for the future.

School Closure Versus Targeted Control Measures for SARS-CoV-2 Infection

OBJECTIVES

To compare effects of school closures with effects of targeted infection prevention and control (IPC) measures in open schools on SARS-CoV-2 infection rates in students.

METHODS

We conducted interrupted time-series analyses to compare trends in infection rates in grades 1-10 in 7 boroughs in Oslo, Norway, between February 15 and April 18, 2021. All schools at all levels had implemented strict IPC measures. While grades 1-4 attended school throughout the study period, school closures were implemented for grades 5-10 from March 17. We obtained individual level data from nationwide registries.

RESULTS

A total of 616, 452, and 446 students in grades 1-4, 5-7 and 8-10, respectively, were registered with a positive SARS-CoV-2 test during the study period, when the α-variant dominated. A statistically significant reduction in postintervention trends was observed for grades 1-4 (coefficient -1.26; 95% confidence interval (CI), -2.44 to -0.09). We did not observe any statistically significant between-group differences in postintervention trends between grades 1-4 and 5-7 (coefficient 0.66; 95% CI, -1.25 to 2.58) nor between grades 1-4 and 8-10 (coefficient -0.63; 95% CI, -2.30 to 1.04). Findings indicate that keeping schools open with strict IPC measures was equally effective as school closures on reducing student infection rates.

CONCLUSIONS

School closure was not more effective than targeted IPC measures in open schools in reducing student infection rates. Our findings suggest that keeping schools open with appropriate IPC measures should be preferred over school closures, considering the negative consequences closures have on students.

Understanding the effectiveness of government interventions against the resurgence of COVID-19 in Europe

European governments use non-pharmaceutical interventions (NPIs) to control resurging waves of COVID-19. However, they only have outdated estimates for how effective individual NPIs were in the first wave. We estimate the effectiveness of 17 NPIs in Europe's second wave from subnational case and death data by introducing a flexible hierarchical Bayesian transmission model and collecting the largest dataset of NPI implementation dates across Europe. Business closures, educational institution closures, and gathering bans reduced transmission, but reduced it less than they did in the first wave. This difference is likely due to organisational safety measures and individual protective behaviours-such as distancing-which made various areas of public life safer and thereby reduced the effect of closing them. Specifically, we find smaller effects for closing educational institutions, suggesting that stringent safety measures made schools safer compared to the first wave. Second-wave estimates outperform previous estimates at predicting transmission in Europe's third wave.

Effects of Relaxed Lockdown on Pediatric ER Visits during SARS-CoV-2 Pandemic in Italy

Previously, we demonstrated an 81% reduction in pediatric Emergency Room (ER) visits in Italy during the strict lockdown due to the SARS-CoV-2 pandemic. Since May 2020, lockdown measures were relaxed until 6 November 2020, when a strict lockdown was patchily reintroduced. Our aim was to evaluate the impact of the relaxed lockdown on pediatric ER visits in Italy. We performed a retrospective multicenter study involving 14 Italian pediatric ERs. We compared total ER visits from 24 September 2020 to 6 November 2020 with those during the corresponding timeframe in 2019. We evaluated 17 ER specific diagnoses grouped in air communicable and non-air communicable diseases. We recognized four different triage categories: white, green, yellow and red. In 2020 total ER visits were reduced by 51% compared to 2019 (16,088 vs. 32,568, respectively). The decrease in air communicable diseases was significantly higher if compared to non-air communicable diseases (-64% vs. -42%, respectively). ER visits in each triage category decreased in 2020 compared to 2019, but in percentage, white and red codes remained stable, while yellow codes slightly increased and green codes slightly decreased. Our results suggest that preventive measures drastically reduced the circulation of air communicable diseases even during the reopening of social activities but to a lesser extent with regard to the strict lockdown period (March-May 2020).

Exposures associated with SARS-CoV-2 infection in France: A nationwide online case-control study

BACKGROUND

We aimed to assess the role of different setting and activities in acquiring SARS-CoV-2 infection.

METHODS

In this nationwide case-control study, cases were SARS-CoV-2 infected adults recruited between 27 October and 30 November 2020. Controls were individuals from the Ipsos market research database matched to cases by age, sex, region, population density and time period. Participants completed an online questionnaire on recent activity-related exposures.

FINDINGS

Among 3426 cases and 1713 controls, in multivariable analysis, we found an increased risk of infection associated with any additional person living in the household (adjusted-OR: 1•16; 95%CI: 1•11-1•21); having children attending day-care (aOR: 1•31; 95%CI: 1•02-1•62), kindergarten (aOR: 1•27; 95%CI: 1•09-1•45), middle school (aOR: 1•30; 95%CI: 1•15-1•47), or high school (aOR: 1•18; 95%CI: 1•05-1•34); with attending professional (aOR: 1•15; 95%CI: 1•04-1•26) or private gatherings (aOR: 1•57; 95%CI: 1•45-1•71); and with having frequented bars and restaurants (aOR: 1•95; 95%CI: 1•76-2•15), or having practiced indoor sports activities (aOR: 1•36; 95%CI: 1•15-1•62). We found no increase in risk associated with frequenting shops, cultural or religious gatherings, or with transportation, except for carpooling (aOR: 1•47; 95%CI: 1•28-1•69). Teleworking was associated with decreased risk of infection (aOR: 0•65; 95%CI: 0•56-0•75).

INTERPRETATION

Places and activities during which infection prevention and control measures may be difficult to fully enforce were those with increased risk of infection. Children attending day-care, kindergarten, middle and high schools, but not primary schools, were potential sources of infection for the household.

FUNDING

Institut Pasteur, Research & Action Emerging Infectious Diseases (REACTing), Fondation de France (Alliance" Tous unis contre le virus").

Saliva Molecular Testing for SARS-CoV-2 Surveillance in Two Italian Primary Schools

BACKGROUND

No evidence has so far proven a significant role of schools in SARS-CoV-2 transmission, while the negative effects of their closure on children and adolescents are well documented. Surveillance, by means of frequent students and staff testing, has been advocated in order to implement school safety. Our aim was to report the results of a school surveillance program for the early detection of SARS-CoV-2 infection in pre- and asymptomatic subjects, by means of molecular salivary testing (MST).

METHODS

School surveillance in two schools in Milan, Italy, was carried out for six weeks. Each participant received a saliva collection kit, to be self-performed.

RESULTS

401 students and 12 teachers were enrolled, and 5 positive children in 5 different classes were observed. All the cases were asymptomatic. Their nasopharyngeal swab was positive on the same day in four cases, while in one case it resulted negative on the same day and positive 3 days later. In one positive case, the whole family was set under surveillance. The positive child did not develop symptoms and no family member was infected.

CONCLUSIONS

MST might represent an efficient way to actively survey communities in order to detect asymptomatic cases, thus limiting SARS-CoV-2 transmission.

Face Masks in Young Children During the COVID-19 Pandemic: Parents' and Pediatricians' Point of View

Background: In countries with high SARS-CoV-2 circulation, the pandemic has presented many challenges on different fronts, affecting lives and livelihoods; efforts to keep schools open are among the most important. In France, to keep schools open, wearing a face mask has been mandatory for children from age 6 years since November 2020. Objective: To evaluate the acceptability and tolerance of this measure by children as well as both parents and pediatricians. Setting: Parents registered on the website of the French Association of Ambulatory Pediatrics and pediatricians members of this association. Participants: All parents and pediatricians who agreed to take part in the survey. Results: Among the 2,954 questionnaires for the parents' survey, the reasons for wearing a mask were understood by 54.6% of parents, most of whom (84.6%) explained the reasons to their children. The parents applied this measure because it was mandatory (93.4%) even if they disagreed (63.3%). When interviewed by parents, children said they were usually embarrassed (80.9%) by the mask. The main symptoms or changes of behavior attributed to the mask according to parents were headache (49.0%), speaking difficulties (45%), change in mood (45.2%) and breathing discomfort (28.1%). Among the 663 pediatricians who responded, many agreed with mandatory mask-wearing at age 6 years (67.7%). Overall, 15% of pediatricians systematically asked about the mask tolerance during the consultation. During the medical consultation, when the parents complained about the mask (64.3%), the main drawbacks were related to fog on glasses (reported by 68.2% of pediatricians), breathing discomfort (53.1% of pediatricians), cutaneous disorders (42.4% of pediatricians) and headaches (38.2% of pediatricians). Conclusion: Despite the many inconveniences reported, children agree to wear the mask better than their parents think. Pediatricians should sufficiently take the opportunity during the consultation to further explain the reasons for wearing the mask because their pedagogical role is crucial.