COVID‐19 in children and the effect of schools reopening on potential transmission to household members

Shapiro Ben David, Shirley; Rahamim‐Cohen, Daniella; Tasher, Diana; Geva, Adi; Azuri, Joseph; Ash, Nachman

AIM: The effect of reopening schools on children's contribution to SARS‐CoV‐2 transmission, especially within households, remains controversial. This study describes the clinical presentation of a large ambulatory COVID‐19 paediatric cohort and evaluates the role of children in household transmission prior to and following school reopening. METHODS: A retrospective database cohort study was conducted in a large Health Maintenance Organization in Israel. Data of all paediatric, laboratory‐confirmed Coronavirus cases between 28/2/2020 and 20/6/2020 were extracted. All cases were analysed for household contacts and primary cases within each family cluster. RESULTS: A total of 1,032 cases under 18 years old (median age 12 years) were included. Of these cases, 432 (41.9%) were asymptomatic; 122 (11.8%) cases acquired the infection at school, and 45 of them were part of two school clusters; 846 children had at least one positive household contact, in 498 family clusters, and among them, 293 primary cases were identified. Only 27 (9.2%) primary cases were under 18 years of age and six (2%) were below 10. The proportion of primary cases did not change after the re‐opening of educational facilities. CONCLUSION: Children, particularly under 10 years of age, are less likely to be the vector for SARS‐CoV‐2 infection within household settings. Opening educational facilities did not change transmission dynamics.