Infectivity of severe acute respiratory syndrome coronavirus 2 in children compared with adults

Bullard et al. in the Journal suggest that the role of pediatric age groups in SARS-CoV-2 transmission has been unclear and that their study finds that children are not the main vectors for spread.(1) Whereas it may be true that pediatric age groups have not been the main foci for COVID-19, the simple finding of lesser live virus quantitations in respiratory specimens does not sufficiently provide evidence of the latter. Undoubtedly most feel compelled to mitigate the role of children in SARS-CoV-2 transmission as there has been an inherent belief that closure of schools has considerable risk for societal disruption and harm to the young individual. Being partial to the attempts to minimize the impact of COVID-19 on our youth is a worthy position, but the reality of common respiratory virus transmission has been firmly understood including that of endemic respiratory coronaviruses otherwise.
Elsewhere in the world, school re-openings have been linked to resurgences.(1) Even in Canada, there are ample citations near weekly where some schools have been considerably impacted. School transmission is inevitably linked to teacher risk and to other associated family risk.(2) Whereas the younger school ages may be less implicated, there is a probable age-dependent stratification by which those in high schools eventually have risk that is similar to adult populations elsewhere.(3) Apart from practical experience with these risks and consequences, modelling studies also give reason to believe that schools can have a considerable impact on transmission and eventual disease burden.(4) In looking at the big picture, it is behaviour that drives transmission more than purely age or school status.(5)
In the summer of 2020 nearing school entry, it was clear that many school districts were not sufficiently prepared for what was to come. In the flurry of COVID-19 activity otherwise, proportionately less dedication was given to teachers, youth, and their families. There evolved an inherent inconsistency in masking and other mitigation strategies. Many were left unknowing of the expected standards. For the number of individuals involved in co-ordinating education Canada-wide, there is ample opportunity for great minds to think alike in providing the best compromise for teaching while maintaining high standards for prevention. As vaccines mitigate disease for older ages to begin, the shift will inevitably occur towards a proportionately higher burden of infection among younger populations. The potential role of youth in SARS-CoV-2 transmission would have been well-known even before the epidemic began. It is now time to focus intensively on how to realistically minimize spread in schools here forward and to safeguard both youth and their contacts.