Omicron and kids: evidence backs keeping schools open

LEADING paediatricians have applauded the states’ continuing resolve to keep schools open amid the surge in COVID-19 cases, saying evidence has consistently showed children are not driving transmission and their symptoms are typically mild.

National Cabinet this year committed to keeping schools open for face-to-face learning, saying they should be considered an essential service. However, many schools have faced crippling staff shortages this winter as a result of the highly contagious Omicron variant. At the time of writing, there were 175 284 active COVID-19 cases in New South Wales, 55 195 in Victoria and 45 097 in Queensland.

Associate Professor Asha Bowen, Head of the Department of Infectious Diseases at Perth Children’s Hospital, told InSight+ the decision to keep schools open was the right one.

“At no point in the pandemic have children been the main vector for this disease,” she said.

Associate Professor Bowen co-authored a recent study which found children in a household were now equally likely to spread the virus as adults but not more likely than adults. The authors acknowledged that significant heterogeneity meant they could not pool the data.

“It remains to be determined if the data shown herein can be translated to scenarios outside of the home,” they wrote.

Associate Professor Bowen told InSight+:

“We need to not think about schools as the first place where we implement policies to try [to] reduce the peak transmission period but think about them as a critical part of our community that needs investments of support.

“That means making sure there are back-up teachers when teachers get sick and making sure ventilation is attended to and continuously checked.”

Dr Kirsty Short, a virologist at the University of Queensland and co-researcher with Associate Professor Bowen agreed.

“I think we have moved past closing schools,” she told InSight+. “In 2022, we also have mask wearing, improved ventilation and paediatric vaccines so it is not the same level of concern as we were talking about in 2020.”

To date, 2 232 793 children aged between 5 and 15 years have received at least one dose of a COVID-19 vaccine. The number with two doses is 1 911 827.

Dr Short co-authored another recent study which found SARS-CoV-2 replicates at significantly lower rates in the nasal membranes of children compared with adults. However, the study also found that this trend was markedly less pronounced in the case of Omicron.

“Our findings are consistent with kids getting infected more frequently with these new variants, but children are still not driving transmission,” Dr Short said.

It comes as research published in the MJA today highlighted the low risk to children from COVID-19 infection during the Delta wave.

The prospective cohort study included 11 985 children with SARS-CoV-2 infection who were either admitted to hospital in the Sydney Children’s Hospital Network (SCHN) or received outpatient care through SCHN’s virtual care service between June and October 2021. The study found the disease was mostly mild or asymptomatic in children, consistent with international evidence, and characterised by runny nose, cough and fever.

The authors wrote: “We need to carefully consider both the harms of infection and those caused by population-level shielding of children from infection, which could be considered as disproportionate with respect to disease risk, although the long term effects of infection are still poorly characterised.”

The study found two-thirds of the 459 children with COVID-19 who were admitted to hospital were there for social rather than medical reasons. This included 202 children whose parents or carers had been hospitalised with COVID-19 and 30 children with special needs whose usual out-of-home care services were not available because of their positive status.

Seven children were admitted with paediatric multisystem inflammatory syndrome (PIMS-TS). All responded well to medical treatment and only two needed intensive care. A total of 15 cases were admitted to intensive care. One death was associated with SARS-CoV-2 infection, that of a child who died of pneumococcal meningitis.

Study co-author, Dr Phoebe Williams told InSight+: “Children have been the real losers of the last 2 years, with disrupted schooling, socialising and sport and not much to gain from all this given their low risk from the virus.”

Dr Williams said one of the challenges was that Australia’s pandemic preparedness plan was based on influenza, where children become easily infected and drive transmission.

“This just wasn’t the case with COVID-19, and it wasn’t really a huge surprise to paediatricians because there are a number of other seasonal coronaviruses that circulate and we know how mild those are in children,” she added.

Dr Williams cited a study by Australia’s National Centre for Immunisation Research and Surveillance in The Lancet in August 2020 which found transmission in NSW schools was low. Both child-to-child and child-to-staff transmission were found to be unlikely.

Noting that school closures were designed to reduce societal movements in an unvaccinated population during the Delta wave, Dr Williams said the argument for keeping schools open was stronger in the Omicron wave.

The new variant had typically milder symptoms in children and lower rates of PIMS-TS compared with previous variants, she said.

The Omicron variant was linked with the death of a toddler in Brisbane in July due to acute haemorrhagic leukoencephalitis. Noting that the child’s death had been referred to the coroner and that COVID-19 may not have been causative, both Dr Williams and Associate Professor Bowen reiterated that, in general, the Omicron variant was not causing more severe illness in children.

Associate Professor Bowen said the decisions to close schools in 2020 and 2021 were more broadly based on reduction of community transmission of COVID-19 rather than evidence of the virus’s behaviour in children.

“In 2020, with the ancestral COVID strain, children had a much lower rate of infection and they were less likely to be able to transmit SARS-CoV-2 compared with adults,” she said. “Those facts were clearly understood and communicated as early as April 2020, but they were largely ignored by policymakers for the first 2 years of the pandemic.

“Throughout the pandemic, children’s and young peoples’ needs have been underconsidered when decisions are being made at a community level,” she said.

Both Associate Professor Bowen and Dr Williams supported the Albanese government’s plan to create an Australian Centre for Disease Control to enable consistent evidence-based public health responses in future, and said this should include paediatric representation.

Subscribe to the free InSight+ weekly newsletter here. It is available to all readers, not just registered medical practitioners.