The role of children in the transmission chain of SARS-CoV-2: a systematic review and update of current evidence

  1. Jonathan E. Suk
  2. Constantine Vardavas
  3. Katerina Nikitara
  4. Revati Phalkey
  5. Jo Leonardi-Bee
  6. Anastasia Pharris
  7. Emma Wiltshire
  8. Tjede Funk
  9. Lisa Ferland
  10. Nick Bundle
  11. Jan C. Semenza

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Abstract

Decisions on school closures and on safe schooling during the COVID-19 pandemic should be evidence-based. We conducted a systematic literature review to assess child-to-child and child-to-adult SARS-CoV-2 transmission and to characterise the potential role of school closures on community transmission. 1337 peer-reviewed articles published through August 31, 2020 were screened; 22 were included in this review. The literature appraised provides sufficient evidence that children can both be infected by and transmit SARS-CoV-2 in community, household and school settings. Transmission by children was most frequently documented in household settings, while examples of children as index cases in school settings were rare. Included studies suggested that school closures may help to reduce SARS- CoV-2 transmission, but the societal, economic, and educational impacts of prolonged school closures must be considered. In-school mitigation measures, alongside continuous surveillance and assessment of emerging evidence, will promote the protection and educational attainment of students and support the educational workforce.

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  1. ScreenIT

    SciScore for 10.1101/2020.11.06.20227264: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    RandomizationAs a high measure of inter-rater agreement was achieved between the two reviewers during the pilot assessment (percentage agreement >90% and/ or Cohen’s Kappa >0.81), the remaining titles were randomly allocated to the two reviewers and screened for eligibility independently by them.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Relevant studies published between December 2019 and August 31, 2020 were identified by searching Medline and Embase.
    Medline
    suggested: (MEDLINE, RRID:SCR_002185)
    Embase
    suggested: (EMBASE, RRID:SCR_001650)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There are important limitations to this study that may impact the direct implications for decision-making. As we assessed peer-reviewed evidence published in two biomedical databases, it inherently reflects the status quo of the end of the previous school year (2019- 2020) due to the lag time between study implementation, peer review and publication. A further limitation of this report refers to the study designs, notably case series and case reports. Finally, the household studies that we assessed reflect a broad geographical and temporal range are limited in comparability due to varying factors such as: background levels of community SARS-CoV-2 transmission; enrolment strategies; household structures and social isolation practices within households; study testing rates; and varying physical distancing policies including school closures. Despite these limitations, the findings presented here provide an up-to-date assessment of the currently published peer-reviewed evidence. However, with an upsurge of cases in autumn 2020, the likelihood of introductions of SARS-CoV-2 into school settings increases. Continuous surveillance and assessment of the evidence is warranted to ensure the maximum protection of the health of students and the educational workforce. Where schools remain open, in-school mitigation measures, particularly for schools with older children, should be adopted and continually refined as new knowledge comes to light.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.11.06.20227264v1 on medRxiv