Transmission of SARS-CoV-2 in educational settings in 2020: a review

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Abstract

School closures have been used as a core non-pharmaceutical intervention (NPI) during the COVID-19 pandemic. This review aims at identifying SARS-CoV-2 transmission in educational settings during the first waves of the pandemic.

Methods

This literature review assessed studies published between December 2019 and 1 April 2021 in Medline and Embase, which included studies that assessed educational settings from approximately January 2020 to January 2021. The inclusion criteria were based on the PCC framework (P-Population, C-Concept, C-Context). The study Population was restricted to people 1–17 years old (excluding neonatal transmission), the Concept was to assess child-to-child and child-to-adult transmission, while the Context was to assess specifically educational setting transmission.

Results

Fifteen studies met inclusion criteria, ranging from daycare centres to high schools and summer camps, while eight studies assessed the re-opening of schools in the 2020–2021 school year. In principle, although there is sufficient evidence that children can both be infected by and transmit SARS-CoV-2 in school settings, the SAR remain relatively low—when NPI measures are implemented in parallel. Moreover, although the evidence was limited, there was an indication that younger children may have a lower SAR than adolescents.

Conclusions

Transmission in educational settings in 2020 was minimal—when NPI measures were implemented in parallel. However, with an upsurge of cases related to variants of concern, continuous surveillance and assessment of the evidence is warranted to ensure the maximum protection of the health of students and the educational workforce, while also minimising the numerous negative impacts that school closures may have on children.

Article activity feed

  1. SciScore for 10.1101/2021.10.13.21264932: (What is this?)

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

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot 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.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Relevant studies published between December 2019 and April 1, 2021 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 interim of the previous school years (January 2020 -January 2021) due to the lag time between study implementation, peer review and publication. A further limitation of this report refers to the fact that these studies represent child-to-child transmission within the context of previous SARS-CoV-2 strains and are not directly applicable to newer and more transmissible variants, such as the SARS-CoV-2 Delta (B.1.617.2) variant of concern. Finally, the included studies reflect a broad geographical and temporal range and are limited in comparability due to varying factors such as: background levels of community SARS-CoV-2 transmission; enrolment strategies and varying NPI policies which in turn depends highly on the geographical region and the socioeconomic context, while accountability to government and political stability were found to exert influence [51]. Hence in light of the above, supporting educators and parents in the implementation of NPIs is important as population based studies have indicated that adults concerned about the impact of COVID-19 on their children’s education were more likely to practice personal protective measures and social distancing [52].

    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.

    Results from scite Reference Check: We found no unreliable references.


    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.