Living rapid review update 18: what is the specific role of schools and daycares in covid-19 transmission?
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Centre for Public Health, Queen's University Belfast United Kingdom
National Collaborating Centre for Methods and Tools, McMaster University
National Collaborating Centre for Methods and Tools, McMaster University Canada
McMaster University
Publication date: 2023-04-26
Popul. Med. 2023;5(Supplement):A442
Countries have implemented various policies to tackle the COVID-19 pandemic. As pandemic conditions evolved and the body of evidence grew, the question of how to safely operate schools and daycares remained unanswered. To support evidence-informed decision-making, the National Collaborating Centre for Methods and Tools maintained a living rapid review to synthesize evidence on the role of schools and daycares on COVID-19 transmission. The search included 31 databases and grey literature sources, including Medline, Embase, PsycINFO, ERIC and medRxiv. Included studies reported data from 2021 forward on transmission (number of cases, cases/population or secondary attack rates (SAR)) within schools/daycares, the impact of infection prevention and control (IPAC) measures on transmission within schools/daycares, or the impact of operating schools/daycares on community transmission. All studies were critically appraised, and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. In the most recent update (December 2022), 58 single studies and 7 syntheses were identified. Results illustrate that SARs are low within school settings when IPAC measures are in place (certainty: moderate). Regarding IPAC measures, face masks may reduce the risk of transmission (certainty: low), test-to-stay policies may not increase transmission risk vs mandatory quarantine (certainty: low), cohorting and hybrid learning may make little to no difference in transmission (certainty: low), and the impact of surveillance testing within schools remained inconclusive (certainty: low). Incidence rates among students and staff were similar to community trends, indicating that school settings do not meaningfully contribute to community incidence, hospitalizations or mortality (certainty: low). The 18th update to this living review includes higher-quality surveillance data and whole-genome sequencing studies, which build upon early case reports and prevalence studies to increase the certainty of findings. Living reviews may help to support ongoing decision-making in the context of evolving pandemic conditions.