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      COVID‐19, children and schools: overlooked and at risk

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          Abstract

          to the editor: The recent MJA article by Hyde 1 presents aspects of the debate regarding children’s transmission of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) and school outbreaks. While we acknowledge this debate, Hyde’s article omits key research on the topic; importantly and specifically, the harms to children with school closures. We highlight some of the facts that Hyde’s Perspective did not cover. A systematic review concluded that children aged under 10 years were less susceptible to infection with SARS‐CoV‐2 compared with adolescents and adults. 2 In addition, Victorian data show that children aged under 12 years are less likely to transmit the virus in school or childcare settings compared with adolescents and adults. 3 Hyde’s assertion that age‐related differences remain in question is not borne out in the literature. Evidence suggests that schools are not sites of heightened transmission risk, but rather reflect community transmission. The data from France 4 referenced in Hyde’s article do not account for confounding associated with increased movement by adults when children return to school. In Victoria, schools were closed not because they were deemed high risk, but to minimise the movement of people, especially adults. 5 Asymptomatic coronavirus disease 2019 (COVID‐19) is not uncommon in children; however, contrary to Hyde’s claim, this does not mean that case detection is difficult or that children contribute disproportionately to transmission. In the scenario presented by Hyde, one would expect outbreaks at schools to be disproportionate to community transmission, but local and international data show that the opposite is true. 3 , 6 As parts of Europe enter lockdown, health authorities, including the World Health Organization and UNICEF, have supported schools staying open. 7 , 8 For some children, school is the safest place. The wide‐ranging indirect psychosocial and educational effects of lockdowns have been reported 9 and have been observed by Victorian teachers and paediatricians; however, this is not discussed in Hyde’s article. To future‐proof the harm to children from school closures, a multidisciplinary team must develop a COVID‐19‐safe school policy. Our team of paediatricians and infectious disease epidemiologists developed a return to school guidance for the safe return to school for children in Victoria which can be scaled up and down depending on the level of community transmission. 3 We are concerned that this Perspective may fuel parental anxiety, and we believe that its lack of rigour should question its place in the MJA. Competing interests The authors have received funding from the Victorian Department of Health and Human Services for analysis and reporting of COVID‐19 in children and schools in Victoria.

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          COVID ‐19, children and schools: overlooked and at risk

          Zoë Hyde (2020)
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            Cluster of COVID-19 in northern France: A retrospective closed cohort study

            Background: The Oise department in France has been heavily affected by COVID-19 in early 2020. Methods: Between 30 March and 4 April 2020, we conducted a retrospective closed cohort study among pupils, their parents and siblings, as well as teachers and non-teaching staff of a high-school located in Oise. Participants completed a questionnaire that covered history of fever and/or respiratory symptoms since 13 January 2020 and had blood tested for the presence of anti-SARS-CoV-2 antibodies. The infection attack rate (IAR) was defined as the proportion of participants with confirmed SARS-CoV-2 infection based on antibody detection. Blood samples from two blood donor centres collected between 23 and 27 March 2020 in the Oise department were also tested for presence of anti-SARS-CoV-2 antibodies. Findings: Of the 661 participants (median age: 37 years), 171 participants had anti-SARS-CoV-2 antibodies. The overall IAR was 25.9% (95% confidence interval (CI) = 22.6-29.4), and the infection fatality rate was 0% (one-sided 97.5% CI = 0-2.1). Nine of the ten participants hospitalised since mid-January were in the infected group, giving a hospitalisation rate of 5.3% (95% CI = 2.4-9.8). Anosmia and ageusia had high positive predictive values for SARS-CoV-2 infection (84.7% and 88.1%, respectively). Smokers had a lower IAR compared to non-smokers (7.2% versus 28.0%, P <0.001). The proportion of infected individuals who had no symptoms during the study period was 17.0% (95% CI = 11.2-23.4). The proportion of donors with anti-SARS-CoV-2 antibodies in two nearby blood banks of the Oise department was 3.0% (95% CI = 1.1-6.4). Interpretation: The relatively low IAR observed in an area where SARS-CoV-2 actively circulated weeks before confinement measures indicates that establishing herd immunity will take time, and that lifting these measures in France will be long and complex.
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              Suppression of SARS-CoV-2 after a second wave in Victoria, Australia

              Abstract Countries around the world are experiencing a second wave of COVID-19 which is proving to be difficult to control. This report describes the combination of physical distancing, mandatory mask wearing, movement restrictions and enhanced test, trace and isolation efforts that can be used to successfully suppress community transmission to zero.
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                Author and article information

                Contributors
                kathleen.ryan@mcri.edu.au
                Journal
                Med J Aust
                Med J Aust
                10.5694/(ISSN)1326-5377
                MJA2
                The Medical Journal of Australia
                John Wiley and Sons Inc. (Hoboken )
                0025-729X
                1326-5377
                28 February 2021
                March 2021
                : 214
                : 4 ( doiID: 10.5694/mja2.v214.4 )
                : 189-189.e1
                Affiliations
                [ 1 ] Murdoch Children’s Research Institute Melbourne VIC
                [ 2 ] Alfred Health Melbourne VIC
                [ 3 ] Monash University Melbourne VIC
                [ 4 ] Royal Children’s Hospital Melbourne Melbourne VIC
                [ 5 ] University of Melbourne Melbourne VIC
                Author notes
                [*] [* ] Correspondence

                kathleen.ryan@ 123456mcri.edu.au

                Author information
                https://orcid.org/0000-0001-5892-4482
                Article
                MJA250936
                10.5694/mja2.50936
                8013862
                33641176
                18616072-0c58-4dff-9458-ecc041e23130
                © 2021 AMPCo Pty Ltd

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                Page count
                Figures: 0, Tables: 0, Pages: 2, Words: 711
                Categories
                Infectious Diseases
                Letters
                Research and Reviews
                Letters
                Custom metadata
                2.0
                March 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.1 mode:remove_FC converted:01.04.2021

                covid‐19,infectious diseases,respiratory tract infections

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