Introduction
COVID-19 epidemic spread out rapidly since its initial outbreak in
China, forcing the World Health Organization (WHO) to declare the state
of global pandemic on March 20201. Children and
adolescents represented less than 13% of the COVID-19 cases confirmed
in Europe between August and November 20202. Children
tend to have a mild infection and 15-35% can be
asymptomatic3 reaching out to a lower number of
hospitalizations or fatal outcomes than adults4. In
Italy, on August 2021, the 15.8% of total COVID-19 cases diagnosed
involved children aged 0-19 years old5. In particular,
all case patients aged <18 years since the loosening of the
first lockdown (4th May 2020), the majority of diagnosed cases occurred
in adolescents aged 13-17 years (41.3%), followed by children aged 7-12
years (28.0%), 2-6 years (21.0%) and 0-1 year (7%). The
hospitalisation rate was 4.8%, with the highest percentage of hospital
admissions in infants aged ≤1 year (16.2%)6.
Moreover, many studies suggest that the paediatric population is a minor
contributor to the spread of the virus, but it remains open to debate
what proportion of this population may contribute to silent
contamination7. However, it is possible that these
data are affected by an underestimation due to the higher rate of
asymptomaticity and milder symptoms in children which makes the
manifestation of the infection difficult to
recognise8. Indeed, from the above-mentioned
surveillance data6, it is difficult to tell whether
children under 12 years of age are less likely to be infected or whether
it is simply more complicated to identify positive cases due to a mostly
asymptomatic presentation. In addition, the possible underestimation in
the identification of paediatric SARS-CoV2 positive patients may also
have been influenced by inadequate testing capacity or a lack of effort
to recruit this population group, justified by a lower frequency of
adverse consequences compared with adults and the
elderly.2 In particular, the lack of efficiency in
tracking systems and the possible limited availability of diagnostic
tests are likely to reduce the contact notification rate in the school
context, in which, following the identification of SARS-CoV-2 positive
individuals, an effective contact tracing strategy should be applied
together with the administration of appropriate diagnostic tests to
identify possible transmission.2 Indeed, the European
Centre for Disease Prevention and Control (ECDC) recommends that in the
general population a major effort should be made to offer diagnostic
tests to the majority of asymptomatic cases to ensure timely isolation
and adequate contact tracing.9
Last, to explore the characteristics of the SARS-CoV-2 infection among
the paediatric population and the issue of asymptomaticity, studies
about the seroprevalence10 reported respectively that
only 47% and 60% of the paediatric population tested positive for the
presence of SARS-CoV2 antibodies complained of symptoms in accordance
with the development of infection.
Thus, in the school context, in line with the above-described data, the
preventive measures implemented by most of countries in case of a
suspected case agree that the student should self-isolate until a
healthcare provider prescribes a test or decides that the student is not
a suspected case11. Focusing on Italy, the various
scenarios in which paediatric patients need to undergo one of the
diagnostic procedures to detect SARS-CoV2 positivity always require the
intermediation of a general practitioner (GP) or a
paediatrician12. As far as we know, no one tried to
investigate a different kind of setting as a valid alternative of
testing in the paediatric population. The aim of this study was to
describe a setting for SARS-CoV 2 testing based on the spontaneous
presentation of paediatric patients without a medical prescription and
explore its appropriateness.