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.