key: cord-0760703-2qbvlv8f authors: Friedman, Nir; Levy, Nitai; Kaplan, Or; Padeh, Gabi; Krupik, Danna; Jacob, Ron; Gamsu, Shirly; Weiser, Giora; Cohen, Naama Kuchinski; Schnapp, Zeev; Cohen, Noy; Feldman, Oren; Porat, Danit; Gal, Moran; Gleyzer, Alexandra; Capua, Tali; Klein, Adi; Sharkansky, Livnat; Shilo, Smadar; Grotto, Itamar; Kozer, Eran; Shavit, Itai title: Pediatric Hospitalizations after School Reopening during the SARS-CoV-2 Alpha (B.1.1.7) Variant Spread: A Multicenter Cross-sectional Study in Israel date: 2022-01-29 journal: Clin Infect Dis DOI: 10.1093/cid/ciac065 sha: 195d1e4716e43f51ccd6806bcce07295dc1fd21b doc_id: 760703 cord_uid: 2qbvlv8f This multicenter, cross-sectional study provides evidence on SARS-CoV-2-associated ED visits and hospitalizations in pediatric wards and intensive care units, after school reopening during the SARS-CoV-2 Alpha (B.1.1.7) variant spread in Israel. Study findings suggest that school reopening was not followed by an increase in SARS-CoV-2-related pediatric morbidity. One of the measures to control the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was closure of schools and daycares (SDC). Reopening of SDC is a priority because of the potential lifelong impact on children and families [1] ; however, it might be associated with increased pediatric morbidity. On late December 2020 the first cases of the Alpha (B.1.1.7) variant were detected in Israel, where it shortly became the predominant variant. Cases steadily increased, reaching over 3,000 new cases daily and a test positivity rate over 5%, justifying closure of the education system. A lockdown was imposed on January 8, 2021. As of late January, the daily number of new SARS-CoV-2 cases started to steadily decline. Phased reopening of SDC began on The study included all patients younger than 18 years of age who visited EDs from home isolation or due to SARS-CoV-2 infection, and all patients who were hospitalized in a pediatric ward or an ICU due to SARS-CoV-2 infection, or diagnosed with Multisystem A hyperinflammatory condition in children and adolescents that typically occurs within four During the 14-week study period, the percentage of the total population vaccinated with two doses of the BNT162b2 mRNA vaccine increased from 40.15% to 55.32%. The weekly number of new SARS-CoV-2 patients in the Israeli population decreased from 26,228 to 86, and the test positivity rate decreased from 4.7% to 0% ( Figure 1A ). Overall, 749 children visited the EDs of the 17 participating hospitals during the 14-week study period, 220 patients with known SARS-CoV-2 infection, 397 patients referred from home isolation, and 132 who tested positive for SARS-CoV-2 in the ED. None of the 16-18year-old patients had received the SARS-CoV-2 vaccine. During these 14 weeks, the weekly number of known SARS-CoV-2 patients who visited the EDs decreased from 68 to 0, the weekly number of children who were referred to the EDs from SARS-CoV-2 isolation decreased from 127 to 1, and the weekly number of patients who tested positive for SARS-CoV-2 in the ED decreased from 30 to 0 ( Figure 1B) . During the 14-week study period, the weekly number of children in the pediatric wards and ICUs decreased from 52 to 0 and from 12 to 0, respectively. The weekly number of children with MIS-C decreased from 9 to 0 ( Figure 1C ). Thirty MIS-C patients were admitted to ICU, and 13 required inotropic or vasoactive support. All the patients recovered and none required extracorporeal membrane oxygenation (ECMO) support. initiation. The findings revealed that children did not greatly contribute to household clusters of infection even when schools were opened [7] . Another study prospectively assessed the risk of SARS-CoV-2 transmission in summer schools, and found that transmission rates to other children and adults were low [8] . A study that assessed the number of SARS-CoV-2 infections that occurred in schools, reported low transmission rates [9] . Our study has several limitations. Firstly, due to the mild illness in most cases, it is possible that some SARS-CoV-2 patients were not diagnosed. As ED protocols did not change throughout the pandemic, we believe that this limitation had no effect on the results. Secondly, the study included 83% of the SARS-CoV-2-related pediatric ED population of Israel and not all of it [6], although we believe that this large sample was representative of the entire population. Thirdly, since this is a single-country study our conclusions may not be generalizable to other countries. In conclusion, we found that the reopening of SDC was not followed by an increase in SARS-CoV-2-related pediatric morbidity. Study findings provide observational evidence for a safe reopening of SDC. Funding: For all 22 authors, no honorarium, grant, or other form of payment was given to produce the manuscript. Pediatric Emergency Department Beer Sheva, Israel 4. Emergency Department, Schneider Children's Medical Center Pediatric Emergency Department Pediatric Emergency Department Pediatric Emergency Department Schools Closures During the SARS-CoV-2 Pandemic: A Catastrophic Global Situation Partner updates: case definition for MIS-C Guidance for COVID-19 Prevention in K-12 Schools Characteristics and Disease Severity of US Children and Adolescents Diagnosed With SARS-CoV-2 Emergency Room Visits Summary 2019. Formal report, State of Israel, Ministry of Health Household Severe Acute Respiratory Syndrome Coronavirus 2 Transmission and Children: A Network Prospective Study Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 Infection Among Children in Summer Schools Applying Stringent Control Measures in A c c e p t e d M a n u s c r i p t