[Use of masks by children to prevent infection with SARS-CoV-2]

A multi-layered strategy for COVID-19 infection prophylaxis in schools: A review of the evidence for masks, distancing, and ventilation

Implications for the academic and interpersonal development of children and adolescents underpin a global political consensus to maintain in-classroom teaching during the ongoing COVID-19 pandemic. In support of this aim, the WHO and UNICEF have called for schools around the globe to be made safer from the risk of COVID-19 transmission. Detailed guidance is needed on how this goal can be successfully implemented in a wide variety of educational settings in order to effectively mitigate impacts on the health of students, staff, their families, and society. This review provides a comprehensive synthesis of current scientific evidence and emerging standards in relation to the use of layered prevention strategies (involving masks, distancing, and ventilation), setting out the basis for their implementation in the school environment. In the presence of increasingly infectious SARS-Cov-2 variants, in-classroom teaching can only be safely maintained through a layered strategy combining multiple protective measures. The precise measures that are needed at any point in time depend upon a number of dynamic factors, including the specific threat-level posed by the circulating variant, the level of community infection, and the political acceptability of the resultant risk. By consistently implementing appropriate prophylaxis measures, evidence shows that the risk of infection from in-classroom teaching can be dramatically reduced. Current studies indicate that wearing high-quality masks and regular testing are amongst the most important measures in preventing infection transmission; whilst effective natural and mechanical ventilation systems have been shown to reduce infection risks in classrooms by over 80%.

[Children in the COVID-19 pandemic and the public health service (ÖGD) : Data and reflections from Frankfurt am Main, Germany]

BACKGROUND

The measures taken to combat the COVID-19 pandemic have severely restricted the opportunities for the development of children. This paper will discuss the reporting data of children and the public health department's activities against the background of the restrictions of school and leisure time offers as well as sports and club activities.

MATERIALS AND METHODS

Reporting data from Frankfurt am Main, Hesse, were obtained using a SURVStat query for the calendar weeks 10/2020-28/2021 and from SURVNet (until 30 June 2021). Contact persons (CP) of SARS-CoV‑2 positive persons from schools and daycare centers were screened for SARS-CoV‑2 by PCR test. These results and those of rapid antigen testing, which has been mandatory for schoolchildren since April 2021, are presented.

RESULTS

Until Easter break, the age-related seven-day incidence values per 100,000 for children 14 years of age and younger were lower than the overall incidence; it was only higher after rapid antigen-testing was mandatory for schoolchildren. Most children with SARS-CoV‑2 had no or mild symptoms; hospitalization was rarely required and no deaths occurred. Contact tracing in schools and daycare centers found no positive contacts in most cases and rarely more than two. Larger outbreaks did not occur.

CONCLUSION

SARS-CoV‑2 infections in children appear to be less frequent and much less severe than in adults. Hygiene rules and contact management have proven themselves effective during times with high incidences in the local population without mandatory rapid antigen testing - and even with a high proportion of variants of concern (alpha and delta variants) in Germany. Against this background, further restriction of school and daycare operations appears neither necessary nor appropriate.

[Impact of wearing face masks in public to prevent infectious diseases on the psychosocial development in children and adolescents: a systematic review]

Hintergrund

Zur Prävention tröpfchenübertragener Infektionskrankheiten wird das Tragen einer Maske im öffentlichen Raum unter bestimmten Bedingungen empfohlen.

Ziel der Arbeit

Ziel war, über eine sensitive Literatursuche möglichst alle deutsch- und englischsprachigen Forschungsergebnisse aus begutachteten Fachzeitschriftenartikeln zu den Auswirkungen des Masketragens zur Prävention von Infektionen auf die psychosoziale Entwicklung von Kindern und Jugendlichen zusammenzutragen.

Methoden

Es wurde ein systematischer Review unter Berücksichtigung verschiedener Studiendesigns durchgeführt (Suchzeitraum bis einschließlich 12.07.2021). Das Verzerrungsrisiko der Studien wurde mit einem Risk-of-Bias-Verfahren ermittelt. Es fand eine deskriptiv-narrative Ergebnissynthese statt.

Ergebnisse

Es wurden 13 Studien eingeschlossen, wobei das Gesamtverzerrungsrisiko in allen Primärstudien als hoch eingeschätzt wurde. Es gibt Hinweise aus Befragungsstudien, dass die Fähigkeit zum Lesen der Mimik von Kindern/Jugendlichen und/oder ihren Betreuer:innen im (Vor‑)Schulsetting durch das Masketragen als beeinträchtigt erlebt wird, die durch mehrere Experimentalstudien bestätigt wurden. 2 Studien berichteten über psychische Symptome wie Ängste oder Stresserleben sowie Konzentrations- und Lernschwierigkeiten durch das Masketragen während der COVID-19-Pandemie. Eine Studie während der SARS-Pandemie 2002/2003 untersuchte mündliche Prüfungsleistungen in Englisch als Fremdsprache und zeigte keinen Unterschied zwischen den Bedingungen „Maske“ versus „keine Maske“.

Diskussion

Zu den Auswirkungen des Masketragens auf verschiedene Entwicklungsbereiche von Kindern und Jugendlichen lassen sich basierend auf der unzureichenden Studienlage nur wenige Erkenntnisse ableiten. Es fehlen Forschungsdaten zu den Folgen für die Endpunkte psychische Entwicklung, Sprachentwicklung, sozioemotionale Entwicklung, soziales Verhalten, Schulerfolg und Teilhabe. Weitere qualitative Studien und epidemiologische Studien sind unbedingt nötig.

Zusatzmaterial online

Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00103-021-03443-5) enthalten.

The impact of face masks on children-A mini review

Aim

Face masks are essential during the COVID‐19 pandemic, and the United Nations Children's Fund and the World Health Organization, recommend that they are used for children aged six years and older. However, parents are increasingly expressing concerns about whether these might be physically harmful. This mini review assessed the evidence.

Method

We conducted a narrative review on the effects of mask wearing on physiological variables in children, using PubMed, the Cochrane Library and the World Health Organization COVID‐19 Database up to 7 November 2020. The lack of paediatric studies prompted a second search for adult studies.

Results

We only found two paediatric studies, published in 2019 and 2020. The 2020 study was not related to COVID‐19. Only one study, performed with N95 respirators, collected medical parameters, and this did not suggest any harmful effects of gas exchange. The eight adult studies, including four prompted by the pandemic and one on surgeons, reported that face masks commonly used during the pandemic did not impair gas exchange during rest or mild exercise.

Conclusion

International guidelines recommend face masks for children aged six years and older, but further studies are needed to provide evidence‐based recommendations for different age groups.

[Children and COVID-19-Data from mandatory reporting and results of contact person testing in daycare centers and schools in Frankfurt am Main, Germany, August-December 2020]

BACKGROUND

In face of the coronavirus disease 2019 (COVID-19) pandemic, the question that children are also drivers of this pandemic and that groups, classes, or the entire facility should be closed when severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurs in schools or daycare centers is always implied. These questions were investigated using the mandatory reporting data in Frankfurt am Main and the extensive testing of contact persons (CP) in schools and daycare centers after the occurrence of an index case.

METHOD

The reporting data were taken from SurvStat. The index cases from daycare centers and schools were isolated and the CPs were offered PCR testing for SARS-CoV‑2 on a voluntary basis, regardless of whether symptoms suggestive of SARS-CoV‑2 had occurred or not. Deep nasal/pharyngeal swabs were collected by paramedics on behalf of the public health department of the city of Frankfurt am Main, Germany, and tested according to established standards at two accredited institutes.

RESULTS

From March to 31 December 2020, 22,715 COVID-19 cases were reported in Frankfurt, including 1588 (7.6%) SARS-CoV‑2 detections in children 14 years and younger. Thus, approximately half as many SARS-CoV‑2 detections were reported in children up to 14 years of age than would have corresponded to their proportion in the population. In autumn 2020, the increase in incidence in children over the weeks followed the increase in incidence in the general population, the age-related incidence of children remained below the incidence in the general population.From week 35 to week 52, index cases were reported from 143 daycare centers and 75 schools. As a result, 7915 CPs were tested. In daycare centers, SARS-CoV‑2 was detected in 4.5% of adult CPs and 2.5% of child CPs and in schools SARS-CoV‑2 was detected in 0.9% of adult CPs and 2.5% of student CPs tested. On average, less than 1 CP tested positive per index case. The rate of positive findings increased with increasing incidence in the overall population. No major outbreak occurred.

DISCUSSION

Regarding the level and timing of age-related incidences among children in Frankfurt am Main, there was no evidence that children were the drivers of the pandemic. Only a small percentage of the examined CPs in schools and daycare centers tested positive for SARS-CoV‑2. In the absence of evidence of intense transmission in the facilities, CP attendance can/should continue under hygiene conditions and there is no need to close entire groups, classes, or even facilities.