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      SARS-CoV-2 transmission in kindergarten to grade 12 schools in the Vancouver Coastal Health region: a descriptive epidemiologic study

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      , MD MPH, , MSc, , MSc, , MPH, , MD MPH, , MD MHSc
      CMAJ Open
      CMA Joule Inc.

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          Abstract

          Background:

          There is an urgent need to assess the role of schools in the spread of SARS-CoV-2 in Canada to inform public health measures. We describe the epidemiology of SARS-CoV-2 infection among students and staff in the Vancouver Coastal Health (VCH) region in the first 3 months of the 2020/2021 academic year, and examine the extent of transmission in schools.

          Methods:

          This descriptive epidemiologic study using contact tracing data included individuals aged 5 years and older with SARS-CoV-2 infection, reported between Sept. 10 and Dec. 18, 2020, who worked in or attended kindergarten to grade 12 (K–12) schools in person in the VCH region. We described case and cluster characteristics and reported the number of school-based transmissions.

          Results:

          During the study period, 699 cases of SARS-CoV-2 infection were reported (55 cases per 10 000 VCH school population). Among cases in VCH resident staff and students, 52.5% (354/674) were linked to a household case or cluster; less than 1.5% (< 10) of infected individuals were hospitalized and none died. Out of 699 cases present at school, 26 clusters with school-based transmission resulted in 55 secondary cases. Staff members accounted for 53.8% of index cases (14/26) while making up 14.3% of the school population (17 742/123 647). Among clusters, 88.5% (23) had fewer than 4 secondary cases.

          Interpretation:

          In our population during the study period, there were no deaths and severe disease was rare; furthermore, school-based SARS-CoV-2 transmissions were uncommon and clusters were small. Our results, which relate primarily to symptomatic disease, support the growing body of evidence that schools likely did not play a major role in SARS-CoV-2 spread in 2020.

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          Most cited references47

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          Epidemiological Characteristics of 2143 Pediatric Patients With 2019 Coronavirus Disease in China

          To identify the epidemiological characteristics and transmission patterns of pediatric patients with the 2019 novel coronavirus disease (COVID-19) in China.
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            COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study

            Summary Background To date, few data on paediatric COVID-19 have been published, and most reports originate from China. This study aimed to capture key data on children and adolescents with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across Europe to inform physicians and health-care service planning during the ongoing pandemic. Methods This multicentre cohort study involved 82 participating health-care institutions across 25 European countries, using a well established research network—the Paediatric Tuberculosis Network European Trials Group (ptbnet)—that mainly comprises paediatric infectious diseases specialists and paediatric pulmonologists. We included all individuals aged 18 years or younger with confirmed SARS-CoV-2 infection, detected at any anatomical site by RT-PCR, between April 1 and April 24, 2020, during the initial peak of the European COVID-19 pandemic. We explored factors associated with need for intensive care unit (ICU) admission and initiation of drug treatment for COVID-19 using univariable analysis, and applied multivariable logistic regression with backwards stepwise analysis to further explore those factors significantly associated with ICU admission. Findings 582 individuals with PCR-confirmed SARS-CoV-2 infection were included, with a median age of 5·0 years (IQR 0·5–12·0) and a sex ratio of 1·15 males per female. 145 (25%) had pre-existing medical conditions. 363 (62%) individuals were admitted to hospital. 48 (8%) individuals required ICU admission, 25 (4%) mechanical ventilation (median duration 7 days, IQR 2–11, range 1–34), 19 (3%) inotropic support, and one (<1%) extracorporeal membrane oxygenation. Significant risk factors for requiring ICU admission in multivariable analyses were being younger than 1 month (odds ratio 5·06, 95% CI 1·72–14·87; p=0·0035), male sex (2·12, 1·06–4·21; p=0·033), pre-existing medical conditions (3·27, 1·67–6·42; p=0·0015), and presence of lower respiratory tract infection signs or symptoms at presentation (10·46, 5·16–21·23; p<0·0001). The most frequently used drug with antiviral activity was hydroxychloroquine (40 [7%] patients), followed by remdesivir (17 [3%] patients), lopinavir–ritonavir (six [1%] patients), and oseltamivir (three [1%] patients). Immunomodulatory medication used included corticosteroids (22 [4%] patients), intravenous immunoglobulin (seven [1%] patients), tocilizumab (four [1%] patients), anakinra (three [1%] patients), and siltuximab (one [<1%] patient). Four children died (case-fatality rate 0·69%, 95% CI 0·20–1·82); at study end, the remaining 578 were alive and only 25 (4%) were still symptomatic or requiring respiratory support. Interpretation COVID-19 is generally a mild disease in children, including infants. However, a small proportion develop severe disease requiring ICU admission and prolonged ventilation, although fatal outcome is overall rare. The data also reflect the current uncertainties regarding specific treatment options, highlighting that additional data on antiviral and immunomodulatory drugs are urgently needed. Funding ptbnet is supported by Deutsche Gesellschaft für Internationale Zusammenarbeit.
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              Well-being of Parents and Children During the COVID-19 Pandemic: A National Survey

              As the coronavirus disease pandemic spread across the United States and protective measures to mitigate its impact were enacted, parents and children experienced widespread disruptions in daily life. Our objective with this national survey was to determine how the pandemic and mitigation efforts affected the physical and emotional well-being of parents and children in the United States through early June 2020.
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                Author and article information

                Journal
                CMAJ Open
                CMAJ Open
                cmajo
                cmajo
                CMAJ Open
                CMA Joule Inc.
                2291-0026
                Jul-Sep 2021
                24 August 2021
                : 9
                : 3
                : E810-E817
                Affiliations
                School of Population and Public Health (Bark, McKee), University of British Columbia; Population Health Surveillance Unit (Dhillon, St-Jean, Kinniburgh), Vancouver Coastal Health; Population and Public Health (McKee), BC Centre for Disease Control; Office of the Chief Medical Health Officer (Choi), Vancouver Coastal Health, Vancouver, BC
                Author notes
                Correspondence to: Alexandra Choi, alexandra.choi1@ 123456vch.ca
                Article
                cmajo.20210106
                10.9778/cmajo.20210106
                8432285
                34429325
                5c93a196-7514-4802-9705-038d2f282efc
                © 2021 CMA Joule Inc. or its licensors

                This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/

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