School, reservoir for viruses: chiseled by seasonal epidemics of influenza and gastroenteritis, the image dies hard. Except with the Sars-CoV-2, the rule suffers exception. According to the researchers, the child is not the main vector of propagation of the epidemic. Subject to compliance with barrier gestures and screening of patients, Professor Michel Tsimaratos, head of the multidisciplinary pediatrics department at the Marseille hospital of Timone (AP-HM), believes that returning to class does not compromise the control of the epidemic. It is even, according to this member of the European Academy of Pediatrics, a public health imperative.

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Is it dangerous for children to go back to school?

I am convinced not. Data from Public Health France attest to this: children contract Covid less easily than adults. Importantly, when they are infected, the vast majority of children report little or no symptoms. In children under 15 years of age, severe forms, such as Kawasaki disease, which we do not yet know very well why they are linked to an infection by Sars-CoV-2, are extremely rare.

But does the risk of contamination exist?

We cannot exclude it. There is now a scientific consensus to say that the risks of transmission of the virus are high in closed places with high human density. It is clear between adults. It is less so among children. According to several American and German studies, the viral load of an infected child is comparable to that of an adult. We can therefore think that their contagious potential is similar. But there is also a noticeable difference: Since they often have few or no symptoms, children might be less likely to project infectious droplets into their surroundings.

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What precautions should I take?

If the barrier gestures are respected, starting with hand washing, there is undoubtedly much less risk of transmission from child to child and from child to adult – therefore from student to teacher. Conversely, the risk of a child being infected by a sick adult justifies, from my point of view, the wearing of a mask by teachers and school staff. In the family context, this implies taking precautions, the contagiousness being maximum two days before and up to eight days after the appearance of the first symptoms. The case of a sick parent should also be considered. It would then be preferable for her children to stay at home for fourteen days. To the parents of my patients, I say: put your children in school. On the other hand, protect yourself by putting on a mask outside the home and washing your hands frequently, especially if there are elderly people or people with co-morbidities around.

Social distancing cannot be ensured in schools, should children be required to wear a mask to limit the circulation of the virus?

Not at any age. In most countries, wearing a mask is recommended from the end of primary school. Before, it’s probably unnecessary. The child would spend his time touching it with his hands, which would make it ineffective! The mask can be recommended when there is a possible concentration of sick people. But a class is not the same as a meeting between people who meet occasionally. In a classroom, if no child has symptoms within a week or two of re-entry, the risk of transmission is probably very low. However, if children go to school by public transport, it is advisable for them to put on a mask from the age of 10 or 11.

In the event of proven contamination of a student or a teacher, do you think it wise to close the establishment?

No. If a child is symptomatic, they should be tested and kept at home as long as they are contagious. Obviously, if there are several children who declare the Covid at the same time, the question may arise of screening the whole class and placing it in quarantine. But if no one has any symptoms, I don’t see the point: the most likely is that the children will immunize themselves gently. Subject to respect for barrier gestures, there is no reason for schools to become reservoirs for viruses. It is undoubtedly easier there than in other places to go up and break the chains of contamination. In my opinion, closing schools poses a much greater risk to children’s health than Covid.

What do you mean ?

We will have to closely study the place that screens and desocialization occupied during confinement. For children, starting with the youngest, socialization is essential. At this stage of their development, they suffer much more from the scarcity of social interactions, from their intellectual and cultural environment, than from Covid. In my opinion, the risks of dependence on screens and certain forms of abuse present a greater health risk for them than that linked to the virus.

Nathalie Raulin


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