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- Jackson C
- Mangtani P
- Hawker J
- Olowokure B
- Vynnycky E
The way that school-age children transmit coronaviruses such as severe acute respiratory syndrome, Middle East respiratory syndrome, and SARS-CoV-2 within school settings and at the local community level is less clear. Regardless, by mid-March 2020, roughly half of the world’s student population was supposed to stay home. Evidence from human influenza outbreaks (where children are key vectors) indicates that school closings are only effective during low viral transmissivity (defined as reproductive numbers
- RM Wines
- Russell SJ
- Croker H
- et al.
Although the role of children in the transmission of COVID-19 remains unclear (in terms of incubation duration and asymptomatic prevalence), a report suggested that children and young adults (10-19 years) transmit COVID-19 in the same measure as adults.
- YJ Park
- Choe yj
- Park O
- et al.
and therefore, it can be a source of SARS-CoV-2 in home-transmitted groups. However, the data are not consistent with previous studies that reported little evidence of transmission from children to adults.
- Zhu Y
- Bloxham CJ
- Hulme KD
- et al.
This knowledge gap is due in part to the disproportionately low rates of community testing in children and adolescents.
- Lavezzo E
- Franchin E
- Ciavarella C
- et al.
) or presymptomatic individuals. Although mass screening is increasingly seen as a way to address this problem, costs, equipment availability, and implementation compromise the feasibility of this approach. A promising, non-invasive tool that can support the COVID-19 response is the use of wastewater-based epidemiology to enable early identification of local outbreaks and facilitate the targeted use of local clinical trials.
- Pole D
- Quintela-Baluja M
- et al.
SARS-CoV-2 has been identified in feces and urine of adults and children, in asymptomatic individuals and in the presymptomatic stage, with prolonged shedding of the virus in the excreta in the convalescent stage in both adults and children.
- Jones DL
- Baluja MQ
- Graham DW
- et al.
However, little data are available on the levels and duration of shedding in children who do not require hospital treatment.
- Wölfel R
- Corman VM
- Guggemos W.
- et al.
SARS-CoV-2 RNA fragments have been isolated from numerous wastewater treatment works, septic tanks, sewers, hospital wastewater treatment systems, and environmental discharge points.
- Jones DL
- Baluja MQ
- Graham DW
- et al.
and it was reported that it is prior to the clinical diagnosis of the cases,
- Chavarria-Miró G
- Anfruns-Estrada E
- plaster S
- et al.
,
- Medema G
- Heijnen L.
- Elsinga G
- Italiaander R.
- Brouwer A
increase the potential of its use within an early warning system. Data at the local community level has the potential to proactively inform public health care strategies (targeting resources with associated time and cost savings) and mitigate growing demand from healthcare providers, especially during the winter months. However, monitoring the occurrence or prevalence at the entrance of a wastewater treatment plant does not allow the identification of specific population groups, limiting its epidemiological value for the management of COVID-19 and breaking transmission chains. More recently, the epidemiological approach based on wastewater has been used successfully for Near Source Tracking (NST), for example in wastewater drains serving buildings, allowing the detection of small groups or even individual cases of COVID-19. NST, used in combination with specific clinical trials, has clear potential to stop outbreaks and is now used in Estonia, Finland, France, Singapore, Turkey, the United Kingdom, and the United States. NST could be more easily justified for the least sampled and most vulnerable or highest risk groups, such as people in hospitals, prisons, nursing homes, schools (particularly boarding schools), preschool settings, and factories. Although wastewater-based epidemiology cannot replace clinical testing, routine surveillance of wastewater across spatial scales (from sewer to building to building level) could allow early identification of local outbreaks by reporting the specific use of local clinical trials (ie when and where) to capture asymptomatic and presymptomatic cases.
Last month’s experience in most countries where the school year has been restarted is that as community cases increase, more children become infected. The wastewater-based epidemiology used by NST provides public health officials with information on the transport of COVID-19 within discrete groups of people for whom swift action could alleviate the risk of a much larger outbreak. The wastewater NST could be the first line of defense for high-risk populations and could offer long-term advancements in public health surveillance after COVID-19.
We declare that there are no competing interests.
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Posted: October 30, 2020
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DOI: https://doi.org/10.1016/S2666-5247(20)30193-2
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