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Home » kindontwikkeling » Onderzoeksliteratuur kinderen, scholen en covid-19: een jaar later

Onderzoeksliteratuur kinderen, scholen en covid-19: een jaar later

“Our perception of risk and prevalence is driven by stories, events, anecdotes, rather than data” – Steven Pinker

“If you succeed [in school], your life will be good. If you fail, your life is going to be much worse. You’re going to live shorter. You’re going to be poorer. That, of course, is in the back of your head when you start talking about closing schools” – Anders Tegnell

Hoewel niet evidence-based als interventie zijn wereldwijd in de meeste landen de scholen gesloten tijdens de pandemie. In Nederland sloten de scholen voor het eerst sinds de Tweede Wereldoorlog, eerst op 16 maart 2020 en op 15 december van datzelfde jaar opnieuw. Data en onderzoek wijzen vanaf het begin in dezelfde richting: kinderen en scholen spelen een beperkte rol.

Lewis, S.J.J., Munro, A.P.S., Smith, G.D., Pollock, A.M. (2021). Closing schools is not evidence based and harms children. The British Medical Journal, 23 Februari

“School closures have been implemented internationally with insufficient evidence for their role in minimising covid-19 transmission and insufficient consideration of the harms to children. (..) The UN convention on the rights of the child and the duty on the government to respect, protect and fulfil those rights have largely been overlooked.(..) In the absence of strong evidence for benefits of school closures, the precautionary principle would be to keep schools open to prevent catastrophic harms to children”

“accumulating evidence shows that teachers and school staff are not at higher risk of hospital admission or death from covid-19 compared with other workers”

Een overzicht

Inmiddels zijn er wereldwijd vele studies verschenen rond kinderen, scholen en covid-19. Een aantal studies op een rij (update: 7 september):


01. Fenton, L., Gribben, C., Caldwell, D., Colville, S., et al. (2021) Risk of hospital admission with covid-19 among teachers compared with healthcare workers and other adults of working age in Scotland, March 2020 to July 2021: population based case-control study. The British Medical Journal, 2 september

“Conclusion: Compared with adults of working age who are otherwise similar, teachers and their household members were not found to be at increased risk of hospital admission with covid-19 and were found to be at lower risk of severe covid-19. These findings should reassure those who are engaged in face-to-face teaching” .

Commentaar BMJ: “Teachers and their household members were not at increased risk of hospital admission with covid-19 at any time during the 2020-21 academic year compared with similar working age adults, including during periods when schools were fully open, study finds”

02. Galow, L., Haag, L., Kahre, E., et al. (2021) Lower household transmission rates of SARS-CoV-2 from children compared to adults. Journal of Infection, 27 april

“the low rate of underage index cases and their lower SAR compared to adult index cases is consistent with previous studies. This supports existing evidence that children are not only less likely to develop severe disease courses but also are less susceptible and less likely to transmit SARS-CoV-2”

03. Bravata, D., Cantor, J.H., Sood, N., & Whaley, C.M. (2021) Back to School: The Effect of School Visits During COVID-19 on COVID-19 Transmission. National Bureau of Economic Research, april

“We find that increases in county-level in-person visits to schools lead to an increase in COVID-19 diagnoses among households with children relative to households without school-age children. However, the effects are small in magnitude. A move from the 25th to the 75th percentile of county-level school visits translates to a 0.3 per 10,000 household increase in COVID-19 diagnoses. This change translates to a 3.2 percent relative increase”

Voor een toelichting van deze studie: interview met twee van de auteurs Chris Whaley Neeraj Sood – The Trade-off of Schools – New NBER paper

04. Mulligan, C.B. (2021) The Incidence and Magnitude of the Health Costs of In-person Schooling during the COVID-19 Pandemic. National Bureau of Economic Research, maart

“Students and teachers at in-person school during 2020 were about 20 times more likely to be infected outside school than in school. (..) To put it another way, the fatality risk to self and living partners, which may include an elderly person, for one day taught in-person by the average nonelderly teacher is similar to the risk of driving 16 miles alone in a car. For the modal teacher, the equivalent is five miles”

05. Soriano-Arandes, A., Gatell, A.,  Serrano, P., et al. (2021) Household SARS-CoV-2 transmission and children: a network prospective study. Clinical Infectious Diseases, 12 maart

“Children are unlikely to cause household COVID-19 clusters or be major drivers of the pandemic even if attending school. Interventions aimed at children are expected to have a small impact on reducing SARS-CoV-2 transmission”

06. Forbes, H., Morton, C.E., Bacon, S., et al. (2021) Association between living with children and outcomes from covid-19: OpenSAFELY cohort study of 12 million adults in England. The British Medical Journal, 7 maart

“In contrast to wave 1, evidence existed of increased risk of reported SARS-CoV-2 infection and covid-19 outcomes among adults living with children during wave 2. However, this did not translate into a materially increased risk of covid-19 mortality, and absolute increases in risk were small”


School photo created by freepik – www.freepik.com


07. Wood, R., Thomson, E., Galbraith, R., et al. (2021) Sharing a household with children and risk of COVID-19: a study of over 300 000 adults living in healthcare worker households in Scotland. The British Medical Journal, 17 februari

“In our large cohort, adults with young children were at lower risk of testing positive for SARS-CoV-2 and possibly also of developing COVID-19 requiring hospitalisation. Adults living with young children were not at increased risk of COVID-19, including during August–October 2020 when nurseries and schools were open for all children”

08. Ingelbeen, B., Peckeu, L., Laga, M., et al. (2021) Reducing contacts to stop SARS-CoV-2 transmission during the second pandemic wave in Brussels, Belgium. Eurosurveillance, 18 februari

“Our findings confirm transmission among and from teenagers, with intergenerational transmission apparent following school opening. Nonetheless, their relative role was limited: transmission events from 10–19-year-olds to other age groups remained fewer than those from adults, and the proportion of cases among 10–19-year-olds did not significantly change after school reopening”

09. Folkhälsomyndigheten (2021) Covid-19 most common among health care groups. Onderzoek Zweedse gezondheidsautoriteiten naar beroepsgroepen en risico op infectie covid-19, 11 februari

“When it comes to school staff, according to the report, they generally do not have a higher risk of infection than people in other occupational groups who have contact with many people, for example service professions. They also have no increased risk of developing serious disease with covid-19”

10. Dattner, I., Goldberg, Y., Katriel, G., et al.  (2021) The role of children in the spread of COVID-19: Using household data from Bnei Brak, Israel, to estimate the relative susceptibility and infectivity of children. PLOS Computational Biology, 11 februari

“We estimate that the susceptibility of children (under 20 years old) is 43% (95% CI: [31%, 55%]) of the susceptibility of adults. The infectivity of children was estimated to be 63% (95% CI: [37%, 88%]) relative to that of adults”

11. Brookman, S., Cook, J., Zucherman, M., et al. (2021) Effect of the new SARS-CoV-2 variant B.1.1.7 on children and young people. The Lancet Child & Adolescent Health, 10 februari

“Importantly, we have found no evidence of more severe disease in children and young people during the second wave, indicating that infection with the B.1.1.7 variant does not result in an appreciably different clinical course to the original strain. These findings are in keeping with early national data. Severe acute respiratory COVID-19 remains an uncommon occurrence in children and young people”

12. Zimmerman, K., Akinboyo, I., Brookheart, M., et al. (2021) Incidence and Secondary Transmission of SARS-CoV-2 Infections in Schools. Pediatrics, 1 februari             

“Over 9 weeks, 11 participating school districts had >90 000 students and staff attend school in person. Among these students and staff, 773 community-acquired SARS-CoV-2 infections were documented by molecular testing. Through contact tracing, health department staff determined an additional 32 infections were acquired within schools. No instances of child-to-adult transmission of SARS-CoV-2 were reported within schools. CONCLUSIONS: In the first 9 weeks of in-person instruction in North Carolina schools, we found extremely limited within-school secondary transmission of SARS-CoV-2, as determined by contact tracing”

Bron: https://www.nature.com/articles/d41586-021-01826-x

13. RIVM, niet gepubliceerde studie (2021). Kinderen, school en COVID-19. Website RIVM (bijgewerkt: 25 februari)

“Vanaf 31 augustus 2020 tot en met 10 januari 2021 zijn ruim 390.000 mensen die werkzaam zijn in het onderwijs of kinderopvang getest. Van deze testen was 9% positief. Dit percentage is lager dan het totaal van 14% bij de ruim 3,7 miljoen volwassenen getest in de teststraten in deze periode”

14. The British Medical Journal (2021) Webinar Covid-19 and schools – known unknowns. BMJ, 28 januari

“Findings [from Scotland] have been reassuring for teachers, as there is now “strong evidence” that teachers are at a similar or lower risk of severe illness or dying from covid-19, than the general working age population, “and that finding persists when schools are open” 

15. Office for National Statistics (2021) Coronavirus (COVID-19) related deaths by occupation, England and Wales: deaths registered between 9 March and 28 December 2020. ONS, 25 januari

Deze studie in de media: Schraer, R. (2021) Covid: Teachers ‘not at higher risk’ of death than average. BBC Health, 25 januari

“Rates of death involving COVID-19 in men and women who worked as teaching and educational professionals, such as secondary school teachers, were not statistically significantly raised when compared with the rates seen in the population among those of the same age and sex”

16. O’Leary, S.T. (2021) To Spread or Not to Spread SARS-CoV-2—Is That the Question? JAMA Pediatrics, 22 januari

“With this large seroprevalence study demonstrating yet again what we have suspected for several months, the answer to that question could not be clearer: we must prioritize the reopening of childcare facilities and elementary schools to full time, in-person learning without exception”

17. Tönshoff  B, Müller B., Elling R, et al. (2021) Prevalence of SARS-CoV-2 infection in children and their parents in southwest Germany. JAMA Pediatrics, januari 22

“The low seroprevalence of SARS-CoV-2 antibodies in young children in this study may indicate that they do not play a key role in SARS-CoV-2 spreading during the current pandemic”

18. Somekh, I., Shohat, T., Keinan-Boker, L., et al. (2021). Reopening Schools and the Dynamics of SARS-CoV-2 Infections in Israel: A Nationwide Study. Clinical Infectious Diseases, 18 januari

“This analysis does not support a major role of school reopening in the resurgence of the COVID-19 curve in Israel. Easing restrictions on large scale gatherings was the major influence on this resurgence”

19. Centers for Disease Prevention and Control (2021) COVID-19 Trends Among Persons Aged 0–24 Years — United States, March 1–December 12, 2020. CDC, 13 januari

“As of December 7, nearly two thirds (62.0%) of U.S. kindergarten through grade 12 (K–12) school districts offered either full or partial (hybrid with virtual) in-person learning. Despite this level of in-person learning, reports to CDC of outbreaks within K–12 schools have been limited, and as of the week beginning December 6, aggregate COVID-19 incidence among the general population in counties where K–12 schools offer in-person education (401.2 per 100,000) was similar to that in counties offering only virtual/online education (418.2 per 100,000)”

Deze studie in de media: Cortez, M.F. (2021) Covid-19 Outbreaks Aren’t Driven by In-Person Classes, CDC Says. Bloomberg, 13 januari

20. Brandal, L.T., Ofitserova, T.S. Meijerink, H., et al. (2021) Minimal transmission of SARS-CoV-2 from paediatric COVID-19 cases in primary schools, Norway, August to November 2020. Eurosurveillance, 7 januari

“This prospective study shows that transmission of SARS-CoV-2 from children under 14 years of age was minimal in primary schools in Oslo and Viken, the two Norwegian counties with the highest COVID-19 incidence and in which 35% of the Norwegian population resides”

“We prospectively examined transmission of SARS-CoV-2 from confirmed paediatric cases in Norwegian primary schools between August and November 2020. All in-school contacts were systematically tested twice during their quarantine period. With preventive measures implemented in schools (strengthened hygiene measures, physical distancing and a clear message to stay home if symptomatic, even with mild symptoms. Use of face masks is not recommended in schools in Norway), we found minimal child-to-child (0.9%, 2/234) and child-to-adult (1.7%, 1/58) transmission, supporting that under 14 year olds are not the drivers of SARS-CoV-2 transmission”

21. Ludvigsson, J.F., Engerström, L., Nordenhäll, C., Larsson, E. (2021) Open Schools, Covid-19, and Child and Teacher Morbidity in Sweden. The New England Journal of Medicine, 6 januari

“Despite Sweden’s having kept schools and preschools open, we found a low incidence of severe Covid-19 among schoolchildren and children of preschool age during the SARS-CoV-2 pandemic. Among the 1.95 million children who were 1 to 16 years of age, 15 children had Covid-19, MIS-C, or both conditions and were admitted to an ICU, which is equal to 1 child in 130,000”

Persbericht: Low risk of severe COVID-19 in children. Karolinska Institutet, 6 januari


2020

22. Ulyte, A., Radtke, T., Abela, I., A., et al. (2020) Clustering and longitudinal change in SARS-CoV-2 seroprevalence in 2 school-children: prospective cohort study of 55 schools in Switzerland. medRxiv, 22 december

“Under a regimen of open schools with some preventive measures in place since August, clustering of seropositive cases occurred in very few classes and not across entire schools despite a clear increase in seropositive children during a period of high 68 transmission of SARS-CoV-2”

23. European Centre for Disease Prevention and Control (2020) COVID-19 in children and the role of school settings in transmission – first update. ECDC, 23 december

“There is a general consensus that the decision to close schools to control the COVID-19 pandemic should be used as a last resort. The negative physical, mental health and educational impact of proactive school closures on children, as well as the economic impact on society more broadly, would likely outweigh the benefits.(..) Educational staff and adults within the school setting are generally not seen to be at a higher risk of infection than other occupations”

24. Prahley, L. (2020) Exclusive: Kids catch and spread coronavirus half as much as adults, Iceland study confirms. National Geographic, 10 december

“This 40,000-person study found that children under 15 were about half as likely as adults to be infected, and only half as likely as adults to transmit the virus to others. Almost all the coronavirus transmissions to children came from adults”

25. Larosa, E., Djuric, O., Cassinadri, M., et al. (2020). Secondary transmission of COVID-19 in preschool and school settings in northern Italy after their reopening in September 2020: a population-based study. Eurosurveillance, 10 december

“Transmission within the schools of Reggio Emilia province, northern Italy, occurred in a non-negligible number of cases, particularly in the age group 10–18 years, i.e. in middle and high schools, while no secondary cases were detected in pre-school children, only one case in primary school and no secondary cases among teachers and staff”

26. Ismail, S.A., Saliba, C., Bernal, J.L., et al. (2020) SARS-CoV-2 infection and transmission in educational settings: a prospective, cross-sectional analysis of infection clusters and outbreaks in England. The Lancet Infectious diseases, 8 december

“SARS-CoV-2 infections and outbreaks were uncommon in educational settings during the summer half-term in England. The strong association with regional COVID-19 incidence emphasises the importance of controlling community transmission to protect educational settings. Interventions should focus on reducing transmission in and among staff”

27. Bismarck-Osten, C. von., Borusyak,K., Schönberg., U. (2020) The Role of Schools in Transmission of the SARS-CoV-2 Virus: Quasi-Experimental Evidence from Germany.  Centre for Research and Analysis of Migration Department of Economics – University College London, 20 november

“Leveraging a difference-in-differences design with staggered adoption, we show that neither the summer closures nor the closures in the fall have had any significant containing effect on the spread of SARS-CoV-2 among children or any spill-over effect on older generations. We also do not find any evidence that the return to school at full capacity after the summer holidays increased infections among children or adults. Instead, we find the number of children infected increased during the last weeks of the summer holiday and decreased in the first weeks after schools reopen”

28. Christakis, D., et al. (2020) Estimation of US Children’s Educational Attainment and Years of Life Lost Associated With Primary School Closures During the Coronavirus Disease 2019 Pandemic.  JAMA, 12 november

“These findings suggest that the decision to close US public primary schools in the early months of 2020 may be associated with a decrease in life expectancy for US children”

29. Viner, R.M., Mytton, O.T., is Bonell, C. (2020) Susceptibility to and transmission of COVID-19 amongst children and adolescents compared with adults: a systematic review and meta-analysis. JAMA, 25 september 

“In this meta-analysis, there is preliminary evidence that children and adolescents have lower susceptibility to SARS-CoV-2, with an odds ratio of 0.56 for being an infected contact compared with adults. There is weak evidence that children and adolescents play a lesser role than adults in transmission of SARS-CoV-2 at a population level. This study provides no information on the infectivity of children”

30. Ludvigsson, J.F. (2020) The first eight months of Sweden’s COVID‐19 strategy and the key actions and actors that were involved. Acta Paediatrica, 20 september

“Sweden’s response was less invasive than many other countries, with no general lockdown. It focused on mitigation: slowing, but not stopping, the pandemic. Physical distancing was recommended in public spaces, but mandatory in bars, restaurants and at events. Visits to nursing facilities were banned. Kindergartens and schools for children up to 16 stayed open, but closed for older children for three months. There were no enforced quarantines for infected households or geographical regions, and facemasks were not recommended outside health care”

31. Ehrhardt J, Ekinci A, Krehl H., et al. (2020). Transmission of SARS-CoV-2 in children aged 0 to 19 years in childcare facilities and schools after their reopening in May 2020, Baden-Württemberg, Germany. Eus Surveillance, 10 september

“Our investigation suggests that child-to-child transmission in schools and childcare facilities is uncommon and not the primary cause of SARS-CoV-2 infection in children”

32. Japan’s Ministry of Education, Culture, Sports, Science and Technology (2020) Education in Japan beyond the crisis of COVID-19 -Leave No One Behind. MEXT, september

‘In the period from June 1, when schools began to fully reopen, to July 31, 242 out of 12 million students in 35,874 schools were reported to have been infected”

33. Macartney, K., Quinn, H.E., Pillsbury, E.J., et al. (2020) Transmission of SARS-CoV-2 in Australian educational settings: a prospective cohort study. The Lancet Child and Adolescent Health, 3 augustus

“SARS-CoV-2 transmission rates were low in NSW educational settings during the first COVID-19 epidemic wave, consistent with mild infrequent disease in the 1·8 million child population. With effective case-contact testing and epidemic management strategies and associated small numbers of attendances while infected, children and teachers did not contribute significantly to COVID-19 transmission via attendance in educational settings”

34. Folkhälsomyndigheten (2020) Covid-19 in schoolchildren – A comparison between Finland and Sweden. Zweedse gezondheidsautoriteiten, 7 juli

“In conclusion, closure or not of schools has had little if any impact on the number of laboratory confirmed cases in school aged children in Finland and Sweden”

35. Lavezzo, E. Franchin, C. Ciavarella, G., et al. (2020). Suppression of a SARS-CoV-2 outbreak in the Italian municipality of Vo. Nature, 30 juni (updated 15 januari 2021)

“Recent studies have found that the clinical progression of infection in children is generally milder than in adults. We found that none of the children under 10 years of age who took part in the study tested positive for SARS-CoV-2 infection at either survey, despite at least 13 of them living together with infected family members. This agrees with a recent study conducted in Iceland and is particularly intriguing given the very high observed odds ratio for adults to become infected when living together with family members who are positive for SARS-CoV-2”

36. Yung CF, Kam KQ, Nadua KD, Chong CY, Tan NWH, Li J, et al. (2020). Novel coronavirus 2019 transmission risk in educational settings. Clinical Infectious Diseases, 25 juni

“Our investigations, especially in preschools, could not detect SARS-CoV-2 transmission despite screening of symptomatic and asymptomatic children. The data suggest that children are not the primary drivers of SARS-CoV-2 transmission in schools and could help inform exit strategies for lifting of lockdowns”

37. Gudbjartsson, D.F., Helgason, A., Jonsson, H., et al. (2020). Spread of SARS-CoV-2 in the Icelandic Population. The New England Journal of Medicine, 11 juni

“In a population-based study in Iceland, children under 10 years of age and females had a lower incidence of SARS-CoV-2 infection than adolescents or adults and males”

38. Heavey, L., Casey, G., Kelly.,  C, Kelly,  D.,  McDarby, G. (2020). No evidence of secondary transmission of COVID-19 from children attending school in Ireland, 2020. Eurosurveillance, 28 mei

“The results moreover echo the experience of other countries, where children are not emerging as considerable drivers of transmission of COVID-19. (…) These findings suggest that schools are not a high risk setting for transmission of COVID-19 between pupils or between staff and pupils”

39. Ludvigsson, J.F. Children are unlikely to be the main drivers of the COVID‐19 pandemic – a systematic review. Acta Paediatrica, 19 mei

“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”

40. Munro, A.P.S., Saul, N. (2020) Children are not COVID-19 super spreaders: time to go back to school. The British Medical Journal, 5 mei

“At the current time, children do not appear to be super spreaders. (..) Governments worldwide should allow all children back to school regardless of comorbidities”

41. Thors, V., S. (2020) Iceland’s data on the infectivity of children cross-infection risk. European Association of Paediatrics, april

“Furthermore, we could also deduct that none of the 1800 cases were infected by a child < 10 years of age whereas infections from adults to children were quite common. With this knowledge in mind, there has been no closure of schools nor day-care centres although they have been running on a limited power also due to staff issues”

Studies naar het effect van schoolsluitingen

  1. Walsh S, Chowdhury A, Russell S, et al. (2021) Do school closures reduce community transmission of COVID-19? A systematic review of observational studies. medRxiv, 4 januari

“Three studies, including the two at lowest risk of bias, reported no impact of school closures on SARS-CoV-2 transmission; whilst the other seven reported protective effects. Effect sizes ranged from no association to substantial and important reductions in community transmission”

2. Haug, N., Geyrhofer, L., Londei, A., et al. (2020) Ranking the effectiveness of worldwide COVID-19 government interventions. Nature Human Behaviour, 16 november

“We showed that the most effective measures include closing and restricting most places where people gather in smaller or larger numbers for extended periods of time (businesses, bars, schools and so on). However, we also find several highly effective measures that are less intrusive”

NB: Er is geen onderzoek gedaan naar ‘schoolsluitingen’. Dat alle onderwijsinstellingen (inclusief universiteiten) onder één noemer gebracht worden is een beperking van deze studie.

Algemene kritiek: “International modelling studies which estimate that school closures have a meaningful effect on reducing transmission rates are all confounded by the near simultaneous introduction of multiple interventions (including lockdowns, curfews, closures of bars and restaurants). Moreover, they do not account for indirect effects of school closures which prevent parents from working outside the home” – Alisdair Munroe, kinderarts en Clinical Research Fellow Paediatric Infectious Diseases – University Hospital Southampton


Voor een uitgebreid literatuuroverzicht kinderen en covid-19, en regelmatige updates, ism UK Royal College of Paediatrics and Child Health:

Boast, A., Munro, A., Goldstein, H., et al. (2020, 2021) An evidence summary of Paediatric COVID-19 literature.


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