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Bhatia R, Sledge I, Baral S. Missing science: A scoping study of COVID-19 epidemiological data in the United States. PLoS One 2022; 17:e0248793. [PMID: 36223335 PMCID: PMC9555641 DOI: 10.1371/journal.pone.0248793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 09/12/2022] [Indexed: 11/06/2022] Open
Abstract
Systematic approaches to epidemiologic data collection are critical for informing pandemic responses, providing information for the targeting and timing of mitigations, for judging the efficacy and efficiency of alternative response strategies, and for conducting real-world impact assessments. Here, we report on a scoping study to assess the completeness of epidemiological data available for COVID-19 pandemic management in the United States, enumerating authoritative US government estimates of parameters of infectious transmission, infection severity, and disease burden and characterizing the extent and scope of US public health affiliated epidemiological investigations published through November 2021. While we found authoritative estimates for most expected transmission and disease severity parameters, some were lacking, and others had significant uncertainties. Moreover, most transmission parameters were not validated domestically or re-assessed over the course of the pandemic. Publicly available disease surveillance measures did grow appreciably in scope and resolution over time; however, their resolution with regards to specific populations and exposure settings remained limited. We identified 283 published epidemiological reports authored by investigators affiliated with U.S. governmental public health entities. Most reported on descriptive studies. Published analytic studies did not appear to fully respond to knowledge gaps or to provide systematic evidence to support, evaluate or tailor community mitigation strategies. The existence of epidemiological data gaps 18 months after the declaration of the COVID-19 pandemic underscores the need for more timely standardization of data collection practices and for anticipatory research priorities and protocols for emerging infectious disease epidemics.
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Affiliation(s)
- Rajiv Bhatia
- Primary Care and Population Health, Stanford University, Stanford, CA, United States of America
- * E-mail:
| | | | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States of America
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2
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Rodriguez-Morales AJ, León-Figueroa DA, Romaní L, McHugh TD, Leblebicioglu H. Vaccination of children against COVID-19: the experience in Latin America. Ann Clin Microbiol Antimicrob 2022; 21:14. [PMID: 35337354 PMCID: PMC8949833 DOI: 10.1186/s12941-022-00505-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 12/18/2022] Open
Affiliation(s)
- Alfonso J Rodriguez-Morales
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda, Colombia. .,Master of Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. .,School of Medicine, Universidad Privada Franz Tamayo (UNIFRANZ), Cochabamba, Bolivia.
| | - Darwin A León-Figueroa
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo, Peru.,Sociedad Científica de Estudiantes de Medicina Veritas (SCIEMVE), Chiclayo, Peru.,Centro de Investigación en Atención Primaria en Salud, Universidad Peruana Cayetano Heredia, Lima, Peru.,Emerge, Unidad de Investigación en Enfermedades Emergentes y Cambio Climático, Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luccio Romaní
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo, Peru.,Centro de Investigación en Atención Primaria en Salud, Universidad Peruana Cayetano Heredia, Lima, Peru.,Emerge, Unidad de Investigación en Enfermedades Emergentes y Cambio Climático, Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Timothy D McHugh
- UCL Centre for Clinical Microbiology, Royal Free Campus, UCL, London, UK
| | - Hakan Leblebicioglu
- Department of Infectious Diseases, VM Medicalpark Samsun Hospital, Samsun, Turkey
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3
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Clyne B, Jordan K, Ahern S, Walsh KA, Byrne P, Carty PG, Drummond L, O'Brien KK, Smith SM, Harrington P, Ryan M, O'Neill M. Transmission of SARS-CoV-2 by children: a rapid review, 30 December 2019 to 10 August 2020. Euro Surveill 2022; 27. [PMID: 35115076 PMCID: PMC8815097 DOI: 10.2807/1560-7917.es.2022.27.5.2001651] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2023] Open
Abstract
BackgroundThe role of children in the transmission of SARS-CoV-2 during the early pandemic was unclear.AimWe aimed to review studies on the transmission of SARS-CoV-2 by children during the early pandemic.MethodsWe searched MEDLINE, Embase, the Cochrane Library, Europe PubMed Central and the preprint servers medRxiv and bioRxiv from 30 December 2019 to 10 August 2020. We assessed the quality of included studies using a series of questions adapted from related tools. We provide a narrative synthesis of the results.ResultsWe identified 28 studies from 17 countries. Ten of 19 studies on household and close contact transmission reported low rates of child-to-adult or child-to-child transmission. Six studies investigated transmission of SARS-CoV-2 in educational settings, with three studies reporting 183 cases from 14,003 close contacts who may have contracted COVID-19 from children index cases at their schools. Three mathematical modelling studies estimated that children were less likely to infect others than adults. All studies were of low to moderate quality.ConclusionsDuring the early pandemic, it appeared that children were not substantially contributing to household transmission of SARS-CoV-2. School-based studies indicated that transmission rates in this setting were low. Large-scale studies of transmission chains using data collected from contact tracing and serological studies detecting past evidence of infection would be needed to verify our findings.
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Affiliation(s)
- Barbara Clyne
- Health Information and Quality Authority, Dublin, Ireland
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Karen Jordan
- Health Information and Quality Authority, Dublin, Ireland
| | - Susan Ahern
- Health Information and Quality Authority, Dublin, Ireland
| | - Kieran A Walsh
- Health Information and Quality Authority, Dublin, Ireland
| | - Paula Byrne
- Health Information and Quality Authority, Dublin, Ireland
| | - Paul G Carty
- Health Information and Quality Authority, Dublin, Ireland
| | - Linda Drummond
- Health Information and Quality Authority, Dublin, Ireland
| | | | - Susan M Smith
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Máirín Ryan
- Health Information and Quality Authority, Dublin, Ireland
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Trinity Health Sciences, St James's Hospital, Dublin, Ireland
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Karki SJ, Joachim A, Heinsohn T, Lange B. Risk of infection and contribution to transmission of SARS-CoV-2 in school staff: a systematic review. BMJ Open 2021; 11:e052690. [PMID: 34732489 PMCID: PMC8572358 DOI: 10.1136/bmjopen-2021-052690] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To summarise the comparative risk of infection in school staff and their contribution to SARS-CoV-2 transmission. DESIGN Systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. DATA SOURCES MEDLINE, WHO COVID-19 database and preView were searched on 29 January 2021. ELIGIBILITY CRITERIA We included studies that reported risk of SARS-CoV-2 infection in school staff or transmission of SARS-CoV-2 in school settings. DATA EXTRACTION AND SYNTHESIS Data extraction was done in duplicates. Data synthesis was qualitative. We report attack rates and infection risk in school settings for staff and students stratified by control measures taken and infection dynamics at the point of data collection. RESULTS Eighteen studies were included. Three studies in low incidence settings showed low attack rates similar for teachers and students. Five studies in medium incidence settings and two studies in high incidence settings showed secondary attack rates up to 16% in school staff.Seroprevalence studies, two in each low and high incidence settings showed an infection risk of 0%-0.2% and 1.7%-28% for teachers.The risk of infection for teachers compared with students were similar in one study in low incidence setting, higher in three studies (RR 1.2-4.4) and lower in three studies in medium to high incidence settings. The risk of infection for teachers in a high infection environment is higher in face-to-face than in distance classes when compared with general population groups. The risk of infections as well as risk of hospitalisation both increased for teachers during school openings compared with school closure. CONCLUSION While in low incidence settings there is little evidence for school staff to be at high risk of SARS-CoV-2 infection, in high incidence settings there is an increased risk of SARS-CoV-2 infection in school staff teaching face-to-face compared to staff teaching digitally and general population. PROSPERO REGISTRATION NUMBER CRD42021239225.
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Affiliation(s)
- Sudip Jung Karki
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Alexandar Joachim
- Department of Paediatrics, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Torben Heinsohn
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
- German Center for Infection Research (DZIF), Braunschweig, Germany
| | - Berit Lange
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
- German Center for Infection Research (DZIF), Braunschweig, Germany
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5
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Filippatos F, Tatsi EB, Michos A. Immune response to SARS-CoV-2 in children: A review of the current knowledge. Pediatr Investig 2021; 5:217-228. [PMID: 34540321 PMCID: PMC8441939 DOI: 10.1002/ped4.12283] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/13/2021] [Indexed: 12/14/2022] Open
Abstract
Host immune responses to severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), especially in children, are still under investigation. Children with coronavirus disease 2019 (COVID‐19) constitute a significant study group of immune responses as they rarely present with severe clinical manifestations, require hospitalization, or develop complications such as multisystem inflammatory syndrome in children (MIS‐C) associated with SARS‐CoV‐2 infection. The deciphering of children’s immune responses during COVID‐19 infection will provide information about the protective mechanisms, while new potential targets for future therapies are likely to be revealed. Despite the limited immunological studies in children with COVID‐19, this review compares data between adults and children in terms of innate and adaptive immunity to SARS‐CoV‐2, discusses the possible reasons why children are mostly asymptomatic, and highlights unanswered or unclear immunological issues. Current evidence suggests that the activity of innate immunity seems to be crucial to the early phases of SARS‐CoV‐2 infection and adaptive memory immunity is vital to prevent reinfection. Despite the limited immunological studies from children with COVID‐19, this review compares data between adults and children in terms of innate and adaptive immunity to SARS‐CoV‐2, discusses the possible reasons why children are mostly asymptomatic, and highlights unanswered or unclear immunological issues.
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Affiliation(s)
- Filippos Filippatos
- First Department of Pediatrics Infectious Diseases and Chemotherapy Research Laboratory Medical School National and Kapodistrian University of Athens "Aghia Sophia" Children's Hospital Athens Greece
| | - Elizabeth-Barbara Tatsi
- First Department of Pediatrics Infectious Diseases and Chemotherapy Research Laboratory Medical School National and Kapodistrian University of Athens "Aghia Sophia" Children's Hospital Athens Greece
| | - Athanasios Michos
- First Department of Pediatrics Infectious Diseases and Chemotherapy Research Laboratory Medical School National and Kapodistrian University of Athens "Aghia Sophia" Children's Hospital Athens Greece
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Irfan O, Li J, Tang K, Wang Z, Bhutta ZA. Risk of infection and transmission of SARS-CoV-2 among children and adolescents in households, communities and educational settings: A systematic review and meta-analysis. J Glob Health 2021; 11:05013. [PMID: 34326997 PMCID: PMC8285769 DOI: 10.7189/jogh.11.05013] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND There is uncertainty with respect to SARS-CoV-2 transmission in children (0-19 years) with controversy on effectiveness of school-closures in controlling the pandemic. It is of equal importance to evaluate the risk of transmission in children who are often asymptomatic or mildly symptomatic carriers that may incidentally transmit SARS-CoV-2 in different settings. We conducted this review to assess transmission and risks for SARS-CoV-2 in children (by age-groups or grades) in community and educational-settings compared to adults. METHODS Data for the review were retrieved from PubMed, EMBASE, Cochrane Library, WHO COVID-19 Database, China National Knowledge Infrastructure (CNKI) Database, WanFang Database, Latin American and Caribbean Health Sciences Literature (LILACS), Google Scholar, and preprints from medRixv and bioRixv) covering a timeline from December 1, 2019 to April 1, 2021. Population-screening, contact-tracing and cohort studies reporting prevalence and transmission of SARS-CoV-2 in children were included. Data were extracted according to PRISMA guidelines. Meta-analyses were performed using Review Manager 5.3. RESULTS Ninety studies were included. Compared to adults, children showed comparable national (risk ratio (RR) = 0.87, 95% confidence interval (CI) = 0.71-1.060 and subnational (RR = 0.81, 95% CI = 0.66-1.01) prevalence in population-screening studies, and lower odds of infection in community/household contact-tracing studies (odds ratio (OR) = 0.62, 95% CI = 0.46-0.84). On disaggregation, adolescents observed comparable risk (OR = 1.22, 95% CI = 0.74-2.04) with adults. In educational-settings, children attending daycare/preschools (OR = 0.53, 95% CI = 0.38-0.72) were observed to be at lower-risk when compared to adults, with odds of infection among primary (OR = 0.85, 95% CI = 0.55-1.31) and high-schoolers (OR = 1.30, 95% CI = 0.71-2.38) comparable to adults. Overall, children and adolescents had lower odds of infection in educational-settings compared to community and household clusters. CONCLUSIONS Children (<10 years) showed lower susceptibility to COVID-19 compared to adults, whereas adolescents in communities and high-schoolers had comparable risk. Risks of infection among children in educational-settings was lower than in communities. Evidence from school-based studies demonstrate it is largely safe for children (<10 years) to be at schools, however older children (10-19 years) might facilitate transmission. Despite this evidence, studies focusing on the effectiveness of mitigation measures in educational settings are urgently needed to support both public health and educational policy-making for school reopening.
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Affiliation(s)
- Omar Irfan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Jiang Li
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Kun Tang
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Zhicheng Wang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
- Institute for Global Health & Development, the Aga Khan University, Karachi, Pakistan
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7
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Xu W, Li X, Dong Y, Dozier M, He Y, Kirolos A, Lang Z, Mathews C, Siegfried N, Theodoratou E. SARS-CoV-2 transmission in schools: An updated living systematic review (version 2; November 2020). J Glob Health 2021; 11:10004. [PMID: 34804514 PMCID: PMC8590829 DOI: 10.7189/jogh.11.10004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Better understanding of SARS-CoV-2 transmission risks is needed to support decision-making around mitigation measures for COVID-19 in schools. METHODS We updated a living systematic review and meta-analysis to investigate the extent of SARS-CoV-2 transmission in schools. In this update we modified our inclusion criteria to include: 1) cohort studies; 2) cross-sectional studies that investigated and cross-assessed SARS-COV-2 positivity rates in schools and communities; and 3) pre-post studies. We performed risk of bias evaluation for all included studies using the Newcastle-Ottawa Scale (NOS). RESULTS 6270 articles were retrieved and six new studies were added in this update. In total from the two updates and using the new inclusion criteria, we identified 11 cohort studies (1st update: n = 5; 2nd update: n = 6) and one cross-sectional study (1st update: n = 1; 2nd update: n = 0). We performed a meta-analysis on nine of the 11 cohort studies investigating IAR in schools. Nine cohort studies reported a total of 91 student and 52 staff index cases that exposed 5698 contacts with 101 secondary infections (overall infection attack rate (IAR) = 1.45%, 95% CI = 0.31%-3.26%). IARs for students and school staff were 1.66% (95% CI = 0.08%-4.78%) and 1.18% (95% CI = 0.00%-4.43%) respectively. The risk of bias was found to be high for most studies identified, limiting the confidence in results. CONCLUSIONS There is limited high-quality evidence available to quantify the extent of SARS-CoV-2 transmission in schools or to compare it to community transmission. Emerging evidence suggests the overall IAR and SARS-CoV-2 positivity rate in school settings are low. Higher IAR were found in students, compared to staff. NOTE This article is a living systematic review that will be updated to reflect emerging evidence. This is the second version of the original article published on 23 December 2020 (J Glob Health 2020;11:021104), and previous versions can be found as data supplements. When citing this paper please consider adding the version number and date of access for clarity.
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Affiliation(s)
- Wei Xu
- Centre for Global Health Research, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Xue Li
- School of Public Health and the Second Affiliated Hospital, Zhejiang University, Hangzhou, China
- Centre for Global Health Research, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Yijia Dong
- Centre for Global Health Research, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Marshall Dozier
- Information Services, University of Edinburgh, Edinburgh, United Kingdom
| | - Yazhou He
- Centre for Global Health Research, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Amir Kirolos
- Centre for Global Health Research, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Zhongyu Lang
- Centre for Global Health Research, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Francie Van Zijl Drive, Parow, South Africa
| | - Nandi Siegfried
- Health Systems Research Unit, South African Medical Research Council, Francie Van Zijl Drive, Parow, South Africa
| | - Evropi Theodoratou
- Centre for Global Health Research, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- Cancer Research UK Edinburgh Centre, Medical Research Council Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - UNCOVER
- School of Public Health and the Second Affiliated Hospital, Zhejiang University, Hangzhou, China
- Centre for Global Health Research, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- Information Services, University of Edinburgh, Edinburgh, United Kingdom
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
- Health Systems Research Unit, South African Medical Research Council, Francie Van Zijl Drive, Parow, South Africa
- Cancer Research UK Edinburgh Centre, Medical Research Council Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
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8
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Dupraz J, Butty A, Duperrex O, Estoppey S, Faivre V, Thabard J, Zuppinger C, Greub G, Pantaleo G, Pasquier J, Rousson V, Egger M, Steiner-Dubuis A, Vassaux S, Masserey E, Bochud M, Gonseth Nusslé S, D'Acremont V. Prevalence of SARS-CoV-2 in Household Members and Other Close Contacts of COVID-19 Cases: A Serologic Study in Canton of Vaud, Switzerland. Open Forum Infect Dis 2021; 8:ofab149. [PMID: 34307723 PMCID: PMC8083624 DOI: 10.1093/ofid/ofab149] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/23/2021] [Indexed: 11/12/2022] Open
Abstract
Background Research on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission within households and other close settings using serological testing is scarce. Methods We invited coronavirus disease 2019 (COVID-19) cases diagnosed between February 27 and April 1, 2020, in Canton of Vaud, Switzerland, to participate, along with household members and other close contacts. Anti-SARS-CoV-2 immunoglobulin G antibodies were measured using a Luminex immunoassay. We estimated factors associated with serological status using generalized estimating equations. Results Overall, 219 cases, 302 household members, and 69 other close contacts participated between May 4 and June 27, 2020. More than half of household members (57.2%; 95% CI, 49.7%-64.3%) had developed a serologic response to SARS-CoV-2, while 19.0% (95% CI, 10.0%-33.2%) of other close contacts were seropositive. After adjusting for individual and household characteristics, infection risk was higher in household members aged ≥65 years than in younger adults (adjusted odds ratio [aOR], 3.63; 95% CI, 1.05-12.60) and in those not strictly adhering to simple hygiene rules like hand washing (aOR, 1.80; 95% CI, 1.02-3.17). The risk was lower when more than 5 people outside home were met during semiconfinement, compared with none (aOR, 0.35; 95% CI, 0.16-0.74). Individual risk of household members to be seropositive was lower in large households (22% less per each additional person). Conclusions During semiconfinement, household members of a COVID-19 case were at very high risk of getting infected, 3 times more than close contacts outside home. This highlights the need to provide clear messages on protective measures applicable at home. For elderly couples, who were especially at risk, providing external support for daily basic activities is essential.
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Affiliation(s)
- Julien Dupraz
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Audrey Butty
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Olivier Duperrex
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Sandrine Estoppey
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Vincent Faivre
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Julien Thabard
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Claire Zuppinger
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Gilbert Greub
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Service of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Giuseppe Pantaleo
- Service of Immunology and Allergy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Swiss Vaccine Research Institute, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jérôme Pasquier
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Valentin Rousson
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Malik Egger
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Amélie Steiner-Dubuis
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Sophie Vassaux
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Eric Masserey
- Cantonal Medical Office, Department of Health and Social Action, Canton of Vaud, Switzerland
| | - Murielle Bochud
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Semira Gonseth Nusslé
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Valérie D'Acremont
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
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9
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Johnson KE, Stoddard M, Nolan RP, White DE, Hochberg NS, Chakravarty A. In the long shadow of our best intentions: Model-based assessment of the consequences of school reopening during the COVID-19 pandemic. PLoS One 2021; 16:e0248509. [PMID: 33765026 PMCID: PMC7993767 DOI: 10.1371/journal.pone.0248509] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/26/2021] [Indexed: 01/10/2023] Open
Abstract
As the world grapples with the ongoing COVID-19 pandemic, a particularly thorny set of questions surrounds the reopening of primary and secondary (K-12) schools. The benefits of in-person learning are numerous, in terms of education quality, mental health, emotional well-being, equity and access to food and shelter. Early reports suggested that children might have reduced susceptibility to COVID-19, and children have been shown to experience fewer complications than older adults. Over the past few months, our understanding of COVID-19 has been further shaped by emerging data, and it is now understood that children are as susceptible to infection as adults and have a similar viral load during infection, even if asymptomatic. Based on this updated understanding of the disease, we have used epidemiological modeling to explore the feasibility and consequences of school reopening in the face of differing rates of COVID-19 prevalence and transmission. We focused our analysis on the United States, but the results are applicable to other countries as well. We demonstrate the potential for a large discrepancy between detected cases and true infections in schools due to the combination of high asymptomatic rates in children coupled with delays in seeking testing and receiving results from diagnostic tests. Our findings indicate that, regardless of the initial prevalence of the disease, and in the absence of robust surveillance testing and contact-tracing, most schools in the United States can expect to remain open for 20-60 days without the emergence of sizeable disease clusters. At this point, even if schools choose to close after outbreaks occur, COVID-19 cases will be seeded from these school clusters and amplified into the community. Thus, our findings suggest that the debate between the risks to student safety and benefits of in-person learning frames a false dual choice. Reopening schools without surveillance testing and contact tracing measures in place will lead to spread within the schools and within the communities that eventually forces a return to remote learning and leaves a trail of infection in its wake.
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Affiliation(s)
- Kaitlyn E. Johnson
- Department of Integrative Biology, The University of Texas at Austin, Austin, TX, United States of America
- Fractal Therapeutics, Cambridge, MA, United States of America
| | | | - Ryan P. Nolan
- Halozyme Therapeutics, San Diego, CA, United States of America
| | | | - Natasha S. Hochberg
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States of America
- Department of Medicine, Boston University School of Medicine, Boston, MA, United States of America
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10
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Naimark D, Mishra S, Barrett K, Khan YA, Mac S, Ximenes R, Sander B. Simulation-Based Estimation of SARS-CoV-2 Infections Associated With School Closures and Community-Based Nonpharmaceutical Interventions in Ontario, Canada. JAMA Netw Open 2021; 4:e213793. [PMID: 33787909 PMCID: PMC8013816 DOI: 10.1001/jamanetworkopen.2021.3793] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 02/06/2021] [Indexed: 12/22/2022] Open
Abstract
Importance Resurgent COVID-19 cases have resulted in the reinstitution of nonpharmaceutical interventions, including school closures, which can have adverse effects on families. Understanding the associations of school closures with the number of incident and cumulative COVID-19 cases is critical for decision-making. Objective To estimate the association of schools being open or closed with the number of COVID-19 cases compared with community-based nonpharmaceutical interventions. Design, Setting, and Participants This decision analytical modelling study developed an agent-based transmission model using a synthetic population of 1 000 000 individuals based on the characteristics of the population of Ontario, Canada. Members of the synthetic population were clustered into households, neighborhoods, or rural districts, cities or rural regions, day care facilities, classrooms (ie, primary, elementary, or high school), colleges or universities, and workplaces. Data were analyzed between May 5, 2020, and October 20, 2020. Exposures School reopening on September 15, 2020, vs schools remaining closed under different scenarios for nonpharmaceutical interventions. Main Outcomes and Measures Incident and cumulative COVID-19 cases between September 1, 2020, and October 31, 2020. Results Among 1 000 000 simulated individuals, the percentage of infections among students and teachers acquired within schools was less than 5% across modeled scenarios. Incident COVID-19 case numbers on October 31, 2020, were 4414 (95% credible interval [CrI], 3491-5382) cases in the scenario with schools remaining closed and 4740 (95% CrI, 3863-5691) cases in the scenario for schools reopening, with no other community-based nonpharmaceutical intervention. In scenarios with community-based nonpharmaceutical interventions implemented, the incident case numbers on October 31 were 714 (95% CrI, 568-908) cases for schools remaining closed and 780 (95% CrI, 580-993) cases for schools reopening. When scenarios applied the case numbers observed in early October in Ontario, the cumulative case numbers were 777 (95% CrI, 621-993) cases for schools remaining closed and 803 (95% CrI, 617-990) cases for schools reopening. In scenarios with implementation of community-based interventions vs no community-based interventions, there was a mean difference of 39 355 cumulative COVID-19 cases by October 31, 2020, while keeping schools closed vs reopening them yielded a mean difference of 2040 cases. Conclusions and Relevance This decision analytical modeling study of a synthetic population of individuals in Ontario, Canada, found that most COVID-19 cases in schools were due to acquisition in the community rather than transmission within schools and that the changes in COVID-19 case numbers associated with school reopenings were relatively small compared with the changes associated with community-based nonpharmaceutical interventions.
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Affiliation(s)
- David Naimark
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, Canada
- Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sharmistha Mishra
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Canada
| | - Kali Barrett
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, Canada
- University Health Network, Toronto, Canada
| | - Yasin A. Khan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, Canada
- University Health Network, Toronto, Canada
| | - Stephen Mac
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, Canada
| | - Raphael Ximenes
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Escola de Matemática Aplicada, Fundação Getúlio Vargas, Rio de Janeiro, Brasil
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- University Health Network, Toronto, Canada
- ICES, Toronto, Canada
- Public Health Ontario, Toronto, Canada
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Hacımustafaoğlu M. COVID-19 and re-opening of schools: Opinions with scientific evidence. TURK PEDIATRI ARSIVI 2020; 55:337-344. [PMID: 33414650 PMCID: PMC7750348 DOI: 10.14744/turkpediatriars.2020.90018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/13/2020] [Indexed: 12/11/2022]
Abstract
Due to the COVID-19 pandemic, more than 90% of students worldwide were affected by education loss. Moreover, for school-age children and adolescents, there may be worsening of nutrition, increasing mental health disorders, lack of physical activity, and related deleterious consequences raise concerns about negative habits, child violence, and abuse. Face-to-face education in schools provides positive educational opportunities that cannot be achieved with online education. In studies from various countries, children have milder disease, constituting as little as 1-8% of all laboratory-confirmed COVID-19 cases, with less transmission capacity to household contacts than adults (0.5-7% vs. 10-20%). Symptomatic or asymptomatic children can infect other people less than adults. Also, the transmission of illness between students at school is less than expected, and the transmission of COVID-19 to students is usually acquired from sick adults rather than sick students. Therefore, with suitable measures, infection risk is less than expected and seems not to be higher than in other public places. COVID-19 measures in schools can be summarized as follows: avoiding crowded/close contact environments as much as possible, respecting the protective (social) distance, wearing appropriate masks, hand hygiene, and some essential protective measurements of classrooms and environment. Measurements should be participatory (students, teachers, education staff, parents, administration), applicable, sustainable, and flexible according to the conditions.
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Affiliation(s)
- Mustafa Hacımustafaoğlu
- Department of Pediatric Infectious Diseases, Uludag University Faculty of Medicine, Bursa, Turkey
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