On the Effect of Age on the Transmission of SARS-CoV-2 in Households, Schools, and the Community

J Infect Dis. 2021 Feb 13;223(3):362-369. doi: 10.1093/infdis/jiaa691.


Background: There is limited information on the effect of age on the transmission of SARS-CoV-2 infection in different settings.

Methods: We reviewed published studies/data on detection of SARS-CoV-2 infection in contacts of COVID-19 cases, serological studies, and studies of infections in schools.

Results: Compared to younger/middle-aged adults, susceptibility to infection for children younger than 10 years is estimated to be significantly lower, while estimated susceptibility to infection in adults older than 60 years is higher. Serological studies suggest that younger adults (particularly those younger than 35 years) often have high cumulative incidence of SARS-CoV-2 infection in the community. There is some evidence that given limited control measures, SARS-CoV-2 may spread robustly in secondary/high schools, and to a lesser degree in primary schools, with class size possibly affecting that spread. There is also evidence of more limited spread in schools when some mitigation measures are implemented. Several potential biases that may affect these studies are discussed.

Conclusions: Mitigation measures should be implemented when opening schools, particularly secondary/high schools. Efforts should be undertaken to diminish mixing in younger adults, particularly individuals aged 18-35 years, to mitigate the spread of the epidemic in the community.

Keywords: SARS-CoV-2; age; children; high schools; primary schools; secondary schools; seroprevalence; susceptibility; young adults.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • COVID-19 / epidemiology
  • COVID-19 / transmission*
  • Databases, Factual
  • Disease Susceptibility
  • Family Characteristics*
  • Humans
  • Incidence
  • Residence Characteristics / statistics & numerical data*
  • SARS-CoV-2 / isolation & purification
  • Schools / statistics & numerical data*