A Look at DESE's Cited Sources: Footnote #12 and #67 - Characteristics of Household Transmission of COVID-19

DESE Claim 1 (footnote #12): "If exposed, children may be less likely to become infected with COVID-19. [...] In China, in households with COVID-19 exposure, children under the age of 18 were infected at a rate of 4% compared with 17% for adults."

DESE Claim 2 (footnote #67): "In China, in households with COVID-19 exposure, children under the age of 18 were infected at a rate of 4% compared with 17% for adults."

Cited Source: Wei Li, Bo Zhang, Jianhua Lu, Shihua Liu, Zhiqiang Chang, Cao Peng, Xinghua Liu, Peng Zhang, Yan Ling, Kaixiong Tao, Jianying Chen, Characteristics of Household Transmission of COVID-19, Clinical Infectious Diseases, , ciaa450, https://doi.org/10.1093/cid/ciaa450

Peer Reviewed?: yes

Study Methodology: Data collection and analysis from COVID-19 patients and their household contacts in China. Data included PCR testing, medical records analysis, and telephone interviews

Notes: The study looks at who within a household becomes infected with COVID-19 after an index case (family member) brings the virus into the home. The rate of secondary infection was 17% for adults and 4% for children in this study from the beginning of the pandemic in Wuhan. 

Supports DESE Claim 1?: Yes. Children may be less likely to get COVID-19. This does not indicate that schools are safe for adults, nor does it indicate that the infection rate within households would be similar to the infection rate in schools.

Supports DESE Claim 2?: Yes.

A Look at DESE's Cited Sources: Footnote #11 and #71 - Susceptibility to and transmission of COVID-19 amongst children and adolescents compared with adults: a systematic review and meta-analysis

DESE Claim 1 (footnote #11): "If exposed, children may be less likely to become infected with COVID-19. A meta-analysis of studies from several countries found that children were only 44% as likely as adults to become infected after exposure (note: pre-print study)."

DESE Claim 2 (footnote #71): "A meta-analysis of studies from several countries found that children were only 44% as likely as adults to become infected after exposure."

Cited Source: Viner, R. M., Mytton, O. T., Bonell, C., Melendez-Torres, G. J., Ward, J. L., Hudson, L., ... & Panovska-Griffiths, J. (2020). Susceptibility to and transmission of COVID-19 amongst children and adolescents compared with adults: a systematic review and meta-analysis. medRxiv. Available at https://www.medrxiv.org/content/10.1101/2020.05.20.20108126v1

Peer reviewed?: no, preprint

Study Methodology: Study meta-analysis "rapid systematic review of contact-tracing studies and population-screening studies"

Notes: This study examines 18 studies. "Studies were of predominantly low and medium quality." Children seemed to have less susceptibility to COVID-19 infection in the studies examined. However, they were more likely to be asymptomatic and the true infection rate likely isn't fully understood because of lack of testing for asymptomatic people who have not have known close contact with someone who has COVID-19.

"The role that children and young people play in transmission of SARS-CoV-2 by is dependent upon multiple factors, including their risk of exposure to potential infection, their probability of being infected upon exposure (susceptibility), the extent to which they develop symptoms upon infection or remain asymptomatic, the extent to which they develop a viral load sufficiently high to transmit and their propensity for making potentially infectious contact with others, dependent upon numbers of social contacts across age-groups and behaviour during those contacts."

One of the most important statements in the report is "Few studies have examined transmission in school settings." There are a lot of unknowns about COVID-19 transmission in schools. COVID-19 amongst children is important to understand, but so is the specific impact of schools on COVID-19 transmission among children and adults.

 

Supports DESE Claim 1?: Yes. Again, this does not predict adult safety in the school environment at all. Only one infected adult or child exposes a lot of people to COVID-19 in a school.

Supports DESE Claim 2? Yes

A Look at DESE's Cited Sources: Footnote #9 and #66: Massachusetts Coronavirus Data

DESE Claim 1 (footnote #9): "In general, rates of COVID-19 infection are lower for children than for adults. [...] In Massachusetts, children under the age of 19 were about four times less likely than the population at large to be diagnosed with COVID-19."

DESE Claim 2 (footnote #66): "In Massachusetts, children under the age of 19 were about four times less likely than the population at large to be diagnosed with COVID-19."

Cited Source: https://www.mass.gov/info-details/covid-19-response-reporting

Peer Reviewed?: no (government informational site)

Study Methodology: public health data release

Notes: Extensive data on Massachusetts COVID-19 data. The June 25 dashboard linked to the page indicates 5,715 cases of COVID-19 in Massachusetts children. The rate in children is 357 per 100,000, compared to 2,223.7 per 100,000 in adults (average of rates for 20-80+). This aligns with the four times likelihood claim. However, it is important to note schools in Massachusetts have been closed for the duration of the widespread pandemic in Massachusetts, meaning that most children have been isolated in small family groups at home.

Supports DESE Claim 1?: Yes. However, the DESE claim about lower infection rate for children does not indicate the safety of a school environment for adults. The infection rate in children being lower has also been during school closures in Massachusetts, which means many children may be in full isolation and this data may not indicate the infection rate that would occur when schools reopen.

Supports DESE Claim 2?: Yes.

A Look at DESE's Cited Sources: Footnote #8, #17, and #62 - Coronavirus Disease 2019 in Children — United States, February 12–April 2, 2020

DESE Claim 1 (footnote #8): "In general, rates of COVID-19 infection are lower for children than for adults. [...] Furthermore, although children under the age of 18 make up 22% of the U.S. population, they account for less than 2% of all cases of COVID-19."

DESE Claim 2 (footnote #17): "As the primary route of transmission for COVID-19 is respiratory"

DESE Claim 3 (footnote #62): "Although children under the age of 18 make up 22% of the U.S. population, they account for less than 2% of all cases of COVID-19.62"

Cited Source: 

Note: the same source is cited differently in the different footnotes. No explanation is provided for this inconsistency.

Footnote #8 and #62 citation: Coronavirus Disease 2019 in Children — United States, February 12–April 2, 2020. MMWR Morb Mortal Wkly Rep 2020;69:422–426. DOI: http://dx.doi.org/10.15585/mmwr.mm6914e4

Footnote #17 citation: CDC., et al. "Coronavirus Disease 2019 in Children—United States, February 12–April 2, 2020." Morbidity and Mortality Weekly Report 69.14 (2020): 422.

Peer reviewed?: unclear (government report from CDC)

Study Methodology: analysis of public health data

Notes: There seem to be fewer COVID-19 infections in children in the USA and China. Some cases of COVID-19 in children can be serious. "Whereas most COVID-19 cases in children are not severe, serious COVID-19 illness resulting in hospitalization still occurs in this age group." The report advocates social distancing and precautions for all ages, since children likely play a role in some transmissions.

Supports DESE Claim 1?: Yes. Again, rates of infection and transmission in children say absolutely nothing about the safety for adults in schools.

Supports DESE Claim 2?: Yes.

Supports DESE Claim 3?: Yes

A Look at DESE's Cited Sources: Footnote #7, #10, and #61 - Age-dependent effects in the transmission and control of COVID-19 epidemics

DESE Claim 1 (footnote #7): "In general, rates of COVID-19 infection are lower for children than for adults. Based on an analysis of data from six countries, children under 20 are half as susceptible to COVID-19 infection than adults."

DESE Claim 2 (footnote #10): "In general, rates of COVID-19 infection are lower for children than for adults. [...] Children are more likely to be asymptomatic, however, which underscores the importance of health behaviors for everyone (masks/face coverings, distancing, handwashing, surface cleaning).

DESE Claim 3 (footnote #61): "Based on data from six countries, children under 20 are half as susceptible to COVID-19 infection than adults."

Cited Source: Davies, N.G., Klepac, P., Liu, Y. et al. Age-dependent effects in the transmission and control of COVID-19 epidemics. Nat Med (2020). https://doi.org/10.1038/s41591-020-0962-9

Peer Reviewed?: not double-blind peer review (editor's name is listed)

Study Methodology: mathematical modeling and statistical analysis

Notes: Less cases of COVID-19 have been seen in children. "The distribution of confirmed COVID-19 cases has shown strong age dependence, with notably few cases in children. This could be because younger ages are less susceptible to infection and/or are less prone to showing clinical symptoms when infected." However, reported cases may not align with the number of children infected with SARS-CoV-2, the infection that causes COVID-19 "If infected children are less likely to show clinical symptoms, then the number of cases reported among children would be lower, but children with subclinical symptoms could still be capable of transmitting the virus to others, potentially at lower rates than fully symptomatic individuals, as has been shown for influenza." 

DESE Claim 1 Supported?: Yes. However, lower rates of COVID-19 in children does not account for the danger of adult to adult transmission in schools. The study does not speak to adult infections and transmission within schools. Lower rates do not mean no infections.

DESE Claim 2 Supported?: Yes. Again, childhood infection rates do not account for adult safety in schools. However, all the precautions suggested in the DESE document are supported by many other sources and public health recommendations.

DESE Claim 3 Supported?: Yes.

A Look at DESE's Cited Sources: Footnote #4 and #60 Cluster of coronavirus disease 2019 (Covid-19) in the French Alps, 2020

DESE Claim 1 (footnote #4): “Furthermore, based on available data and effective implementation of critical health and safety practices, the rate of in-school transmissions has been low” (same claim as #1-3)

DESE Claim 2 (footnote #60): "One infected student (9 years old) in the French Alps attended three schools while symptomatic; none of 112 contacts became infected."

Cited Source: Danis, K., Epaulard, O., Bénet, T., Gaymard, A., Campoy, S., Bothelo-Nevers, E., ... & Boudalaa, Z. (2020). Cluster of coronavirus disease 2019 (Covid-19) in the French Alps, 2020. Clinical Infectious Diseases. Available at https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa424/5819060

Peer Reviewed?: unclear

Study Methodology: case study with contact tracing

Notes: The sentence DESE likely latched on to about child transmission indicates that the one child who was infected at a resort in the French Alps did not pass the disease on to many others. "The fact that an infected child did not transmit the disease despite close interactions within schools suggests potential different transmission dynamics in children." That is a huge conclusion to attempt to draw from one case, especially since the child in question had other diseases at the same time. A single child not spreading a disease does not mean children in general do not spread the disease. The study also notes, "It is also possible that the very low viral load of the pediatric case and the subsequent lack of transmission might be related to his coinfection and the co-circulation of respiratory viruses." A child who has just COVID-19 may spread the virus differently than one who also has other infections. 

DESE Claim 1 Supported?: extremely limited (1 case does not make a rule).

DESE Claim 2 Supported?: Yes

A Look at DESE's Cited Sources: Footnotes #3, #6, and #59 - COVID-19 in schools – the experience in NSW

DESE Claim 1 (footnote #3): “Furthermore, based on available data and effective implementation of critical health and safety practices, the rate of in-school transmissions has been low” (same claim as #1-2, 4)

DESE Claim 2 (footnote #6): "Schools do not appear to have played a major role in COVID-19 transmission. [...] In a case study from New South Wales Australia, after 18 cases were found in schools (12 in high schools and 6 in primary schools), only 0.3% of student contacts were infected (1 in 695 individuals in 10 high schools and 1 in 168 individuals in primary schools). No teachers or staff were infected."

DESE Claim 3 (footnote #59): "In a case study from New South Wales Australia, after 18 cases were found in schools (12 in high schools and 6 in primary schools), only 0.3% of student contacts were infected (1 in 695 individuals in 10 high schools and 1 in 168 individuals in primary schools). No teachers or staff were infected."

Cited Source: National Centre for Immunisation Research and Surveillance (NCIRS) (2020). COVID-19 in schools – the experience in NSW. Available at http://ncirs.org.au/sites/default/files/2020-04/NCIRS%20NSW%20Schools%20COVID_Summary_FINAL%20public_26%20April%202020.pdf

Peer Reviewed?: No - government report, peer review for publication in process

Study Methodology:  case study with contact tracing follow-up

Notes: Report involves 18 cases of COVID-19 in 15 schools and their close contacts. Again, a small sample size. "No teacher or staff member contracted COVID-19 from any of the initial school cases. One child from a primary school and one child from a high school may have contracted COVID-19 from the initial cases at their schools."

This Australian report's definition of close contact is different than the one I've seen being used most in the USA (the report calls 2 hours in the same room or 15 minutes face to face close contact, most in the USA say only the latter). Additionally, close contact isolation protocols were used: "Once the close contacts are identified, they are required to isolate themselves at home for 14 days from the date of last exposure to the infectious case, watch for any symptoms and if they become unwell, go to the doctor or a fever clinic to get a nose/throat swab to test for COVID-19". Notably, 12 of the 18 cases were in high schools.

Schools during this study were likely at lower occupancy than usual. "on 23 March 2020 the NSW Premier advised that although schools remained open, parents were encouraged to keep their children at home for online learning." This is critical, since MA is looking at a full-capacity reopen, without urging parents to keep children home to learn online. 

DESE Claim 1 Supported?: Extremely limited - low number of cases studied, and in schools functioning at less than full-capacity 

DESE Claim 2 Supported?: Again, extremely limited support. Low number of cases studied, and schools were not at full capacity during the study (parents encouraged to keep kids home).

DESE Claim 3 Supported?: Yes.