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A research team of LKS Faculty of Medicine, The University of Hong Kong (HKUMed) showed evidence that the risk of children contracting COVID-19 at school is relatively low, and their psychosocial well-being is prone to adverse effects due to prolonged school closure. The findings have been published in JAMA Network Open [link to publication] and European Child & Adolescent Psychiatry [link to publication] respectively.

Home as the primary route of COVID-19 transmission in Hong Kong
In the largest paediatric study of its kind in Hong Kong, which surveyed 397 children and adolescents infected with COVID-19 in the first three waves of outbreaks, the HKUMed research team found that nearly all of those who were domestically infected with identifiable sources (183 out of 186) had family members living in the same household also infected with COVID-19. The three other infected individuals were reportedly schoolmates who had close contact with each other.

The research team, comprised of HKUMed’s Department of Paediatrics and Adolescent Medicine and Department of Microbiology, as well as the Paediatric Infectious Disease Centre of Princess Margaret Hospital, also noticed that there was no report of COVID-19 infection during the Hong Kong Diploma of Secondary Education (HKDSE) examinations, which took place from 24 April through 25 May 2020 with more than 50,000 candidates. The researchers concluded that it could be attributed to the frequent cleaning and disinfection, social distancing and other precautionary measures taken by the examination venues.

‘The survey results clearly showed that close contact with their parents and grandparents was the primary route through which Hong Kong children and adolescents got infected with COVID-19, indicating an urgent need for eligible adults to get vaccinated,’ said Dr Patrick Ip, Clinical Associate Professor of HKUMed’s Department of Paediatrics and Adolescent Medicine and co-corresponding author of the study. ‘Vaccination is the best way to protect our children from being infected. Yet this must be supported by the proven effective means of protection, such as wearing a mask, washing hands frequently and keeping good personal hygiene. All these measures are indispensable in our fight against COVID-19.’

Children’s psychosocial well-being adversely affected by prolonged school closure
In another large-scale survey of 29,202 Hong Kong families with children aged 2-12, the HKUMed researchers found that even children without COVID-19 infections are prone to an array of psychosocial problems. For example, children were shown to have elevated hyperactivity symptoms, with their symptom scores higher by 7.5% during the COVID-related school closures than before the pandemic. The problem is present across all age groups and more prominent among younger children aged 2-5. The stress level of parents also increased by 5.6% when compared with the pre-pandemic scores. Parents of older children (aged 6-12) recorded a slightly higher stress level than their counterparts of children aged 2-5.

During the COVID-19 pandemic, the team also observed that children who went to bed earlier and those who slept longer had fewer psychosocial problems. Similarly, more active children exhibited fewer psychosocial problems and subsequently resulted in less parental stress. Although distance learning enabled by digital technologies has become pivotal during school closure, the HKUMed team observed that the amount of time children spent on electronic devices for gaming and recreational purposes had increased on average by about one hour per day after school closures, and the 6-12 years group showed the largest growth. However, extended use of electronic devices for gaming and learning purposes was associated with increased psychosocial problems, especially among younger children, resulting in more parental stress.

Children with special educational needs (SENs) were found to have poorer mental well-being during the pandemic because most had their rehabilitation training and medical appointments cancelled or postponed. They had significantly more emotional symptoms and hyperactivity/inattention problems. This also resulted in higher stress levels for their parents.

‘It is evident that children’s psychosocial well-being has been adversely affected by extended school closure during the pandemic. More caution and precision are desirable when planning for school closure in the future,’ said Dr Mike Kwan, Honorary Clinical Associate Professor, Department of Paediatrics and Adolescent Medicine, HKUMed and co-author of the second study. ‘For children with special needs and other vulnerable groups, it is essential to maintain, or minimise disruption to medical and rehabilitation care to ensure their well-being, during the challenging times of the pandemic.’

Dr Kwan also stressed, ‘Eligible persons aged 16 or above in the household or carers of children and youths should receive COVID-19 vaccination to not only protect themselves, but very importantly, to protect our young generation for whom there is no licensed vaccine to offer in an effective and safe way.’

About the Hong Kong COVID-19 Paediatric Study Group
The Hong Kong COVID-19 Paediatric Study Group comprises paediatricians, microbiologists, paediatric surgeons, experts in infectious diseases, pharmacology, education and psychology. Led by the Department of Paediatrics and Adolescent Medicine and Department of Microbiology, HKUMed, and the Paediatric Infectious Disease Centre, Princess Margaret Hospital, this study group coordinated with all paediatric units managing children with COVID-19 infection in Hong Kong. The study group has collaborated with Wuhan of Mainland China, South Korea and the United Kingdom and has published several large-scale paediatric COVID-19 studies in high-impact peer-reviewed journals. It has also obtained a Collaborative Research Fund titled "SUCCESS" (Support to Children and families during COVID-19 pandemic: Effective Service development and evaluation Study) [Project reference number: C7149-20GF].

Media enquiries
Please contact LKS Faculty of Medicine of The University of Hong Kong by email (medmedia@hku.hk).