November 3, 2020

expert reaction to preprint from the OpenSAFELY platform looking at living with children and COVID-19 outcomes

A preprint, an unpublished non-peer reviewed study, from the OpenSAFELY platform, looks at the association between living with children and outcomes from COVID-19.

This Roundup accompanied an SMC Briefing.

Dr Simon Clarke, Associate Professor of Cellular Microbiology at the University of Reading, said:

“It makes sense for schools to remains open since the evidence suggests young children are not big spreaders of Covid-19.  However older teenagers should be counted as potential spreaders, so secondary schools may be problematic.  But even teenagers are likely to have parents who aren’t yet in the older, at-risk group, and are therefore very unlikely to suffer severe health issues if they caught it themselves.  This, added to the other social and educational benefits, shows that there really was little need to close schools even during the first lockdown.

“Complications arise when you consider the risk to older or clinically vulnerable parents, and of course teachers and childcare professionals, without whom you cannot keep schools and nurseries open.  Evidence suggests that classrooms and other learning spaces present a low, but not zero, risk of transmission on the whole, so it will be important that good social distancing and hygiene practices continue to be observed in them to keep it that way.”

Dr David McAllister, Senior Clinical Lecturer and Honorary Consultant (Public Health), University of Glasgow, said:

“This study of 9 million adults in England found no increased risk of COVID-19 infection and a decreased risk of COVID-19 death among adults who shared a household with children under the age of 12.  Strengths of the study include its representativeness and the large sample size, which meant that they were able to examine the risks before and after schools were closed, as well as among people above and below 65 years old, and among those who were shielding.

“Like our own pre-print in over 300,000 Scottish healthcare workers and their households (https://www.medrxiv.org/content/10.1101/2020.09.21.20196428v1), one of the hypotheses that this study tested was that children might exert a protective effect on adults with whom they are in close contact.  The inherent limitations of routine healthcare data (of these the foremost being residual confounding) mean that it is difficult to make strong causal claims from this type of research.  Nonetheless the observation here that COVID-19 mortality was lower among adults who shared a household with children aged 0-11, together with our own finding that COVID-19 infection (and perhaps hospitalisation) was lower in adults sharing a household with children aged 0-11 (in a cohort of healthcare workers and their households), provides a compelling case for further studies in other settings – where both exposure to SARS-CoV-2 and contact with young children are common – in order to address this important causal question.

“Notwithstanding causation, a more straightforward conclusion can be drawn from both this study and our own, namely that sharing a household with school-aged children does not place the adults with whom they live at greater risk.  This observation has crucial implications as societies seek to minimise the harms from COVID-19, while also minimising the indirect harms caused by preventative measures, especially where these harms affect children.”

Preprint (not a paper): ‘Association between living with children and outcomes from COVID-19: an OpenSAFELY cohort study of 12 million adults in England’ by Harriet Forbes et al was posted on medRxiv on Tuesday 3 November 2020.  This work is not peer-reviewed.

https://www.medrxiv.org/content/10.1101/2020.11.01.20222315v1

All our previous output on this subject can be seen at this weblink:

www.sciencemediacentre.org/tag/covid-19

Declared interests

Dr David McAllister: “I collaborate with one of the senior authors of this study.”