An Evidence Base for School Health Policy during the COVID-19 Pandemic
Objective: Children represent a small fraction of confirmed COVID-19 cases, with a low case fatality rate (CFR). In this paper, we lay out an evidence-based policy for reopening schools. Methods: We gathered age-specific COVID-19 case counts and identified mortality data
for 14 countries. Dose-response meta-analysis was used to examine the relationship of the incremental case fatality rate (CFR) to age. In addition, an evidence-to-decision framework (EtD) was used to correlate the dose-response data with other epidemiological characteristics of COVID-19 in
childhood. Results: In the dose-response analysis, we found that there was an almost negligible fatality below age 18. CFR rose little between ages 5 to 50 years. The confidence intervals were narrow, suggesting relative homogeneity across countries. Further data suggested decreased
child-hood transmission from respiratory droplets and a low viral load among children. Conclusions: Opening up schools and kindergartens is unlikely to impact COVID-19 case or mortality rates in both the child and adult populations. We outline a robust plan for schools that recommends
that general principles not be micromanaged, with authority left to schools and monitored by public health authorities.
Keywords: ADOLESCENT HEALTH; CHILD & CHILD TRANSMISSION; COMMUNICABLE DISEASE; CORONAVIRUS; COVID-19; SARS-COV-2; SCHOOL REOPENING POLICY
Document Type: Research Article
Publication date: 01 January 2021
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