key: cord-341648-z4lflkmo authors: Isaacs, David; Britton, Philip; Howard‐Jones, Annaleise; Kesson, Alison; Khatami, Ameneh; Marais, Ben; Nayda, Claire; Outhred, Alexander title: To what extent do children transmit SARS‐CoV‐2 virus? date: 2020-06-16 journal: J Paediatr Child Health DOI: 10.1111/jpc.14937 sha: doc_id: 341648 cord_uid: z4lflkmo nan extreme rarity in reports from around the world, although this could be for lack of testing. A current child care outbreak in Sydney was initiated and spread by infected adults. SARS-CoV-2 is mainly spread by droplets and through touching contaminated surfaces. Studies show SARS-CoV-2 can be detected by polymerase chain reaction in the stool of affected infants for several weeks, raising the possibility of faecal-oral spread. Reassuringly, German researchers found no live virus in stool despite viral RNA being detectable, suggesting the positive test is due to dead viral debris shed from the respiratory tract rather than active virus. One would expect child care clusters to be common if asymptomatic or mildly symptomatic pre-school children were even moderately infectious. School outbreaks are also rare, but can be serious. New Zealand's single biggest cluster of COVID-19 was at a secondary girls' school, Marist College, Auckland. 6 The outbreak reportedly started with an infected teacher who attended a school cultural event, following which 94 staff and pupils became infected. The extent of any child-to-child or child-to-adult spread is as yet uncertain. 6 An unreviewed study of 15 New South Wales schools found nine staff and nine students who had tested positive for SARS-CoV-2. 7 Only one of their 168 primary school contacts and only one of 695 secondary school contacts became infected; both were probably infected by schoolmates. 7 It is possible that asymptomatic and mildly infected children are important transmitters of SARS-CoV-2, but the evidence to date suggests children rarely spread the virus. A systematic review of school closure to control COVID-19 found insufficient data to comment on efficacy. 8 Studies suggest school closures in China, Hong Kong and Singapore had little or no effect on control of the 2003 outbreak with the related SARS virus, which like infection with SARS-CoV-2 was much milder in children than adults. 8 However, we should be cautious about extrapolation from SARS to SARS-CoV-2. Modelling studies suggest school closures would prevent fewer than 5% of COVID-19 deaths, much less than other social distancing interventions, and would have major adverse effects on children and on the workforce, but modelling studies are only as good as the data. 9 In conclusion, the available evidence to date suggests children are unlikely to be major transmitters of SARS- Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: An observational cohort study Coronavirus disease 2019 in children -United States Children are unlikely to have been the primary source of household SARS-CoV-2 infections COVID-19 -Significant Clusters. Wellington: NZ Ministry of Health COVID-19 in Schools -The NSW Experience. Sydney: NCIRS; 2020 School closure and management practices during coronavirus outbreaks including COVID-19: A systematic review Special report: The simulations driving the world's response to COVID-19 4 Discipline of Child and Adolescent Health, University of Sydney Sydney, New South Wales, Australia