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SCIENCE – On October 29, Prime Minister Jean Castex unveiled the terms of the new confinement that should stem the second wave of Covid-19 that is sweeping France. With adequate restrictions “on two essential points, school and work”. It was a mistake?
This Friday, November 6, Europe 1 states that the Director-General of Health, Jérôme Salomon, wrote in a confidential note that with the current re-containment there will be a “high and prolonged” plateau of cases (and therefore of deaths). The blame, in particular, on schools and public services has remained open, according to number 2 of the ministry.
A few hours earlier, the Ministry of Education had just tightened the health protocol in high schools. Jean-Michel Blanquer has announced up to 50% of distance training courses to address the worsening of the coronavirus epidemic. When the birth was announced, it was the compulsory mask from 6 years old, compared to 11 years from the beginning of the school year, which was in effect.
Why do these steps just now? Why reduce attendance for high school only? While obviously there is a lot to say about the government’s preparation for the second wave, it should above all be remembered that the link between Covid-19 and school is a very thorny topic. The disastrous effects of a lack of education are well known and documented. But the impact of opening schools is more difficult to establish. Infectiousness of children has been debated in the scientific community since January. And while our knowledge has progressed well, researchers are also still divided.
Children are also affected by Covid-19
Classic respiratory diseases are often very common in young people. It is therefore with surprise that we have witnessed, at the beginning of the coronavirus pandemic, a virtual absence of positive minors. Fortunately, dozens of studies have been published since then on the subject of childhood, Covid-19 and school. We know that the youngest can be infected. We know they can contaminate. We also know that they often have very mild or even asymptomatic symptoms (which explains why they weren’t detected at first).
But while schools are among the places that set off an epidemic for the flu, it is not known if this is the case with the coronavirus. There is no consensus. To schematize, two theses collide. Or the young are not very contaminated and if there can be cases in schools, this is not where the coronavirus will get out of control. Or the reunions of our darlings are time bombs for the epidemic we hadn’t anticipated, especially since schools were closed during the first wave in most countries.
Yet many studies have been published. But recent analyzes attempting to take stock of these studies really disagree. Some (such as that of the epidemiologist Zoë Hyde or the collective of doctors and researchers “On the side of science”) instead conclude that there is a risk of contamination and infectiousness of children equal to that of adults. Others (such as the one carried out by several American pediatricians, or this meta-analysis published on October 29 by three epidemiologists of the Journal of Infectious Diseases) believe that children are less contagious. Or more exactly that contagiousness increases with age, which changes everything.
Small and big deviations
Because one of the main sources of this great vagueness around children mainly concerns their age. Some studies compare people under 18 to adults. Others are age groups from 0 to 4 years, from 5 to 8, from 0 to 11, from 12 to 16. Logic: it depends both on the method chosen, but also on the demographic data available and different age groups in the schools of each country.
On the one hand, advocates of minor contagiousness among the youngest recall that talking about “children” and including all minors is nonsense. In the meta-analysis discussed above, the researchers analyzed numerous studies to find out how much one person infects others. “Several studies suggest that infectivity increases somewhat with age,” the study said. But above all that children under 10 run “significantly” less risk of contracting the infection.
In India, for example, where thousands of contact cases have been tested, if there was a high percentage of young people, the incidence rate is actually much lower among children aged 0 to 4 (6.3 per 10,000) and in 5-17 years (12.7) compared to adults (about 40). Britain also conducted random PCR screening campaigns in its population, remember Alasdair Munro, pediatrician and infectious disease specialist. From 21 August to 1 October, when the second wave begins, very few children under 11 are contaminated. For 17-24 year olds, however, it is not the same thing. I’m above average.
Conflicting studies
“It seems that what the little ones are in the flu, the young adults are at Sars-Cov2,” explains Alasdair Mundo. For the 12 to 16 age group, the results are more mixed between the two. In a more recent survey that analyzes the period from 12 September to 23 October, the strong contamination of young people aged 17-24 is still equally evident, but young people aged 12 to 16 are increasingly contaminated. Infections among the under 11s are also on the rise, similarly to what is happening in the general population.
There may be a biological explanation for this age difference. In a study published in May, scientists found that the receptors the coronavirus binds to to infect human cells (ACE2) were proportional to age. Clearly, the more we grow, the more we will develop these receptors.
However, the fear of injury is still present. “Young children are not very symptomatic and therefore poorly tested. There is also an aversion to the tampon in the nose, so we will only take one tampon. PCRs in children are not really comparable to those in adults ”, specifies HuffPost Michaël Rochoy, general practitioner, co-founder of the Stop-Postillons collective and co-author of the article for the “Du cote de la science” collective. He also notes that in serological studies the difference between adults and children is much less clear. But these studies also have their biases, the meta-analysis authors recall.
School, cause or consequence?
We find this debate again when we try to analyze the role of schools in the pandemic. The collective “On the side of science” recalls that in Sweden, where schools have remained open, the positive rate of children is close to that of adults. A study published on 22 October analyzing the impact of measures taken in 131 countries also concludes that school reopening tends to lead to an increase in the epidemic. But it is difficult to separate it from the removal of other restrictions.
Furthermore, most of the outbreaks were detected in secondary schools (the equivalent of colleges and high schools), recalls the study published in Journal of Infectious Diseases. “The question of making the difference between kindergarten / primary and college / high school may arise, due to the available data, but these, again, are unclear,” estimates Michaël Rochoy.
The debate on schools is similar to that of the chicken and the egg: do schools create homes or feed on a virus already deeply rooted in the territory? There is, however, one thing that most authors agree on: in times of pandemic, schools must adapt. And that’s before it’s too late.
Necessary restrictive measures
“Social distancing, downsizing in the classroom, massive screening, some forty contact cases and wearing a mask” are necessary, the meta-analysis estimates. Who cites an eloquent example: in Germany, where significant restrictive measures are in place, few houses in schools have been identified. And most of it involved cases involving professors.
Zoë Hyde goes further, recommending the same kind of measures when the circulation of the virus is low, but in a situation of high diffusion, schools have to close and classes take place online.
And in France today? “I no longer think it is a health problem, but a political one. The current imprisonment is insufficient, Jérôme Salomon is right. Now we have to give priority to what is superfluous ”, says Michaël Rochoy. “In my opinion, the most important thing is to keep schools as long as possible, especially elementary and nursery schools, given the data we have, even if they are perhaps biased.” But is it still possible given the situation?
The improvement of the health protocol implemented by Jean-Michel Blanquer goes in the right direction. But for the co-founder of the Stop-Postillons collective, this is happening too late. “We have been offering these prevention methods since August: masks, staff restraint, etc. But now, with the current wave, it is too late. Yes, it will work, but what we want today is not something that works. We want something that works. like a spell to avoid a plateau of mortality that promises to be terrible. “
See also on The Huffpost: Concerned about Covid-19, high school students block their school
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