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Open Schools, Covid-19, and Child and Teacher Morbidity in Sweden


to the Editor:

In mid-March 2020, several countries decided to close schools in an effort to limit the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (Kovid-19). Made.1,2 Sweden was one of the few countries that decided to keep preschools (usually caring for children between 1 and 6 years old) and schools (with children between 7 and 16 years old) open. Here, we present data on Kövid-19 from Sweden among children aged 1 to 16 years and their teachers. In Sweden, Kovid-19 prevailed in the community during the spring of 2020.3 In Sweden social distinctions were encouraged, but not wearing a face mask.3

Data on Critical Kovid-19, as defined by the Intensive Care Unit (ICU) admission, were prospectively recorded in the Swedish intensive care registry nationwide. We followed all children who were admitted to the ICU from 1 March to 30 June 2020 (school ended around 10 June), with laboratory-verified or medically verified Kovid-19, Including patients who were admitted to multisystem inflammatory syndrome in children. C, which is likely to be related to Kovid-19)4 According to the Swedish Pediatric Rheumatology Quality Register. (More information on the registry and link to the scientific acronym Health Organization on MIS-C is provided Supplementary Addendum, With the full text of this paper available at NEJM.org.) The Stockholm Ethics Review Board approved the study. Informed consent was abolished by the review board.

Characteristics of children with CIS-19, including MIS-C, admitted to the Swedish ICU in March – June 2020.

The number of deaths due to any cause among 1,951,905 children (as of December 31, 2019) in Sweden from age 1 to 16 was 65 during the pre-Kovid-19 period of February 2019, 69 during February 2020 and 4 months was. Kovid-19 (March through March 2020) exposed (see) Supplementary Addendum). From March to June 2020, a total of 15 children, including Kovid-19 (MIS-C), were admitted to an ICU (0.77 per 100,000 children in this age group).Table 1), 4 of which were 1 to 6 years old (0.54 per 100,000) and 11 were 7 to 16 years old (0.90 per 100,000). Four children had an underlying chronic costing condition (cancer in 2, chronic kidney disease in 1, and hematologic disease in 1). No children with Kovid-19 died.

Sweden Public Health Agency data (published report)5 (Personal communication) revealed that 10 preschool teachers and 20 school teachers in Sweden received intensive care of Kovid-19 by 30 June 2020 (20 for 103,596 school students, which is equivalent to 19 per 100,000). Compared with other occupations (excluding health care workers), this corresponds to sexual and age-adjusted relative risks of 1.10 (95% confidence interval). [CI]0.49 to 2.49 among preschool teachers) and 0.43 (95% CI, 0.28 to 0.68) among school students. Supplementary Addendum).

The present study had some limitations. We lack data on home transmissions of Kovid-19 from schoolchildren, and 95% confidence intervals for our results are wide.

Despite Sweden keeping school and preschool open, we observed a low incidence of severe Kovid-19 among schoolchildren and preschool-age children during the SARS-CoV-2 epidemic. Of the 1.95 million children who were between the ages of 1 and 16, 15 children had Kovid-19, MIS-C or both conditions and were admitted to the ICU, which is equivalent to 1 child in 130,000.

Jonas F. Ludwigson, MD, PhD.
Karolinska Institute, Stockholm, Sweden

Lars Engrestrum, MD, PhD.
Vrinnevi Hospital, Norcoping, Sweden

Charlotte Nordenhail, MD, PhD.
Swedish Association of Pediatric Rheumatology, Stockholm, Sweden

Emma Larsen, MD, Ph.D.
Karolinska Institute, Stockholm, Sweden

Disclosure forms The full text of this paper is available at NEJM.org provided by the authors.

The paper was published on January 6, 2021 on NEJM.org.

  1. 1. Zhu An, Zhang De, Wang w, and others. A novel coronovirus of pneumonia patients in China, 2019. N angle j med 2020; 382:727733.

  2. 2. Wine rm, Russell S.J., Crocker H, and others. School closures and management practices during coronovirus outbreaks including COVID-19: a rapid systematic review. Lancet Child Adolescent Health 2020; 4:397404.

  3. 3. Ludwigson JF. The first eight months of Sweden’s COVID-19 strategy and the major actions and actors involved. Acta Pediatre 2020; 109:24592471.

  4. 4. Whittaker e, Bamford A, Kenny jay, and others. Clinical signs of 58 children with a pediatric inflammatory multisystem syndrome temporarily associated with SARS-CoV-2. Jama 2020; 324:259269.

  5. 5. Public Health Agency of Sweden. The prevalence of Kovid-19 in various occupational groups within the school. 2020 (https://www.folkhalsomyndigheten.se/publicerat-material/publikationsarkiv/f/forekomst-av-covid-19-i-olika-yrkesgrupper-inom-skolan/).

Characteristics of children with CIS-19, including MIS-C, admitted to the Swedish ICU in March – June 2020.*

Ages Gender SARS-CoV-2 Test Results Days in ICU Entry number BP and laboratory measures on admission Organ support Complications
PCR Antibodies
1 year§ F Negative Affirmative 5 1 Systolic BP, 70 mm Hg; Sao2, 99%; BE, +0.6 mmol / liter; Lactate, 1.6 mmol / liter MIS-C, septic shock, kidney failure
3 years F Affirmative N d 38 3 Systolic BP, 75 to 143 mm Hg; Sao2, 96%; Lactate, 1.2 mmol / liter Aggressive mechanical ventilation Clostridium difficile Infection
4 years F Affirmative Affirmative 6 1 Systolic BP, 87 mm Hg; Sao2, 99% MIS-C, kidney failure, coagulation disorder
5 year F Affirmative Affirmative 3 1 Systolic BP, 83 mm Hg; Sao2, 98%; BE, −0.7 mmol / liter MIS-C
7 years4 M Negative N d 1 Systolic BP, 85 mm Hg, Sao2, 97%; BE, −0.7 mmol / liter Iron deficiency, coma, fever
7 years F Affirmative Affirmative 35 2 Systolic BP, 115 mm Hg; Sao2, 90%; Lactate, 0.8; BE, +5 mmol / liter Aggressive mechanical ventilation, renal replacement therapy
10 years§ F Negative Affirmative 1 1 Systolic BP, 95 mm Hg; Sao2, 99%; Lactate, 1.1 mmol / liter; BE, −1.5 mmol / liter MIS-C, cardiomyopathy
12 years M Affirmative N d 1 Systolic BP, 100 mm Hg; Sao2, 98%; BE, −6 mmol / liter
12 years M Affirmative N d 2 1 Viral pneumonia
13 years M Affirmative N d 1 1 2 Systolic BP, 123 to 137 mm Hg; Sao2, 92%; Lactate, 0.9 mmol / liter; BE, +3.2 mmol / liter
13 years F Affirmative Affirmative 7 2 Systolic BP, 80 mm Hg; Sao2, 98%; Lactate, 3.7 mmol / liter; BE, −9 mmol / liter Aggressive mechanical ventilation MIS-C, heart failure
14 years§ M Negative Affirmative 4 1 Systolic BP, 57 mm Hg; Sao2, 98%; Lactate, 3.4 mmol / liter; BE, −1.5 mmol / liter MIS-100, myocarditis, sepsis
14 years M Affirmative N d 4 2 Systolic BP, 90 to 100 mm Hg; Sao2, 83%; Lactate, 2.7 mmol / liter; BE, +4 mmol / liter Aggressive mechanical ventilation
16 years M Affirmative Affirmative 9 1
16 years4 M Negative Affirmative 5 1 MIS-C, myocarditis with heart failure



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