Children and COVID-19 Research Library

This systematic review aims to understand the infection rate, clinical presentation, clinical outcomes and transmission dynamics for SARS-CoV-2, in order to inform clinical and public health measures. Children appear to be less affected by COVID-19 than adults by observed rate of cases in large epidemiological studies. Limited data on attack rate indicate that children are just as susceptible to infection. Data on clinical outcomes are scarce but include several reports of asymptomatic infection and a milder course of disease in young children, though radiological abnormalities are noted. Severe cases are not reported in detail and there are little data relating to transmission.

Many countries have closed schools and kindergartens to minimise COVID‐19, but the role that children play in disease transmission is unclear. This systematic literature review from the MEDLINE and EMBASE databases and medRxiv/bioRxiv preprint servers to 11 May 2020 identified 700 published and unpublished papers on COVID‐19 transmission by children. Children accounted for a small fraction of COVID‐19 cases and mostly had social contacts with peers or parents, rather than older people at risk of severe disease. Data on viral loads were scarce, but indicated that children may have lower levels than adults, partly because they often have fewer symptoms, and this should decrease the transmission risk. Household transmission studies showed that children were rarely the index case and case studies suggested that children with COVID‐19 seldom caused outbreaks. However, it is highly likely that children can transmit the SARS‐COV‐2 virus, which causes COVID‐19, and even asymptomatic children can have viral loads.

Conclusion
Children are unlikely to be the main drivers of the pandemic. Opening up schools and kindergartens is unlikely to impact COVID‐19 mortality rates in older people.

Gaining control of an infectious disease outbreak can require making difficult decisions, particularly when infections are human-to-human transmissible. Children are often in close physical proximity at school, have less-than-perfect hygiene behaviours and have low prior immunity to many infections. For this reason, school closures are often proposed as one way of delaying the spread of infection. Given these considerations surrounding school closures, this study aimed to summarise existing literature on children’s activities and contacts made outside the home during unplanned school closures in this rapid evidence review. To expand, it examined: (i) what is currently known about the impact of unplanned school closure on children’s interaction with others outside the home, (ii) who provides childcare during a closure, (iii) what factors are associated with children interacting with others outside the home during a closure, and (iv) what affected parents think about closures.