SARS-CoV-2 infection and transmission in educational settings: a prospective, cross-sectional analysis of infection clusters and outbreaks in England

Ismail, Sharif; Saliba, Vanessa; Bernal, Jamie Lopez; Ramsay, Mary; Ladhani, Shamez

doi:10.1016/s1473-3099(20)30882-3

Cited by 313 publications

(371 citation statements)

References 18 publications

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“…appear to be demonstrably more frequent in schools than in noneducational settings (2). Temporal trends in the United States also indicate that among school-aged children, schoolbased transmission might be no higher than transmission outside the school setting (3,4); the limited in-school transmission observed in Florida has also been observed in other states (5) and countries (6). Success in preventing the introduction of SARS-CoV-2 into schools depends upon controlling community transmission and adhering to mitigation measures in schools, particularly masking, physical distancing, testing, and increasing room air ventilation (2,4,7).…”

Section: Discussionmentioning

confidence: 99%

COVID-19 in Primary and Secondary School Settings During the First Semester of School Reopening — Florida, August–December 2020

Doyle¹,

Kendrick²,

Troelstrup³

et al. 2021

MMWR Morb. Mortal. Wkly. Rep.

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On March 19, 2021, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). After detection of cases of COVID-19 in Florida in March 2020, the governor declared a state of emergency on March 9,* and all school districts in the state suspended in-person instruction by March 20. Most kindergarten through grade 12 (K-12) public and private schools in Florida reopened for in-person learning during August 2020, with varying options for remote learning offered by school districts. During August 10-December 21, 2020, a total of 63,654 COVID-19 cases were reported in school-aged children; an estimated 60% of these cases were not school-related. Fewer than 1% of registered students were identified as having school-related COVID-19 and <11% of K-12 schools reported outbreaks. District incidences among students correlated with the background disease incidence in the county; resumption of in-person education was not associated with a proportionate increase in COVID-19 among school-aged children. Higher rates among students were observed in smaller districts, districts without mandatory maskuse policies, and districts with a lower proportion of students participating in remote learning. These findings highlight the importance of implementing both community-level and school-based strategies to reduce the spread of COVID-19 and suggest that school reopening can be achieved without resulting in widespread illness among students in K-12 school settings. Florida has one independent school district in each of its 67 counties. For the 2020-21 school year, 2,809,553 registered students were enrolled in approximately 6,800 public, charter, and private K-12 schools, ranging from 707 to 334,756 students per school district. In response to the COVID-19 pandemic, some school districts delayed the start of the 2020-21 academic year after suspension of in-person learning in March. Most schools resumed in-person instruction sometime during August 10-31, 2020, except those in the two largest school districts, Broward and Miami-Dade, which began remote learning in August but did not resume in-person instruction until October 9 and November 10, respectively. Statewide, as of September 24, 45% of registered students received full-time in-person instruction. To assess the occurrence of COVID-19 in Florida schools after resumption of in-person instruction, CDC and the Florida Department of Health (FDOH) reviewed school-related cases *

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Section: Discussionmentioning

confidence: 99%

COVID-19 in Primary and Secondary School Settings During the First Semester of School Reopening — Florida, August–December 2020

Doyle¹,

Kendrick²,

Troelstrup³

et al. 2021

MMWR Morb. Mortal. Wkly. Rep.

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“…During August-December 2020, many U.S. K-12 schools implemented fully online (12%) or hybrid models (58%) of instruction because of concerns about transmission in schools (4). In spring 2020 in Israel, a large SARS-CoV-2 outbreak in a high school was documented (5); however, a recent analysis of schools across Europe found relatively low levels of school-related transmission (6). Earlier in the U.S. pandemic, outbreaks were detected in camps at which campers did not wear masks and close contact occurred (7).…”

Section: Discussionmentioning

confidence: 99%

“…Earlier in the U.S. pandemic, outbreaks were detected in camps at which campers did not wear masks and close contact occurred (7). Although risk for transmission has appeared lower in elementary schools, data about transmission in K-12 educational settings are lacking because of limited screening (6). Schools can minimize SARS-CoV-2 transmission during in-person learning if welldesigned risk mitigation protocols are followed, including frequent facility-wide testing and universal masking.…”

Section: Discussionmentioning

confidence: 99%

Minimal SARS-CoV-2 Transmission After Implementation of a Comprehensive Mitigation Strategy at a School — New Jersey, August 20–November 27, 2020

Volpp¹,

Kraut²,

Ghosh³

et al. 2021

MMWR Morb. Mortal. Wkly. Rep.

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During fall 2020, many U.S. kindergarten through grade 12 (K-12) schools closed campuses and instituted remote learning to limit in-school transmission of SARS-CoV-2, the virus that causes COVID-19 (1,2). A New Jersey grade 9-12 boarding school with 520 full-time resident students, 255 commuter students, and 405 faculty and staff members implemented a comprehensive mitigation strategy that included universal masking, testing, upgraded air-handling equipment to improve ventilation, physical distancing of ≥6 ft, contact tracing, and quarantine and isolation protocols to prevent and control transmission of SARS-CoV-2 among students, faculty, and staff members. Mandatory twice-weekly screening using real-time reverse transcription-polymerase chain reaction (RT-PCR) testing of all students and staff members during August 20-November 27, 2020, resulted in the testing of 21,449 specimens. A total of 19 (5%) of 405 faculty and staff members and eight (1%) of 775 students received positive test results; only two identified cases were plausibly caused by secondary transmission on campus. Comprehensive mitigation approaches including frequent testing and universal masking can help prevent outbreaks in in-person high school settings even when community transmission is ongoing. During August 20-November 27, 2020, a private boarding school in New Jersey implemented rigorous, comprehensive strategies to prevent introduction and transmission of SARS-CoV-2, including requiring students to quarantine for 2 weeks before arriving, and, upon arrival, to provide documentation of a negative RT-PCR test result performed within 7-10 days before campus arrival (Box). Upon opening in the fall, the school conducted twice-weekly RT-PCR screening of all students, faculty, and staff members during August 20-November 27. Students' specimens were tested by using Broad Laboratories anterior nasal swab, high-throughput version of the CDC 2019-nCoV RT-PCR Diagnostic Panel, validated in accordance with guidance by the College of American Pathologists (issued on March 19, 2020) and the Food and Drug Administration (issued on February 29, 2020).* Faculty and staff member saliva samples were processed * https://www.fda.gov/medical-devices/coronavirus-disease-2019-covid-19emergency-use-authorizations-medical-devices/vitro-diagnostics-euas †

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“…Most of the other studies of SARS-CoV-2 in schools have focused on contact tracing of index cases [16,28], thus potentially missing unidentified cases. Other studies have relied on the prevalence of diagnosed SARS-CoV-2 cases to estimate the frequency of outbreaks and risk for children infected while schools are operating in person [16–18]. Finally, a few ecological studies tried to estimate the overall effect of closing and opening schools on the development of the pandemic (in terms of diagnosed and reported cases and deaths) [29– 31], with major limitations of uncontrolled confounding, high level of aggregation (e.g., pooling school and university closures as one intervention, or analyzing aggregated outcomes on country-level) and potentially measuring the outcome in a population not exposed to the intervention.…”

Section: Discussionmentioning

confidence: 99%

Clustering and longitudinal change in SARS-CoV-2 seroprevalence in school-children: prospective cohort study of 55 schools in Switzerland

Ulytė

Radtke

Abela

et al. 2020

Preprint

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Background and aimsThe facilitating role of schools in SARS-CoV-2 infection spread is still debated and the potential of school closures to mitigate transmission unclear. In autumn 2020, Switzerland experienced one of the highest second waves of the SARS-CoV-2 pandemic in Europe while keeping schools open, thus offering a high-exposure environment to study SARS-CoV-2 infections in schools. The aim of this study was to examine longitudinal change in SARS-CoV-2 seroprevalence in children and the evolution of clustering within classes and schools from June to November, 2020, in a prospective cohort study of school children in the canton of Zurich, Switzerland.MethodsChildren from randomly selected schools and classes, stratified by district, were invited to participate in serological testing of SARS-CoV-2 in June-July and October-November 2020. Parents of children filled questionnaires on sociodemographic and health-related questions. 55 schools and 275 classes within them were enrolled, with 2603 children participating in the first, and 2552 in the second testing (age range 6-16 years). We evaluated longitudinal changes of seroprevalence in districts and investigated clustering of seropositive cases within classes and schools.ResultsOverall SARS-CoV-2 seroprevalence was 2.4% (95% CrI 1.4%-3.6%) in summer and 4.5% (95% CrI 3.2%-6.0%) in not previously seropositive children in late autumn, leading to estimated 7.8% (95% CrI 6.2%-9.5%) of ever seropositive children, without significant differences among lower, middle and upper school levels. Among the 2223 children with serology tested twice, 28 (40%) of previously seropositive were negative, and 109 (5%) previously negative became seropositive. Seroprevalence was not different between school levels or sexes, but varied across districts (1.7% to 15.0%). Between June-July and October-November 2020, the ratio of diagnosed to newly seropositive children was 1 to 8. At least one newly seropositive child was detected in 47 of 55 schools and 90 of 275 classes. Among 130 classes with high participation rate, 0, 1-2 or ≥3 seropositive children were present in 73 (56%), 50 (38%) and 7 (5%) classes, respectively. Class level explained slightly more variation of individual serological results (standard deviation of random effects (SD) 0.97) than school level (SD 0.61) in the multilevel logistic regression models. Symptoms were reported for 22% of seronegative and 29% of newly seropositive children since summer.ConclusionsUnder a regimen of open schools with some preventive measures in place since August, clustering of seropositive cases occurred in very few classes and not across entire schools despite a clear increase in seropositive children during a period of high transmission of SARS-CoV-2.Trial registrationClinicalTrials.gov NCT04448717. https://clinicaltrials.gov/ct2/show/NCT04448717

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SARS-CoV-2 infection and transmission in educational settings: a prospective, cross-sectional analysis of infection clusters and outbreaks in England

Cited by 313 publications

References 18 publications

COVID-19 in Primary and Secondary School Settings During the First Semester of School Reopening — Florida, August–December 2020

COVID-19 in Primary and Secondary School Settings During the First Semester of School Reopening — Florida, August–December 2020

Minimal SARS-CoV-2 Transmission After Implementation of a Comprehensive Mitigation Strategy at a School — New Jersey, August 20–November 27, 2020

Clustering and longitudinal change in SARS-CoV-2 seroprevalence in school-children: prospective cohort study of 55 schools in Switzerland

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