write.as

This is a brief review of the peer-reviewed publications on the topic of school reopening, with an emphasis on the UK policy. The scope of reviewed articles comprise all the 90 results in the PubMed database on the “COVID schools reopening” query. Last update: August 10, 2020 by bh. https://write.as/obx42cuzf5zof8lf.md Many countries worldwide, partially or fully, including Canada and the U.S., have adopted the strategy of maintaining indefinite school closures until a vaccine or treatment is available, and many EU countries are practicing only partial or school-level reopening where physical distancing is possible (Sheikh et al. 2020). As COVID-19 mortality increases with age, transmission to adults is a significant concern, especially for those who are immunocompromised. The policy in the UK could likely by the test-and-test strategy, however, given that up to 45% of COVID-19 infections are asymptomatic and that pre-symptomatic individuals have high viral loads and are responsible for large proportion of transmission (Vermund & Pitzer 2020), this measure could be ineffective. Perhaps, the most comprehensive and recent modeling study done to date on this topic is by Panovska-Griffiths et al. (2020), published in August. There, the authors conclude that only the large-scale population-wide testing, combined with follow-up tracing and isolation, could prevent the second wave. There is no evidence of such system being implemented. Recent evidence shows that HVAC systems should also be taken into account as an effective COVID-19 spread vector, which the government fully ignores, as is with the Eat Out to Help Out scheme discounting dining. If infected persons are contained within the same air circulation circuit, very few traditional sanitizing and distancing measures are, in fact, effective (Lu et al. 2020; Correia et al. 2020; Jayaweera et al. 2020). Epidemiologists compare the current situation to influenza, whereby universal vaccine is a “must” to safely reopen schools, noting that asymptomatic transmission represents a substantial proportion of new infections (Vermund & Pitzer 2020). There is some weak indication that school children do not facilitate secondary transmissions, in the study by Heavey et al. (2020) in Ireland, however, there authors specifically mention their work has limitations due to the small number of cases. In a systematic review of 16 articles on the topic of school closures by Viner et al. (2020), published in April, authors conclude very little is known on the spread of coronavirus in school environment, with an important remark of that keeping the schools open only for essential workers is a better strategy. A more recent review by Li et al. (2020) on the similar topic that included multiple countries and the study by Crawford et al. (2020) for Connecticut were similar. Among the notable articles is the work of Xing et al. (2020) who identify stool shedding as a considerable spreading vector, with viral RNA detected in stools 4 weeks after infection. Citing their work, “a cautious approach should be considered when conducting aerosol-generating procedures,” albeit it is difficult to imagine the magnitude of hygiene measures required. On a brighter note, rapid communication by Johansen et al. (2020) provides guidelines to schools for infection prevention, based on a positive experience in Norway. Another set of useful guidelines may be taken from Cheng et al. (2020) and Bonell et al. (2020). REFERENCES Bonell C, Melendez-Torres GJ, Viner RM, et al. An evidence-based theory of change for reducing SARS-CoV-2 transmission in reopened schools [published online ahead of print, 2020 Jul 21]. Health Place. 2020;64:102398. doi:10.1016/j.healthplace.2020.102398 Cheng SY, Wang CJ, Shen AC, Chang SC. How to Safely Reopen Colleges and Universities During COVID-19: Experiences From Taiwan [published online ahead of print, 2020 Jul 2]. Ann Intern Med. 2020;M20-2927. doi:10.7326/M20-2927 Correia G, Rodrigues L, Gameiro da Silva M, Gonçalves T. Airborne route and bad use of ventilation systems as non-negligible factors in SARS-CoV-2 transmission. Med Hypotheses. 2020;141:109781. doi:10.1016/j.mehy.2020.109781 Crawford FW, Li ZR, Morozova O. COVID-19 projections for reopening Connecticut. Preprint. medRxiv. 2020;2020.06.16.20126425. Published 2020 Jun 19. doi:10.1101/2020.06.16.20126425 Heavey L, Casey G, Kelly C, Kelly D, McDarby G. No evidence of secondary transmission of COVID-19 from children attending school in Ireland, 2020. Euro Surveill. 2020;25(21):2000903. doi:10.2807/1560-7917.ES.2020.25.21.2000903 Jayaweera M, Perera H, Gunawardana B, Manatunge J. Transmission of COVID-19 virus by droplets and aerosols: A critical review on the unresolved dichotomy [published online ahead of print, 2020 Jun 13]. Environ Res. 2020;188:109819. doi:10.1016/j.envres.2020.109819 Johansen TB, Astrup E, Jore S, et al. Infection prevention guidelines and considerations for paediatric risk groups when reopening primary schools during COVID-19 pandemic, Norway, April 2020. Euro Surveill. 2020;25(22):2000921. doi:10.2807/1560-7917.ES.2020.25.22.2000921 Li X, Xu W, Dozier M, et al. The role of children in transmission of SARS-CoV-2: A rapid review. J Glob Health. 2020;10(1):011101. doi:10.7189/jogh.10.011101 Lu J, Gu J, Li K, et al. COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020. Emerg Infect Dis. 2020;26(7):1628-1631. doi:10.3201/eid2607.200764 Panovska-Griffiths J, Kerr CC, Stuart RM, et al. Determining the optimal strategy for reopening schools, the impact of test and trace interventions, and the risk of occurrence of a second COVID-19 epidemic wave in the UK: a modelling study [published online ahead of print, 2020 Aug 3]. Lancet Child Adolesc Health. 2020;S2352-4642(20)30250-9. doi:10.1016/S2352-4642(20)30250-9 Sheikh A, Sheikh A, Sheikh Z, Dhami S. Reopening schools after the COVID-19 lockdown. J Glob Health. 2020;10(1):010376. doi:10.7189/jogh.10.010376 Vermund SH, Pitzer VE. Asymptomatic transmission and the infection fatality risk for COVID-19: Implications for school reopening [published online ahead of print, 2020 Jun 25]. Clin Infect Dis. 2020;ciaa855. doi:10.1093/cid/ciaa855 Viner RM, Russell SJ, Croker H, et al. School closure and management practices during coronavirus outbreaks including COVID-19: a rapid systematic review. Lancet Child Adolesc Health. 2020;4(5):397-404. doi:10.1016/S2352-4642(20)30095-X Xing YH, Ni W, Wu Q, et al. Prolonged viral shedding in feces of pediatric patients with coronavirus disease 2019. J Microbiol Immunol Infect. 2020;53(3):473-480. doi:10.1016/j.jmii.2020.03.021