Severe Acute Respiratory Syndrome Coronavirus 2 Transmission in a Georgia School District—United States, December 2020–January 2021

Abstract

Background To inform prevention strategies, we assessed the extent of SARS-CoV-2 transmission and settings in which transmission occurred in a Georgia public school district. Methods During December 1, 2020–January 22, 2021, SARS-CoV-2–infected index cases and their close contacts in schools were identified by school and public health officials. For in-school contacts, we assessed symptoms and offered SARS-CoV-2 RT-PCR testing; performed epidemiologic investigations and whole-genome sequencing to identify in-school transmission; and calculated secondary attack rate (SAR) by school setting (e.g., sports, elementary school classroom), index case role (i.e., staff, student), and index case symptomatic status. Results We identified 86 index cases and 1,119 contacts, 688 (63.1%) of whom received testing. Fifty-nine (8.7%) of 679 contacts tested positive; 15 (17.4%) of 86 index cases resulted in ≥2 positive contacts. Among 55 persons testing positive with available symptom data, 31 (56.4%) were asymptomatic. Highest SAR were in indoor, high-contact sports settings (23.8%, 95% confidence interval [CI] 12.7, 33.3), staff meetings/lunches (18.2%, CI 4.5–31.8), and elementary school classrooms (9.5%, CI 6.5–12.5). SAR was higher for staff (13.1%, CI 9.0–17.2) versus student index cases (5.8%, CI 3.6–8.0) and for symptomatic (10.9%, CI 8.1–13.9) versus asymptomatic index cases (3.0%, CI 1.0–5.5). Conclusions Indoor sports may pose a risk to the safe operation of in-person learning. Preventing infection in staff members, through measures that include COVID-19 vaccination, is critical to reducing in-school transmission. Because many positive contacts were asymptomatic, contact tracing should be paired with testing, regardless of symptoms.

Occurrence and transmission potential of asymptomatic and presymptomatic SARS-CoV-2 infections: update of a living systematic review and meta-analysis

“…The searches for studies about asymptomatic or presymptomatic SARS-CoV-2, on 25 , eight studies reporting on secondary attack rates [35,81,131,142,[165][166][167][168], and 13 mathematical modelling studies [7,165,[169][170][171][172][173][174][175][176][177][178][179]. At the time of the search on 6 July 2021, five records were preprints.…”

Is Symptom Screening Useful for Identifying COVID-19 Infection in School Settings? Georgia, USA

“…This analysis provided an in-depth examination of the reported presence or absence of symptoms in staff and students who were exposed to COVID-19 in a Georgia school district during a time of high community transmission (Gettings et al, 2021). The data presented here demonstrate the importance of testing asymptomatic persons in a childcentric setting consistent with CDC guidance (CDC, 2021a); testing recommendations (CDC, 2021d) based solely on symptomatic status would have missed 56% of contacts positive for SARS-CoV-2.…”

“…Methods and findings from the full transmission investigation were previously published (Gettings et al, 2021;Gold et al, 2021). In brief, SARS-CoV-2 positive students and staff were identified as index cases by the local public health department in collaboration with the school district.…”

“…Staff or student contacts were defined as those exposed (within six feet for longer than 15 min cumulatively over a 24-h period) in schools to a person with lab-confirmed COVID-19 during the case's infectious period (beginning 48 h prior to a case's positive test if asymptomatic, or 48-h prior to symptom onset (CDC, 2021b)). The investigation identified 14 clusters of 3 or more cases among COVID-19-positive contacts to school associated index cases (Gettings et al, 2021;Gold et al, 2021).…”

“…At the time of data collection, educational staff and children were not eligible for vaccination in Georgia. During the investigation period, the COVID-19 seven-day county incidence peaked with a high of 705 cases per 100,000 on January 13, 2021 (Gettings et al, 2021).…”