SARS-CoV-2 transmission in schools: an updated living systematic review (version 2; November 2020)
Open accessAbstract
BACKGROUND: Better understanding of SARS-CoV-2 transmission risks is needed to support decision-making around mitigation measures for COVID-19 in schools. METHODS: We updated a living systematic review and meta-analysis to investigate the extent of SARS-CoV-2 transmission in schools. In this update we modified our inclusion criteria to include: 1) cohort studies; 2) cross-sectional studies that investigated and cross-assessed SARS-COV-2 positivity rates in schools and communities; and 3) pre-post studies. We performed risk of bias evaluation for all included studies using the Newcastle-Ottawa Scale (NOS). RESULTS: update: n = 0). We performed a meta-analysis on nine of the 11 cohort studies investigating IAR in schools. Nine cohort studies reported a total of 91 student and 52 staff index cases that exposed 5698 contacts with 101 secondary infections (overall infection attack rate (IAR) = 1.45%, 95% CI = 0.31%-3.26%). IARs for students and school staff were 1.66% (95% CI = 0.08%-4.78%) and 1.18% (95% CI = 0.00%-4.43%) respectively. The risk of bias was found to be high for most studies identified, limiting the confidence in results. CONCLUSIONS: There is limited high-quality evidence available to quantify the extent of SARS-CoV-2 transmission in schools or to compare it to community transmission. Emerging evidence suggests the overall IAR and SARS-CoV-2 positivity rate in school settings are low. Higher IAR were found in students, compared to staff. NOTE: This article is a living systematic review that will be updated to reflect emerging evidence. This is the second version of the original article published on 23 December 2020 (J Glob Health 2020;11:021104), and previous versions can be found as data supplements. When citing this paper please consider adding the version number and date of access for clarity.
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In-person schooling was deprioritised even as other non-essential or less essential activities continued.
“In-person schooling was deprioritised even as other non-essential or less essential community and economic activities continued.”
From The Lancet Commission on lessons for the future from the COVID-19 pandemic (2022) · cites this paper as [309]
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- [6]Protocol: What is the evidence for transmission of COVID-19 by children in schools? A living systematic review. Available: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=192839. Accessed: 11 Sep 2020. PMC7774027 33437465
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The Lancet Commission on lessons for the future from the COVID-19 pandemic
Sachs, J. D., Karim, S. S. A., Aknin, L., Allen, J., Brosbøl, K., Colombo, F., Barron, G. C., Espinosa, M. F., Gaspar, V., Gaviria, A., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(22)01585-9 · Cited by 842 · see citing works
- Authors
- Xu, W., Li, X., Dong, Y., Dozier, M., He, Y., Kirolos, A., Lang, Z., Mathews, C., Siegfried, N., Theodoratou, E., & UNCOVER
- Affiliations
- University of Edinburgh (GB)
- Second Affiliated Hospital of Zhejiang University (CN)
- University of Liverpool (GB)
- South African Medical Research Council (ZA)
- Centre for Global Health Research, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- ORCID
- Venue
- Journal of Global Health
- Published
- 2021-06-10
- Volume
- 11
- Pages
- 10004-10004
- ISSN
- 2047-2978 (ISSN-L)
- 2047-2986
- PMC
- PMC8590829
- OpenAlex
- W3188838180
- Cited by
- 8
- References
- 36
- Citations by year
- 2026: 1 · 2024: 1 · 2023: 3 · 2022: 3
- FWCI
- 0.18
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Global Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
- Funders
- Wellcome Trust (203919/Z/16/Z, 203919, ISSF3)
- International Seafood Sustainability Foundation
- Cancer Research UK (C31250/A22804)
- Topics
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Infection Control and Ventilation
- Keywords
- SARS-CoV-2, COVID-19 pandemic, school transmission, infection attack rate, secondary infection, school staff, students, community transmission, COVID-19 mitigation measures
- MeSH terms
- COVID-19, SARS-CoV-2, Cross-Sectional Studies, Humans, Schools, Students
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