COVID-19 in children and the role of school settings in COVID-19 transmission

Key messages 

• A small proportion (<5%) of overall COVID-19 cases reported in the EU/EEA and the UK are among children (those aged 18 years and under). When diagnosed with COVID-19, children are much less likely to be hospitalised or have fatal outcomes than adults. 
• Children are more likely to have a mild or asymptomatic infection, meaning that the infection may go undetected or undiagnosed. 
• When symptomatic, children shed virus in similar quantities to adults and can infect others in a similar way to adults. It is unknown how infectious asymptomatic children are. 
• While very few significant outbreaks of COVID-19 in schools have been documented, they do occur, and may be difficult to detect due to the relative lack of symptoms in children. 
• In general, the majority of countries report slightly lower seroprevalence in children than in adult groups, however these differences are small and uncertain. More specialised studies need to be performed with the focus on children to better understand infection and antibody dynamics.  Investigations of cases identified in school settings suggest that child to child transmission in schools is uncommon and not the primary cause of SARS-CoV-2 infection in children whose onset of infection coincides with the period during which they are attending school, particularly in preschools and primary schools. 
• If appropriate physical distancing and hygiene measures are applied, schools are unlikely to be more effective propagating environments than other occupational or leisure settings with similar densities of people. 
• There is conflicting published evidence on the impact of school closure/re-opening on community transmission levels, although the evidence from contact tracing in schools, and observational data from a number of EU countries suggest that re-opening schools has not been associated with significant increases in community transmission. 
• Available evidence also indicates that closures of childcare and educational institutions are unlikely to be an effective single control measure for community transmission of COVID-19 and such closures would be unlikely to provide significant additional protection of children’s health, since most develop a very mild form of COVID-19, if any. 
• Decisions on control measures in schools and school closures/openings should be consistent with decisions on other physical distancing and public health response measures within the community.

Citation: COVID-19 in children and the role of school settings in COVID-19 transmission, 6 August 2020.

Stockholm: ECDC; 2020.

© European Centre for Disease Prevention and Control, Stockholm, 2020.