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Children are not COVID-19 super spreaders: time to go back to school
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  • Published on:
    In support of safe hospital care of children and staff during the Covid-19 Pandemic
    • Terence W. Prendiville, Paediatric Cardiologist Children's Hospital Ireland at Crumlin
    • Other Contributors:
      • Niall Linnane, Paediatric Cardiology SpR
      • Jennie Ryan, Paediatric cardiology Advanced Nurse Practitioner

    Since the introduction of the national delay phase response to Covid-19 Coronavirus in the republic of Ireland on March 12th and subsequent advise to stay at home from March 27th, essential paediatric cardiac services have had to continue in a limited capacity.
    In that time, our national tertiary referral centre has seen 428 children in the out-patient's setting, 223 on the cardiac day ward, and performed an intervention (cardiac surgery or cardiac catheterization) in 140 cases. This includes 41 cardiac by-pass cases, 22 non-bypass cases, 49 interventional cardiac catheterization cases and 6 hybrid procedures involving both the cardiac surgery and cardiac catheterization teams.
    Of the 49 patients screened pre-operatively, not one positive (and asymptomatic) case was identified.
    Adhering to government advice on social distancing and appropriate PPE where indicated, not a single member of the extended medical team has been known to cntract Covid-19 Coronavirus from contact with patients or their families in this time.
    This anecdotal case experience from one institution supports the proposal to allow children to return to school regardless of comorbidities, in recognition of the considerable long-term educational and social harm that exclusion would result in.

    Conflict of Interest:
    None declared.
  • Published on:
    Time to go back to school: several good reasons beyond low infection risk
    • Federico Marchetti, Director, Pediatrician Department of Paediatrics, Santa Maria delle Croci Hospital, Ravenna, Italy
    • Other Contributors:
      • Giorgio Tamburlini, Director

    Munro APS &  Faust SL, in their viewpoint (1) quite correctly build on the evidence of low risk of contagion and rare complications of Covid-19 infection among children to call for reopening of schools. There are, however, several other good reasons to be considered.

    First, as all international agencies have highlighted, prolonged closure yields serious consequences for all children and particularly for those already living in difficult circumstances, such as extreme poverty, disability, or violent environments (2,3). UNESCO estimates that at least 177 countries have instituted school closures at national level and several other countries have established closings at regional or local level (4). With over 90% of students worldwide (more than 1.5 billion young people) currently out of the educational context, it is clear that the greatest threats from Covid-19 to children and adolescents are to be found in educational loss, poorer nutrition, increased exposure to intrafamiliar violence, rising incidence of mental health disorders and lack of physical activity rather than in the clinical consequences of Covid-19 infection (4-8). Inequality in education and health will increase dramatically as consequences are inevitably greater for vulnerable children due to social, material and educational poverty, disability and chronic diseases, special educational needs, and lack of access to distance learning technologies (1). The risk of dangerous habits, such as increasing...

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    Conflict of Interest:
    None declared.
  • Published on:
    Children are being kept at home to protect the elderly from COVID-19
    • Sunil S Bhopal, NIHR Academic Clinical Lecturer in Population Health Paediatrics, Newcastle University & Honorary Assistant Professor, LSHTM Newcastle University
    • Other Contributors:
      • Jayashree Bagaria, Public Health Practitioner
      • Raj Bhopal, Emeritus Professor of Public Health

    Munro and Faust call for children to return to school despite the outstanding clinical and epidemiological questions outlined in their Viewpoint “Children are not COVID-19 super spreaders: time to go back to school”[1]. We think that their core argument – that children are minimally infected with SARS-CoV2, that they spread it less than adults, and that even children with comorbidities are relatively spared the most serious effects of COVID-19 – can be augmented with the question “is it ethical to confine children to the home for the protection of the elderly?”.

    In England, 11 COVID-19 deaths were reported in 0-19 year olds up to 5 May 2020[2]. For the same period in Germany this number is three[3], and in France five[4]. During that time, the Global Burden of Disease study estimates that in each of those countries, over a thousand 0-19 year olds died from all-causes, including several hundred from road traffic injury and tens from pneumonia[5].

    We do not keep children at home to protect them from these causes of death, so why are we doing this for COVID-19? We think the public, especially parents, need to understand that this is being done mainly for the benefit of adults (and especially the elderly and other vulnerable groups). This is a societal choice with immediate and potentially life-long consequences which needs careful evaluation of risks and benefits. While scientific evaluation takes place and will take time, the communication of our decision clea...

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    Conflict of Interest:
    None declared.