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      Children and adolescents in the CoVid-19 pandemic: Schools and daycare centers are to be opened again without restrictions. The protection of teachers, educators, carers and parents and the general hygiene rules do not conflict with this Translated title: Kinder und Jugendliche in der CoVid-19-Pandemie: Schulen und Kitas sollen wieder uneingeschränkt geöffnet werden. Der Schutz von Lehrern, Erziehern, Betreuern und Eltern und die allgemeinen Hygieneregeln stehen dem nicht entgegen

      * , 1 , 2 , 2 , 1 , 1 , 3 , 3 , 4 , 5 , * , 4 , German Society for Hospital Hygiene (DGKH), German Society for Pediatric Infectious Diseases (DGPI), German Academy for Pediatric and Adolescent Medicine (DAKJ), Society of Hygiene, Environmental and Public Health Sciences (GHUP), Professional Association of Pediatricians in Germany (bvkj e.V.)

      GMS Hygiene and Infection Control

      German Medical Science GMS Publishing House

      SARS-CoV-2, children, adolescents, school, kindergarten

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          Abstract

          In the opinion of the medical societies of hygiene and pediatrics undersigning the present statement, the analyses published to date regarding transmission of SARS-CoV-2 and the course of CoVid-19 show that children play a much less significant role in the spread of the virus than do adults.

          According to the findings available to date, not only do children and adolescents less frequently fall ill with CoVid-19, they also generally become less severely ill than do adults. The vast majority of infections in children and adolescents are asymptomatic or oligosymptomatic. Even the first analyses from China demonstrated that children and adolescents play a subordinate role in the transmission of the virus – not only to other children and adolescents, but also to adults.

          Taking into account regional infection rates and available resources, daycare centers, kindergartens and elementary schools promptly should be reopened. For children, this should be possible without excessive restrictions, such as clustering into very small groups, implementation of barrier precautions, maintaining appropriate distance from others or wearing masks. A factor more decisive than individual group size is the issue of sustaining the constancy of respective group members and the avoidance of intermixing. Children can be taught basic rules of hygiene such as handwashing and careful hygiene behavior when coming into contact with others during mealtimes and/or when using sanitary facilities. Independent of the prevention measures implemented for children and adolescents, the protection of teachers, educators and caregivers is crucial, (e.g., the maintenance of appropriate distance from others, use of medical masks, situation-dependent hand disinfection, when necessary, supported by regular pool testing). Children over the age of 10 and adolescents up to school graduation age are more capable of actively understanding and conforming to specific hygiene rules. For this group, maintaining appropriate distance from others (1.5 meters), wearing a mouth-and-nose protection (whenever they are not sitting in their assigned classroom seats) and consistent education regarding the basic rules of infection prevention may provide increased options for normalizing teaching activities. Children and adolescents suspected of infection with SARS-CoV-2 should be tested immediately in order to either confirm or rule out such an infection. Evidence of individual infections in children or students must not automatically lead to the closure of the entire daycare center or school. A detailed analysis of the chain of infection is a prerequisite for a balanced approach to infection control. The opening of schools and children’s facilities should be accompanied by specifically structured, model surveillance studies that further clarify outstanding questions about infectious disease events and hygiene control. These prospective, concomitant examinations will be essential for the purpose of evaluating and verifying the effectiveness of the required hygiene measures.

          Zusammenfassung

          Nach Ansicht der unterzeichnenden Hygiene- und Pädiatrie-Fachgesellschaften zeigen die bislang veröffentlichten Analysen über die Ausbreitungsdynamik von SARS-CoV-2 und die Verläufe von CoVid-19, dass Kinder im Vergleich zu Erwachsenen eine deutlich untergeordnetere Rolle in der Verbreitung des Virus einnehmen.

          Kinder und Jugendliche erkranken nach den bislang vorliegenden Erkenntnissen nicht nur seltener, sondern auch im Falle einer Infektion in der Regel weniger schwer als Erwachsene. Die übergroße Mehrzahl der Infektionen im Kindes- und Jugendalter verläuft asymptomatisch oder oligosymptomatisch. Zusätzlich belegen bereits die ersten Analysen aus China, dass Kinder und Jugendliche bei der Virusübertragung auf andere Kinder und Jugendliche, aber auch auf Erwachsene eine untergeordnete Rolle spielen.

          Kitas, Kindergärten und Grundschulen sollen zeitnah – unter Berücksichtigung der regionalen Neuinfektionsrate und der vorhandenen Kapazitäten – wieder eröffnet werden. Dies ist auf Seiten der Kinder ohne massive Einschränkungen, zu denen z.B. Kleinstgruppenbildung und Barriereschutzmaßnahmen wie Abstandswahrung und Maskentragen gehören würden, möglich. Entscheidender als die individuelle Gruppengröße ist die Frage der nachhaltigen Konstanz der jeweiligen Gruppe und Vermeidung von Durchmischungen. Kinder können in Grundregeln der Hygiene wie Händewaschen und achtsames Hygieneverhalten im Umgang miteinander, beim Essen und in den Sanitäreinrichtungen spielerisch und kindgerecht unterwiesen werden. Unabhängig von den bei Kindern und Jugendlichen umgesetzten Präventionsmaßnahmen ist der Schutz des Lehr-, Erziehungs- und Betreuungspersonals ganz entscheidend (Abstandswahrung untereinander, Mund-Nasen-Schutz, situationsabhängige Möglichkeit zur Händedesinfektion, ggfls. unterstützt durch regelmäßige Pooltestung). Kinder im Alter über 10 Jahre und Jugendliche bis zum Schulabschluss können aktiver in konkrete Hygieneregeln einbezogen werden. Hier erlauben eine weitgehende Abstandswahrung (1,5 m), das Tragen einer Mund-Nasen-Bedeckung (solange die Schüler nicht an dem ihnen zugewiesenen Platz sitzen) und die konsequente Erziehung in den Grundregeln der Infektionsprävention größere Spielräume für eine Normalisierung des Unterrichtsbetriebes. Kinder und Jugendliche mit V.a. eine SARS-CoV-2-Infektion sollen unverzüglich untersucht werden, um eine solche Infektion zu sichern oder auszuschließen. Der Nachweis einzelner Infektionen bei Kindern oder Schülern darf nicht automatisch zur erneuten Schließung der gesamten Kita oder Schule führen. Eine detaillierte Analyse der Infektionskette ist Voraussetzung für ein abgewogenes Infektionsmanagement. Die Öffnung der Schulen und Kindereinrichtungen sollte durch strukturierte wissenschaftliche Surveillance-Untersuchungen exemplarisch begleitet werden, die die noch offenen Fragen zum infektiologischen Geschehen und Hygienemanagement weitergehend abklären. Diese prospektiven und begleitenden Untersuchungen sind essentiell, um die Wirksamkeit der bereits jetzt geforderten Hygienemaßnahmen zu evaluieren und zu verifizieren.

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          Flash Survey on SARS-CoV-2 Infections in Pediatric Patients on anti-Cancer Treatment

          Introduction Since the beginning of COVID-19 pandemics, it is known that the severe course of the disease occurs mostly among elderly, whereas it is rare among children and young adults. Comorbidities, in particular diabetes and hypertension, clearly associated with age, besides obesity and smoke are strongly associated with the need of intensive treatment and a dismal outcome. A weaker immunity of the elderly has been proposed as a possible explanation of this uneven age distribution. Along the same line, anecdotal information from Wuhan, China mentioned a severe course of COVID-19 in a child treated for leukemia. Aim and methods We made a flash survey on COVID19 incidence and severity among children on anticancer treatment. Respondents were asked by email to fill in a short web based survey. Results We received reports from 25 countries, where approximately 10,000 patients at risk are followed. At the time of the survey, over 200 of these children were tested, nine of whom were positive for COVID-19. Eight of the nine cases had asymptomatic to mild disease and one was just diagnosed with COVID-19. We also discuss preventive measures that are in place or should be taken as well as treatment options in immunocompromised children with COVID-19. Conclusion Thus, even children receiving anti-cancer chemotherapy may have a mild or asymptomatic course of COVID-19. While we should not underestimate the risk of developing a more severe course of COVID-19 than observed here, the intensity of preventive measures should not cause delays or obstructions in oncological treatment.
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            COVID-19 in Children With Cancer in New York City

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              Pandemic school closures: risks and opportunities

              The novel coronavirus disease 2019 (COVID-19) has swept across 210 countries and territories with over 1·2 million cases and 67 594 deaths reported by April 6, 2020. Most countries have implemented social distancing measures to curb the spread of infection and minimise the impact of the virus. 188 countries have implemented country-wide school closures, but a modelling study by Ferguson and colleagues concluded that in the UK, school closures alone will reduce COVID-19 deaths by only 2–4%. Most evidence for school closures has come from influenza outbreaks such as the 2009 H1N1 influenza pandemic in which children were disproportionately affected. During that time, the US closed 700 schools but the response was local and only for a couple of weeks. To tackle COVID-19, Chinese schools have been closed for more than 2 months, and many countries have closed their schools and colleges indefinitely. Despite increasing reports of some children with underlying conditions experiencing serious illness and even death, the vast majority of children and adolescents experience mild symptoms in response to SARS-CoV-2 infection. With over 90% of the world's students (more than 1·5 billion young people) currently out of education, it's clear that the greatest threats from COVID-19 to children and adolescents lie outside the clinic. A systematic review by Russell Viner and colleagues, published on April 6, assessed findings from 16 studies looking at the effects of school closures on coronavirus outbreaks in China, Hong Kong, and Singapore. They found limited benefit on slowing the spread of the virus, and the authors stress that closures must be considered within the wider context of loss of essential workers due to childcare demands, restrictions in learning, socialising, and physical activity for pupils, and the substantial risks to the most vulnerable children, including those in low-income settings. Following school closures amidst the west African Ebola epidemic, rates of child labour, neglect, sexual abuse, and adolescent pregnancies spiked, and many children never returned to school. Many children will suffer from a lack of access to school-provided social assistance, such as free lunches or clean water and washing facilities. Those engaged with school-facilitated health care, such as vaccinations and mental health services, may miss out on vital health provisions. Children confined at home will struggle to achieve the WHO 24 h movement behaviour guidelines which recommend 60 minutes a day of moderate-to-vigorous physical activity for 5–17 year olds. This jeopardises not only young people's mental wellbeing and healthy weight status, but also increases the risk of establishing dangerous habits, such as increased screen time and snacking that can damage future cardiovascular and musculoskeletal health. For adolescents, school closures and social distancing may be particularly challenging. During adolescence young people grow in independence and begin to prioritise connections with peers over parents—disruption of these can pose significant challenges to young people's wellbeing. Adolescents may also be grieving for the rites of passage they were due to experience and feeling apprehensive about an uncertain future in the face of cancelled exams. Anxiety might also arise in older children and adolescents as they try to understand the pandemic and the threat it poses to them, their families, and friends. Public health officials must prioritise national plans for how and when to reopen schools, with consideration of alternative measures such as reduced hours or staggered lessons. Many children will likely require support as they transition back to normal life, especially those who have experienced bereavement. In the meantime, the pandemic offers an opportunity for young people to develop and hone their resilience and adaptability, and appreciate the value of social responsibility and self-sacrifice for the protection of the most vulnerable. Many inspirational young people are rising up to drive the COVID-19 response in their communities. Xian Lu, who moved to Wuhan to cook 400 meals a day for medical personnel during the city's peak crisis, is one of ten young people recently recognised by Jayathma Wickramanayake, the UN Secretary General's Envoy on Youth for their efforts in fighting the pandemic. It is imperative that we validate the experiences of the young during this global crisis, that we listen to their creative solutions for coping and connecting, and that we empower them to utilise their new skills to create a more robust, caring, and connected society as we emerge into the changed world. © 2020 John Birdsall Social Issues Photo Library/Science Photo Library 2020 Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
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                Author and article information

                Journal
                GMS Hyg Infect Control
                GMS Hyg Infect Control
                GMS Hyg Infect Control
                GMS Hygiene and Infection Control
                German Medical Science GMS Publishing House
                2196-5226
                28 May 2020
                2020
                : 15
                Affiliations
                [1 ]German Society for Hospital Hygiene (DGKH), Berlin, Germany
                [2 ]German Academy for Pediatric and Adolescent Medicine (DAKJ), Berlin, Germany
                [3 ]Professional Association of Pediatricians in Germany (bvkj e.V.), Cologne, Germany
                [4 ]German Society for Pediatric Infectious Diseases (DGPI), Berlin, Germany
                [5 ]Society of Hygiene, Environmental and Public Health Sciences (GHUP), Munich, Germany
                Author notes
                *To whom correspondence should be addressed: Arne Simon, Deutsche Gesellschaft für Pädiatrische Infektiologie (DGPI), Chausseestr. 128/129, 10115 Berlin, Germany, E-mail: arne.simon@ 123456uks.eu
                Article
                dgkh000346 Doc11 urn:nbn:de:0183-dgkh0003467
                10.3205/dgkh000346
                7273848
                Copyright © 2020 Walger et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

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                sars-cov-2, children, adolescents, school, kindergarten

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