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Question re: children, schools
WHO Conference /source / Monday, July 13, 2020 / Press briefings
(*Imo, this transcription can not express how powerful it is to hear Dr. Mike speak these words in person, video linked below)
Christine: (22:36)
Hi, Christine Theodorou ABC News. I wanted to ask a question about transmission among children. From the last notes I have, the WHO reported children seem to be less affected, experienced mild disease and are less likely to show clinical symptoms. You had previously said that children are susceptible just as adults and can transmit, but from some of the household transmission studies, excuse me, we’re looking at, it was very rare that a child infects an adult. And you were trying to better understand when people are infectious, how people are infectious and how do you measure that. Today we’re seeing a report from Chief Health Officer in Victoria state, Australia, warning that extensive testing in the state revealed child to child transmissions are quote, more apparent than they first thought. And in the US as you know, there’s an intense debate that’s ongoing around school reopenings. we wanted to ask if there’s updated guidance from the WHO on child transmissions? Whether that be child to child, or child to adult. Thank you in advance.
Doctor Maria Van Kerkhove: (23:38)
So I can start and perhaps Mike would like to supplement. So this is a very important question. And this is one that has been on our radar from the beginning of course and I’m looking at transmission as well as severity. And so what you had said about children tend to be less affected in terms of being as cases, that is true, representing between one and 3%, in some countries up to 5% of the reported cases to WHO. There are some seroprevalent studies that are being conducted that are looking at antibody response in children. And there are a few studies that are coming out now. Again, they’re not all peer reviewed publications, but some of those are pre-print. And what we’re seeing from them is that children do seem to be, we need to break down what children mean. The youngest children under 10 years old for example, versus children over 10. And it depends on how the study broke down age. Some of them range from five to nine, some of them range from 10 to 14. But what we’re seeing is that children in the youngest age groups have a lower seroprevalence. And those that are above 10 seemed to have a similar seroprevalence to those that are among young adults and above 20 years old, which means that they can be infected, which we’ve said from the beginning, but they do tend to have more mild disease. In terms of transmission, there’s quite a lot that we still need to understand about transmission in children. Many of the schools in many of the countries that imposed these public health and social measures or so-called lockdown measures did include closing of schools, although not all did. And we’re learning from some countries as they’re opening up some of those restrictions, we have heard of some outbreaks in schools mainly among the older children. But again, there’s a lot that we don’t know about transmission among children.
With regards to schools and advice on schools, WHO has issued guidance on the safe running of schools and making sure that certain measures are in place. We’ve also issued guidance on considerations of when schools can reopen. And that takes into account a lot of different factors that decision makers need to take. Whether it relates to the transmission that is occurring in the local area or the catchment area of the schools, the type of school structure it has, the ability for the school to be able to implement the measures like physical distancing, hand washing, et cetera. And so there’s a number of considerations that need to take place. But as you highlighted, children do seem to be less affected but they can be infected and that is important. Our understanding of transmission in children is still limited, and we know that overall they tend to have more mild disease, but in some situations they can have severe disease and we have seen children that have died.
Doctor Michael Ryan: (26:37)
Yes. Thank you, Maria. I think that’s says it all. I think we’ve been around. If we cast our minds back over the last couple of months, we’ve had healthy debates around everything from longterm care facilities, to transmission in dormitories, to transmissions in airplanes, to transmission on public transport, healthcare settings, to workplace and now schools. And Maria is absolutely correct in that we don’t fully understand the full contribution of children to the overall epidemic. The fact remains that when community transmission exists and when community transmission is intense, children will be exposed to that virus and children will be part of the transmission cycle. They will be exposed, some will be infected, and they may infect others. What we don’t fully understand is the impact on those children in the long term. We know in the short term, they tend to have milder infections. We don’t know the impact in the long term, and we don’t know to what extent they pass that infection on and affect others. But we do know that that can happen.
So when we look at that and we can have the same issues when it comes to the workplace, and we talk about employees and the workplace, and we talk about longterm care facilities and health workers in the facilities and older people and visitors. And to what extent do visitors bring the disease in or to what extent do health workers participate in transmission. And all of this is in the setting of what’s happening in the community. And in communities where transmission has been effectively suppressed, where countries have been successful in driving down transmission of the disease across the board, then you reach a point where everything is safer. The problem we have in some countries right now is that it’s very difficult to determine the safety of any environment because there is just so much transmission going on that all potential environments in which people mix are essentially problematic. And that’s a problem.
We’ve all paid a heavy price. Countries around the world have gone into very serious movement restrictions, stay at home orders, in order to suppress the virus transmission. And as countries have opened up, in some countries, the suppression of the virus has been kept in place. Countries have opened up carefully, sequentially in a stepwise fashion and have strengthened their public health architecture and have strengthened their capacity to investigate clusters and suppress the disease and in some cases implement subnational or targeted measures at movement restriction or stay at home orders. And in that case, schools are part of that. So yes, there is an issue around how much, and to what extent children participate in transmission. There are real issues around how schools can be reopened safely. But the best and safest way to reopen schools is in the context of low community transmission that has been effectively suppressed by a broad based comprehensive strategy.
We can’t move from let’s deal with the schools, and then we all deal with that for a week or two, and then let’s deal with the workplace, or then let’s deal with infection in hospitals or longterm care facilities. This is playing Whac-A-Mole. We have got to focus on a comprehensive longterm strategy that focuses on everything at one time. We’ve got to chew gum and walk at the same time and we keep pulling ourselves down various rabbit holes. Schools are a hugely important part of this. They’re a hugely important part of our social educational architecture, the baseline of our civilization. But we can’t turn schools into yet another political football in this game. It’s not fair on our children. So we have to look at this carefully in the light of the transmission, in any given country or any given setting. And we have to make decisions that are based on the best interests of our children, be it their educational or their health interests. And that must be based on data. That must be based on understanding the risks in the specific setting in which schools are. What is the community transmission and what are those risks? And my fear in this is that we create these political footballs that get kicked around the place and for me, we need to get back to what the director general has just spoken about.
Comprehensive strategies, sustained commitment to broad- based virus suppression. If we suppress the virus in our society, in our communities, then our schools can open safely. And there are many countries around the world in which schools are reopening, successfully and safely because countries have dealt with the real problem, community transmission. So I would advise us all to look carefully at schools. We will continue to. I think we have a technical advisory group meeting coming up, Maria might want to speak to that. We’re bringing experts together from all over the world once more, to look at how we manage and open schools in a safe and effective way, but please let us not turn this into yet another political football.
Doctor Maria Van Kerkhove: (31:42)
Let me add that we have a technical advisory group that’s been pulled together to advise on us on educational institutions, specifically around how we do this safely. And it’s a global collaboration. There’s a large number of scientists that are helping to advise us on this. We have our second meeting this week and that is something that we have specifically pulled together for this because it is such a complex issue and it is such an important issue for all of us.
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Again, I invite you to hear Dr. Mike speak these words in person. See for yourselves at 26:37 if you can spare a few moments- start it around 26:00ish to “get the flow”. This exactly why I’ve been so impressed with Dr. Mike from the start. He is absolutely brilliant, passionate, committed...this man is a warrior and has literally gone door to door in the middle of wars in a helmet and bulletproof vest to contact trace...this man is a HERO, I just can’t say enough about him.Again, this is from last week, Monday, July 13:
Thanks, margarita. You are right. A quick listen from 26:00ish gives the whole expert story.
When can schools open safely?
When community transmission is low, negligible, zero, zip.
That is the bottom line.
