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Urgent need to develop evidence-based COVID-19 recommendations for primary schools
  1. Sanjay Patel1,2,
  2. Cristina Epalza Ibarrondo3,
  3. Julie Toubiana4,
  4. Dimitri Van der Linden5,6
  1. 1 Department of Paediatric Immunology & Infectious Diseases, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  2. 2 NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  3. 3 Pediatric Infectious Diseases Unit, Department of Pediatrics. Pediatric Research and Clinical Trials Unit (UPIC), Translational Research Network in Pediatric Infectious Diseases (RITIP), Hospital Universitario 12 de Octubre, Madrid, Spain
  4. 4 Department of General Pediatrics and Pediatric Infectious Diseases, Necker-Enfants Malades Hospitals, Paris, Île-de-France, France
  5. 5 Pediatric Infectious Diseases, General Pediatrics, Pediatric Department, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
  6. 6 Institut de Recherche Expérimentale et Clinique (IREC), UCLouvain Saint-Louis Bruxelles, Bruxelles, Belgium
  1. Correspondence to Dr Sanjay Patel, Department of Paediatric Immunology & Infectious Diseases, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; sanjayvp99{at}

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Much has been learnt about the epidemiology of SARS-CoV-2 since December 2019. Children are not superspreaders of SARS-CoV-2.1 They appear to have far lower rates of infection and lower rates of transmission compared with adults, especially young children below 10–14 years of age.2–4 However, many of these data need to be interpreted with caution because they were collected early in the pandemic, when children had limited exposure to SARS-CoV-2 due to the introduction of national lockdowns and closure of schools. Encouragingly, more recent data collected following the reopening of schools in September suggest that rates of SARS-CoV-2 in children remain low compared with adults, even in areas with increasingly high prevalence (figure 1).

Figure 1

COVID-19 positive case heat maps by age group and region – England data. Provided by public health England outbreak surveillance team.

Schools in most countries across Europe were closed in March 2020 at the start of the COVID-19 pandemic. However, it is now recognised that the negative impact on children from not attending school far outweighed any benefits in terms of reducing transmission of SARS-CoV-2 at population level.5 Not only does missed schooling impact on the long-term educational prospects, it also exposes children to significant harm in terms of safeguarding and abuse,6 emotional and psychological health7 and child poverty. For these reasons, despite most countries across Europe deciding to close schools at the start of the pandemic, there was a huge appetite for reopening them …

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  • Twitter @doctorsanjay

  • Contributors SP conceived the paper. SP wrote the first draft of the manuscript, and SP, CEI, JT and DVdL all edited and agreed on the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.