A review of COVID-19 in schools and daycares by McMaster University researchers finds these settings were not a significant source of transmission of the virus when infection prevention and control measures were used.The extensive two-year review was published February 15 in The Lancet Child and Adolescent Health. It examined more than 34,000 references, including databases, websites and studies, related to transmission in child-care settings and schools across the globe. The findings cast doubt on the necessity of the school closures. In Ontario schools were closed for three successive school years for a total of 135 days. Assistant professor Sarah Neil-Sztramko, the lead author of the review, said schools didn't drive the pandemic.“We found that after that initial shutdown where everything was locked down, schools did not appear to have much impact on community level transmission when infection prevention control measures were in place,” Neil-Sztramko said in a statement.The review was launched in response to a need for “timely, up-to-date access to scientific evidence to guide decision making," the authors said, and has been updated 18 times.“The role of schools and daycares in COVID-19 transmission, from a growing number of studies, were reported in several reviews; the overall findings were mixed and these reviews became quickly outdated as new and often higher-quality evidence emerged,” the authors explained.“The purpose of this living rapid review was to continually identify, appraise and summarize emerging research evidence about the risk of transmission of COVID-19 among children and adults in schools and daycares, the effect of infection prevention and control (IPAC) measures on COVID-19 transmission within schools and daycares and the effect of opening schools and daycares on community-level transmission.”The review said that masking, vaccinations and test-to-stay policies were the best methods to reduce COVID-19’s spread in schools and daycares. Meanwhile, mandatory quarantining, cohorting and hybrid learning may have made “little to no difference in transmission."“It is important to understand which measures mitigate transmission so that schools can remain open as much as possible, given the negative impacts that were found during COVID-19 when they were closed,” Neil-Sztramko said.The review associated remote learning with increased educational disparities, especially for low-income families and students in remote areas with limited access to technology.“School closures also reduced opportunities for students to interact with their peers, which has been shown to have an adverse effect on their social and emotional development,” the review read.“Additionally, the fear, stress and isolation caused by the pandemic contributed to a substantial increase in loneliness, anxiety, depression and other mental health problems.”The authors said although children can spread COVID-19, they don't do so very much.“Although the data consistently show that children can both contract and transmit COVID-19, based on published reports to date, following reopening, the risk of widespread transmission from child to child and child to adult is low, particularly when IPAC measures are in place and adhered to,” the review explained.“This trend appears to be consistent in the data collected with early variants of concern. Even when absolute case numbers were high, most infections originated from outside of school.”The researchers said the review provides a “strong and factual foundation” on how to handle future pandemics.“If there were to be another wave where community transmission was increasing and straining the health-care system, strategies such as masking, vaccination and test-to-stay interventions are effective in fighting transmission, allowing schools to stay open,” Neil-Sztramko said.
