The role of educational settings in the transmission chain of SARS-CoV-2 in 2020: a systematic review

Abstract BackgroundSchool closures have been used as a core Non pharmaceutical intervention during the COVID-19 pandemic, however the role of educational settings in COVID-19 transmission is still unclear. MethodsThis systematic literature review assessed studies published between December 2019 and April 1, 2021 in Medline and Embase, which included studies that assessed educational settings from approximately January 2020 to January 2021. The inclusion criteria were based on the PCC framework (P-Population, C-Concept, C-Context). The study Population was restricted to people 1-17 years old (excluding neonatal transmission), the Concept was to assess child-to-child and child-to-adult transmission, while the Context was to assess specifically educational setting transmission clusters. ResultsFifteen studies met inclusion criteria, ranging from daycare centers to high schools and summer camps, while eight studies assessed the re-opening of schools in the 2020-2021 school year. In principle although there is sufficient evidence that children can both be infected by and transmit SARS-CoV-2 in school settings, the SAR remain relatively low -when NPI measures are implemented in parallel. Moreover, although the evidence was limited there was an indication that younger children may have a lower SAR than adolescents. ConclusionsTransmission in educational settings in 2020 was minimal -when NPI measures were implemented in parallel. However, with an upsurge of cases related to variants of concern, continuous surveillance and assessment of the evidence is warranted to ensure the maximum protection of the health of students and the educational workforce, while also minimising the numerous negative impacts that school closures may have on children. Strengths and limitations of this studyThis study provides a rapid review of the peer-reviewed literature pertaining to SARS-CoV-2 transmission by children within educational settings.The review reflects the status quo of the previous school years (January 2020 -January 2021) due to the lag time between study implementation, peer review and publication.The included studies represent child-to-child transmission within the context of previous SARS-CoV-2 strains and are not directly applicable to newer variants.