COVID-19, Immunodeficiency and School Attendance

18 May 2020

This information has been developed for parents and carers, to guide decisions about school attendance for children with primary immunodeficiency (PID) during the COVID-19 pandemic. Public health measures implemented by Australian and New Zealand governments have been successful in controlling the spread of SARS-CoV-2, the coronavirus that causes COVID-19. This means that plans are being made in most regions to re-open schools for face to face learning.

pdfASCIA PCC COVID-19 Immunodeficiency School Attendance 2020174.15 KB

For parents of more vulnerable children, including those with PID, the decision to send their children back to school is complex. The type and degree of immunocompromise varies widely between children with PID, so it is important to ask your child’s clinical immunologist if you have specific questions.

As schools in Australia and New Zealand re-open, with measures in place to reduce the spread of COVID-19 (and other respiratory infections), we recommend that many children with PID return to school.

This advice is based upon the following facts:

  • Children are far less likely than adults to contract SARS-CoV-2 infection and the risk of severe COVID-19 is very low.
  • Evidence suggests that most immunosuppressed children are not at a significantly higher risk of severe COVID-19 than their age matched peers.
  • Very low rates of community transmission mean that the risk of contracting SARS-CoV-2 infection is currently very low. The improved availability of testing and contact tracing mean that we are well placed to isolate and contain outbreaks as they occur.
  • There is good evidence that children don’t spread SARS-CoV-2 like adults. Child-to-child transmission is rare and it is very unusual for asymptomatic children to spread COVID-19.
  • The low risk of contracting SARS-CoV-2 is likely to persist for many months or even longer, depending upon if, and when a vaccine becomes available. It is not in children’s best interests to exclude them from school indefinitely when the evidence suggests that the risk of developing severe COVID-19 is very low.

We understand there will be questions about this advice and will attempt to answer some questions here.

What evidence suggests that children with PID don’t have an increased risk of severe COVID-19?

ASCIA has been following reports and liaising with colleagues from countries that have been much more severely affected by the pandemic than Australia or New Zealand. An international survey is underway to document how many patients with PID have COVID-19. As of early May 2020, only a small number of patients with known PID have been diagnosed with COVID-19 and there is currently no evidence that children with PID are at increased risk of severe COVID-19.

What is the evidence that transmission of COVID-19 in schools is rare?

There have been a number of studies which have shown that the risk of transmissions in schools is low:

  • The NSW government has released a report regarding their investigation of 15 schools where cases were identified in March 2020. There were only two cases of probable secondary infection among 735 students who were close contacts of known cases (0.2%).
  • A population-based study in Iceland did not detect any cases of asymptomatic infection in children under 10 years of age.
  • International studies have consistently found that it is quite rare for children to infect other children or adults.

What is the Government advice regarding children with complex medical conditions?

  • Australian and New Zealand Governments provide official and up-to-date online advice for people at higher risk of COVID-19.
  • Advice from the Australian Health Protection Principal Committee (AHPPC) on reducing the potential risk of COVID-19 transmission in schools is available here.
  • Advice from the New Zealand government on specific public health control measures to be undertaken in schools to reduce COVID-19 transmission is available here.

Are there any groups of patients who should not return to school?

The type and degree of immunocompromise varies widely between children with PID, so it is important to ask your child’s clinical immunologist if you have specific questions. Advice may differ depending upon the child’s circumstances, infection transmission rates in their community and possibly the state or country they live in.

Is the risk different for primary or secondary school aged children?

There is a slight increase in risk of contracting COVID-19 in secondary school aged children, compared to primary school aged children, and the risk of transmission at school appears to be slightly higher in older teenagers. However, this slight increase in risk is not sufficient to make different recommendations regarding returning to school for these two groups.

Do children have to practice social distancing at school?

Returning to school does not mean that everything will return to normal. There will be an increased focus on handwashing and other hygiene measures.

We understand that social distancing is not practical for younger children, and it does not appear to be necessary, due to low risk of transmission in this age group.

Older students are generally more capable of complying with social distancing recommendations. As students in later secondary years probably do have a slightly higher risk of contracting the virus from other students, older children should make every effort to follow recommendations regarding regular handwashing and social distancing.

The greatest risk for school outbreaks remains adults. Therefore, it is very important that parents comply with restrictions to minimise contact they have with other parents, teachers and students in the school environment.

Should children wear masks at school?

The role of masks has attracted a lot of attention in the media. The use of masks has mostly been recommended in countries where there is widespread community transmission, to reduce spread of the virus.

It is understood that the potential benefit of widespread use of masks is to reduce the risk of asymptomatic adults spreading the virus, rather than protecting someone from contracting the virus.

Therefore, wearing a mask at school is unlikely to provide any additional protection for your child.

Further information

This information has been adapted with permission from the Australian & New Zealand Children’s Haematology/Oncology Group (ANZCHOG) oncology and bone marrow transplant (BMT) advice.

The ASCIA COVID-19 webpage www.allergy.org.au/members/covid-19 is regularly reviewed and updated.

© ASCIA 2020

ASCIA is the peak professional body of clinical immunology/allergy specialists in Australia and New Zealand.

ASCIA resources are based on published literature and expert review, however, they are not intended to replace medical advice. The content of ASCIA resources is not influenced by any commercial organisations.

For more information go to www.allergy.org.au

To donate to immunology research go to www.allergyimmunology.org.au 

Mod ASCIA Member
Donate to AIFA
go to NAS website
Member Login
ASCIA Update

Information for the community about allergic diseases, immunodeficiencies and other immune diseases.
See latest edition here...
Join our mailing list:

About ASCIA

ASCIA is the peak professional body of clinical immunology and allergy in Australia and New Zealand
ASCIA promotes and advances the study and knowledge of allergy and other immune diseases

Quick Links

About ASCIA

ASCIA is a registered trademark of the Australasian Society of Clinical Immunology and Allergy. All content is subject to copyright for the Australasian Society of Clinical Immunology and Allergy. Read more...

The content for the website is developed and approved by ASCIA Committee and ASCIA Working Party Members. Read more...

Disclaimer I Privacy

The ASCIA website is intended for use by ASCIA members, health professionals and the general public. The content provided is for education, communication and information purposes only and is not intended to replace or constitute medical advice or treatments. Read more...

ASCIA respects your privacy. Read our privacy policy here...

Sponsors | Advertising

ASCIA does not endorse products from sponsoring organisations, nor is it influenced by sponsoring organisations with regard to the content of education programs and websites. 

The ASCIA website does not accept advertising. Any link to a third-party website does not imply any endorsement by ASCIA.

Accreditiation

healthdirect

This website is certified by Health On the Net Foundation. Click to verify. This site complies with the HONcode standard for trustworthy health information: verify here.