SARS-CoV-2 acquisition and immune pathogenesis among school-aged learners in four diverse schools

  1. Dan M. Cooper
  2. Michael Z. Zulu
  3. Allen Jankeel
  4. Izabela Coimbra Ibraim
  5. Jessica Ardo
  6. Kirsten Kasper
  7. Diana Stephens
  8. Andria Meyer
  9. Annamarie Stehli
  10. Curt Condon
  11. Mary E. Londoño
  12. Casey M. Schreiber
  13. Nanette V. Lopez
  14. Ricky L. Camplain
  15. Michael Weiss
  16. Charles Golden
  17. Shlomit Radom-Aizik
  18. Bernadette Boden-Albala
  19. Clayton Chau
  20. Ilhem Messaoudi
  21. Erlinda R. Ulloa

Reviewed by

Read the full article

Listed in

Log in to save this article

Abstract

Background

Understanding SARS-CoV-2 infection in children is necessary to reopen schools safely.

Methods

We measured SARS-CoV-2 infection in 320 learners [10.5 ± 2.1 (sd); 7–17 y.o.] at four diverse schools with either remote or on-site learning. Schools A and B served low-income Hispanic learners; school C served many special-needs learners, and all provided predominantly remote instruction. School D served middle- and upper-income learners, with predominantly on-site instruction. Testing occurred in the fall (2020), and 6–8 weeks later during the fall-winter surge (notable for a tenfold increase in COVID-19 cases). Immune responses and mitigation fidelity were also measured.

Results

We found SARS-CoV-2 infections in 17 learners only during the surge. School A (97% remote learners) had the highest infection (10/70, 14.3%, p  < 0.01) and IgG positivity rates (13/66, 19.7%). School D (93% on-site learners) had the lowest infection and IgG positivity rates (1/63, 1.6%). Mitigation compliance [physical distancing (mean 87.4%) and face-covering (91.3%)] was remarkably high at all schools. Documented SARS-CoV-2-infected learners had neutralizing antibodies (94.7%), robust IFN-γ + T cell responses, and reduced monocytes.

Conclusions

Schools can implement successful mitigation strategies across a wide range of student diversity. Despite asymptomatic to mild SARS-CoV-2 infection, children generate robust humoral and cellular immune responses.

Impact

  • Successful COVID-19 mitigation was implemented across a diverse range of schools.

  • School-associated SARS-CoV-2 infections reflect regional rates rather than remote or on-site learning.

  • Seropositive school-aged children with asymptomatic to mild SARS-CoV-2 infections generate robust humoral and cellular immunity.

Article activity feed

  1. Version published to 10.1038/s41390-021-01660-x
  2. Version published to 10.1101/2021.03.20.21254035v2 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2021.03.20.21254035: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: IRB Approval and Consent: The study was approved by the institutional review boards at the Children’s Hospital of Orange County (CHOC) and the University of California Irvine (UCI).
    Consent: Informed assent from the children and informed consent from parents or legally authorized guardians, or from the adult participants, were obtained remotely or in person.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    IgG and IgM antibody titers against N and receptor binding domain from spike protein (RBD) were measured using standard ELISA.
    IgM
    suggested: None
    Software and Algorithms
    SentencesResources
    Presence of nucleocapsid protein (N)-specific IgG was determined with the Abbott Architect immunoassay.
    Abbott Architect
    suggested: (Abbott ARCHITECT i1000sr System, RRID:SCR_019328)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  4. Version published to 10.1101/2021.03.20.21254035v1 on medRxiv