Policies on children and schools during the SARS-CoV-2 pandemic in Western Europe

Abstract

During the pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), mitigation policies for children have been a topic of considerable uncertainty and debate. Although some children have co-morbidities which increase their risk for severe coronavirus disease (COVID-19), and complications such as multisystem inflammatory syndrome and long COVID, most children only get mild COVID-19. On the other hand, consistent evidence shows that mass mitigation measures had enormous adverse impacts on children. A central question can thus be posed: What amount of mitigation should children bear, in response to a disease that is disproportionally affecting older people? In this review, we analyze the distinct child versus adult epidemiology, policies, mitigation trade-offs and outcomes in children in Western Europe. The highly heterogenous European policies applied to children compared to adults did not lead to significant measurable differences in outcomes. Remarkably, the relative epidemiological importance of transmission from school-age children to other age groups remains uncertain, with current evidence suggesting that schools often follow, rather than lead, community transmission. Important learning points for future pandemics are summarized.

Effects of COVID-19-targeted non-pharmaceutical interventions on pediatric hospital admissions in North Italian hospitals, 2017 to 2022: a quasi-experimental study interrupted time-series analysis

“…Concerning the pediatric population in particular, it would be essential to elucidate the role of school closures on the control of pandemic spread ( 39 ). Recent reviews ( 12 , 34 , 40 ) suggested that measures implemented in the school setting may have limited the number or proportion of cases and deaths among adults, and delayed the progression of the pandemic. This seems to contrast with a report on data from Sweden, where school closure was only reserved for upper secondary schools, indicating that the number of deaths per population unit was lower than most other high-income countries that applied stringent school closure policies ( 41 ).…”

“…On the other hand, some authors emphasize a range of “side effects” of NPIs, including economic, educational, and health repercussions, disproportionately affecting more vulnerable populations, including children, with little health benefits ( 11 ). To manage future health crises, therefore, it is crucial that these strategies are further assessed to inform future pandemic policy and avoid past mistakes ( 12 ).…”

Embracing dynamic public health policy impacts in infectious diseases responses: leveraging implementation science to improve practice

“…The lower risk of severe and fatal infections conferred by natural and vaccine-induced immunity also caused smaller absolute risk reduction associated with NPIs policies. Simultaneous with decreasing impact due to fidelity and sustainment challenges, as the duration of some of the interventions increased, most notably school and business closures, their negative impacts became increasingly apparent ( 37 – 40 ). Overtime, these costs altered perceived appropriateness and acceptability of these pandemic mitigation policies.…”

Characteristic analysis of China's actions against the COVID‐19 in schools and comparison with other countries

“…In other parts of the world, schools and students are also suffering from the pandemic. The government and schools have taken similar actions, including online teaching, keeping a social distance (Soriano-Arandes et al, 2023), creating social bubbles for college students, conducting virus testing, and encouraging vaccination (Howard-Jones et al, 2022). But there are some differences in their attitude toward the virus and the measures they have taken compared with China.…”