An Open Access article published in the Health Behavior and Policy Review Journal.
The full article is available as a PDF download.


Saif Badran, MD, MRCS(Ed)*
Omran A.H. Musa, MA* Twitter
Somaya Al-maadeed, PhD, SMIEE
Egon Toft, MD, PhD
Suhail A. Doi, MBBS, PhD

* These authors contributed equally.


Children represent a small fraction of confirmed COVID-19 cases, with a low case fatality rate (CFR). In this paper, we lay out an evidence-based policy for reopening schools.


We gathered age-specific COVID-19 case counts and identified mortality data for 14 countries. Dose-response meta-analysis was used to examine the relationship of the incremental case fatality rate (CFR) to age. In addition, an evidence-to-decision framework (EtD) was used to correlate the dose-response data with other epidemiological characteristics of COVID-19 in childhood.


In the dose-response analysis, we found that there was an almost negligible fatality below age 18. CFR rose little between ages 5 to 50 years. The confidence intervals were narrow, suggesting relative homogeneity across countries. Further data suggested decreased child-hood transmission from respiratory droplets and a low viral load among children.


Opening up schools and kindergartens is unlikely to impact COVID-19 case or mortality rates in both the child and adult populations. We outline a robust plan for schools that recommends that general principles not be micromanaged, with authority left to schools and monitored by public health authorities.

Source: Health Behavior and Policy Review, Volume 8, Number 1, January 2021, pp. 40-47(8)
Publisher: Paris Scholar Publishing Ltd.