In an urgent attempt to curb the spread of SARS-CoV-2, K-12 schools across the U.S. have swiftly shut down and remained closed for approximately 2 months. As many countries have entered or are planning to enter a gradual reopening phase, clinical studies have found that children mainly have low transmission rates as well as asymptomatic to mild disease. As such, policymakers, healthcare systems, and educational institutions are considering reopening schools for fall 2020.



UPDATE: As of September 1, 2020, New York City schools are reopening September 16th with the first week being remote then after that there will be cohorts. Students get to choose if they want to be fully remote or in-person (hybrid). Students can go to remote learning anytime they choose if they do not feel comfortable being in the classroom once they are in. But, they are unable to go back into the classrooms once they are out. 

Re-opening Schools for Fall 2020 During COVID-19 Pandemic

- ANNALS Academy of Medicine Singapore
- Annals of Internal Medicine
- CBS News
- Epidemiology and Infection
- JAMA
- medRxiv
- Health and Place
- Wiley
- Eurosurveillance
- The Lancet Infectious Diseases
- The Lancet Child & Adolescent Health
- The Lancet Public Health 
- The Journal of Hospital Infection
- Journal Of Parenteral And Enteral Nutrition
- Italian Journal of Pediatrics
- The Journal of Pediatrics
- GMS Hygiene and Infection Control
- Morbidity and Mortality Weekly Report 
- Medical Journal 
- Collegian 
- American Academy of Pediatrics
- The British Medical Journal (BMJ) 

References for Re-opening Childcare/ Educational Environments During the COVID-19 Pandemic by Journal

Based on the present knowledge of health professionals as of May 19, 2020 children get COVID-19 less frequently and less severely than adults, as such, daycares should be reopened. Especially for kids under the age of 10, current data shows a lower rate of transmission. Taking into account that there is a lack of evidence for the transmission of an infected child to an adult and that a large majority of infections in children are asymptomatic or minor, reopening daycare centers is possible without excessive restrictions. 

Reopening Daycare Centers During the COVID-19 Pandemic

- SARS-CoV-2 Transmission and Infection Among Attendees of An Overnight Camp - Georgia, June 2020

Studies On Re-opening of Summer Camps During COVID-19 Pandemic 

The college/university settings pose unique challenges to the management of students and faculty/staff during the COVID-19 pandemic. The dense populations and close-quarters of residential environments on most college campuses create high risks for viral transmission. On the other hand, college students may be more willing to follow proper safety protocol instituted by a college and may be more able to handle remote learning when necessary. 

Reopening Colleges/Universities for Fall 2020 during the COVID-19 Pandemic

References for Re-opening Childcare/ Educational Environments During the COVID-19 Pandemic by News/Other Source

- Schools (K-12)

- Universities/Colleges

- Summer Camps

- Daycares

- Nurseries

Syracuse University

Smith College

- Case Demographics of Patients
- Categorized by Geographic Location
- Communicable Period
- Control Strategies
- Disparate COVID-19 Outcomes
- Fatality
- Interventions
- Patient Comorbidities
- Patient Laboratory Results
- Psychological effects
- Recovery & Rehabilitation
- Re-opening of Childcare/ Educational Environments
- Secondary Infections
- Signs
- Symptomology
- Time from Onset to Reporting
- Telehealth (telemedicine)
- Transmission
- Risk Factors
- COVID-19 Vaccination Uptake

Focuses of Epidemiological studies on COVID-19

Due to differences in testing and case definitions, as well as how new COVID-19 is, the fatality of the virus is not well-defined yet.

Fatality of COVID-19

Countries have implemented multiple control strategies for reducing the spread of COVID-19, such as closing schools and businesses to enforce social distancing.

Struggle pertaining to controlling the virus:
The epidemiology of the respiratory virus changes rapidly. Reponses have to be nimble. Given that everyone is susceptible to for which we lack effective biologic interventions, the response has required large-scale behavior change, including social distancing and public masking.

Control Strategies for COVID-19

- Age
- Education
- Employment
- Ethnicity
- Gender
- Income
- Marital status
- Race





Case Demographics of Patients with COVID-19

- Asia
- Africa 
- North America
- South America
- Europe
- Australia & Oceania 

Epidemiological studies on COVID-19 Categorized by Continents

The progression of COVID-19 varies greatly by individual and demographic, as do many of the factors related to the disease. Studies have been analyzing the disease progression timeline, or the time frames before patients feel symptoms, are admitted to the hospital, are admitted to the ICU, are put on a mechanical ventilator, experience acute respiratory distress syndrome, etc. Not every COVID-19 case will reach each of these events.

COVID-19 Clinical Disease Progression Timeline

- 0-19 (n=123): 0%
- 20-44 (n=705): 0.1–0.2%
- 45-54 (n=429): 0.5–0.8%
- 55-64 (n=429): 1.4–2.6%
- 65-74 (n=409): 2.7–4.9%
- 75-84 (n=210): 4.3–10.5%
- greater than or equal to 85 (n=144): 10.4–27.3%
- Total (n=2,449): 1.8–3.4%

Case-Fatality Among COVID-19 Patients in the United States by Age

Following a primary infection of SARS-CoV-2, some patients acquire a secondary infection of SARS-CoV-2, or a co-infection with a different bacteria or virus

Secondary/Co-Infections of COVID-19

COVID-19 patients have gone through laboratory testing to determine the impact and extent of SARS-CoV-2 on the body.

COVID-19 Laboratory Results

The spread of the SARS-CoV-2 virus has produced or highlighted disparate outcomes of different types between population groups all over the world. Health disparities can highlight inequitable access, treatment, etc. within a country or state and often indicate the need for public health intervention.

Disparate COVID-19 Outcomes

Due to the varying experiences for those with COVID-19, recovery and rehabilitation look different for many individuals. As a baseline, "for persons recovered from COVID-19 illness, CDC recommends that isolation be maintained for at least 10 days after illness onset and at least 3 days (72 hours) after recovery. Illness onset is defined as the date symptoms begin. Recovery is defined as resolution of fever without the use of fever-reducing medications with progressive improvement or resolution of other symptoms. Ideally, isolation should be maintained for this full period to the extent that it is practicable under rapidly changing circumstances."

COVID-19 Recovery & Rehabilitation

- Resuscitation
- Convalescent Plasma (CP) Transfusion

COVID-19 Patient Interventions

The seroprevalence of COVID-19 is the measurement of the level of the pathogen in a population. There have been difficulties with estimating the seroprevalence in large populations because of the unknown qualities of COVID-19, expense in widespread population collection, asymptomatic infection, etc.

Seroprevalence of SARS-CoV-2 (COVID-19) 

A communicable period is defined as the interval from the first day of positive ribonucleic acid test to the first day of continuous negative test. For COVID-19, the communicable period has been established as two days before onset of symptoms until three days of symptom relief and no fever. 

Communicable Period of COVID-19

- Fever (when high temperature is measured)
- Laboratory confirmation of illness via viral testing
- Radiological lung abnormalities such as ground-glass chest and stripe shadowing


Clinical Characteristics of Asymptomatic COVID-19 Patients

Telehealth are health-related services and information through electronic communication technologies to help patients with or people influenced by COVID-19. It allows long-distance patient and clinician care, education, and monitoring. Telemedicine is sometimes used as a synonym, or is used in a more limited sense to describe remote clinical services, such as diagnosis and monitoring. 

Telehealth (telemedicine) and COVID-19

Presence and severity of symptoms of COVID-19 depend largely on individual characteristics. COVID-19 produces both symptomatic and asymptomatic infection.

Symptomology of COVID-19 

The psychological effect COVID-19 is having on the populations affected by the pandemic

Psychological Effects of COVID-19 Pandemic

COVID-19 comorbidities are high risk conditions that put patients at greater risk for infection and negative outcomes. Some COVID-19 comorbidities have been found to be: 
- Cancer 
- Cardiovascular Disease
- Diabetes
- Digestive Diseases
- HIV
- Hypertension
- Immunological Disease
- Liver Injury
- Obesity
- Renal disease
- Respiratory System Disease

COVID-19 Patient Comorbidities

Re-opening Childcare/ Educational Environments

COVID-19 is spread through person-to-person transmission. The virus spreads mainly through close personal contact (such as when people are within 6 feet of one another) and through the respiratory droplets of someone infected with COVID-19.  Aerosol transmission is also likely, but the relative contribution of these smaller respiratory particles is not completely understood. While less common, spreading can also occur when people touch contaminated objects or surfaces and then their faces, eyes, or mouth. 

Transmission of COVID-19

- smoking
- high BMI
- old age
- congregate housing
- environmental conditions
- Immune system conditions

Risk Factors For COVID-19

We can explore factors that affect the uptake of established adult vaccinations to inform efforts of COVID-19 vaccine acceptance. 

- Social Factors 
- Knowledge, Attitudes, and Beliefs
- Racial Factors
- Age

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