SARS-CoV-2 Infections in Children Following the Re-Opening of Schools and the Impact of National Lockdown during Autumn 2020: Prospective, National Observational Cohort Surveillance, England (preprint)

ABSTRACT

Background: The reopening of schools during the COVID-19 pandemic has raised concern for the safety of staff and students, their families and the wider community. We monitored SARS-CoV-2 infection rates in school-aged children and compared them with adult infection rates before and after schools reopened in England. Methods: Public Health England receives daily electronic reports of all SARS-CoV-2 tests nationally. SARS-CoV-2 infection rates by school year from July to November 2020 were analysed, including the effect of a week-long half-term school break in October and national month-long lockdown whilst keeping schools open in November 2020Findings: SARS-CoV-2 infections rates were low during early summer but started increasing in mid-August, initially in young adults followed by secondary and then primary school-aged children prior to schools reopening in September 2020. Cases in school-aged children lagged behind and followed adult trends after schools reopened, with a strong age gradient in weekly infection rates. There was a strong (P<0.001) correlation in regional infection rates between adults and secondary (R2=0.96-0.98), primary (R2=0.93-0.94) and preschool-aged (R2=0.62-0.85) children. The half-term break had a small and transient effect on infection rates in school-aged children, but there was a sharp decline in adult cases followed a week later by a decline in student cases after national lockdown in November 2020.Interpretation: In school-aged children, SARS-CoV-2 infections followed the same trajectory as adult cases and only declined after national lockdown was implemented whilst keeping schools open. Maintaining low community infection rates is critical for keeping schools open during the pandemic.Funding: PHE