Friday, June 26, 2020

A Look at DESE's Cited Sources: Footnotes #1, #5, and #57 - What settings have been linked to SARS-CoV-2 transmission clusters?

DESE Claim 1 (footnote #1): “Furthermore, based on available data and effective implementation of critical health and safety practices, the rate of in-school transmissions has been low”

DESE Claim 2 (footnote #5): "Schools do not appear to have played a major role in COVID-19 transmission. In a review of COVID clusters, only 4% (8 of 210) involved school transmission."

DESE Claim 3 (footnote #57): "In a review of COVID-19 clusters, only 4% (8 of 210) involved school transmission."

Cited Source: Leclerc, Q. J., Fuller, N. M., Knight, L. E., Funk, S., Knight, G. M., & CMMID COVID-19 Working Group. (2020). What settings have been linked to SARS-CoV-2 transmission clusters?. Wellcome Open Research, 5(83), 83. Available at https://wellcomeopenresearch.org/articles/5-83/v2

Peer reviewed: one “invited peer reviewer” of updated article (no blind peer review as is standard in most journals)

Study methodology: “We performed a systematic review of available literature and media reports to find settings reported in peer reviewed articles and media with these characteristics. These sources are curated and made available in an editable online database.”. The study only looked at abstracts and articles published in English, which means omission of some clusters has likely occurred.

Notes: Virus is most likely (not exclusively) to be transmitted in hospital and elder care settings. It is important to note that many schools were closed during the period of the study, and three clusters linked to schools were found. “The vast majority of these clusters were associated with indoor or indoor/outdoor settings (21/22).” Schools, as largely indoor settings, could have outbreaks. The authors do not address the fact that schools were largely closed during the study period.

The school clusters, according to the linked data table in the article, had a wide range in the number of cases. “We found only a small number of clusters linked to schools (8/201), and there the SARS-CoV-2 cases reported were most often in teachers or other staff.“ The article notes that in two of the smaller clusters, 7/8 and 16/26 cases were staff. The article also references a French school cluster that included more children than staff.

The study does note that asymptomatic cases are likely underreported. “In many settings, only symptomatic cases of disease severe enough to require hospitalization are tested and ultimately reported. This misses those infections that result in mildly symptomatic or asymptomatic symptoms, although there is mounting evidence for a significant proportion of infections to remain asymptomatic .“ The authors do acknowledge that school data especially may not be complete. “Nor do we have universal screening for detection of all infections, many of which will be asymptomatic. The importance of such universal testing for infection in interpreting whether transmission has occurred in a setting is highlighted by the difference between the low number of clusters linked to schools and the high level of infection reported in one French high school study.”

DESE seems to have missed part of the article towards the end. “More generally, the role of children in widespread transmission of the virus is unclear, and whether reopening schools could trigger increased introductions of the virus into households and further within-household spread will have to be carefully monitored.” In other words, there needs to be more research.

DESE Claim 1 Supported?: No. The authors of the study make no claim about the risk of transmission in schools, only note that so far there have not been a ton of school clusters.

DESE Claim 2 Supported?: No. Limited open schools during the time of the study make the data unable to support or refute the initial claim. The second quoted sentence is true, for the limited dataset which the source works from. However, that doesn't prove that schools won't spread COVID-19 at full capacity when they're open.

DESE Claim 3 Supported?: Yes. However, schools were closed during many of the studies, so this data i not predictive. 

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