SARS-CoV-2 acquisition and immune pathogenesis among school-aged learners in four diverse schools
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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
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Successful COVID-19 mitigation was implemented across a diverse range of schools.
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School-associated SARS-CoV-2 infections reflect regional rates rather than remote or on-site learning.
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Seropositive school-aged children with asymptomatic to mild SARS-CoV-2 infections generate robust humoral and cellular immunity.
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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 Statement IRB: 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.Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Antibodies Sentences Resources IgG and IgM antibody titers against N and receptor binding domain from spike protein (RBD) were measured using standard ELISA. IgMsuggested: NoneSciScore 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 Statement IRB: 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.Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Antibodies Sentences Resources IgG and IgM antibody titers against N and receptor binding domain from spike protein (RBD) were measured using standard ELISA. IgMsuggested: NoneSoftware and Algorithms Sentences Resources Presence of nucleocapsid protein (N)-specific IgG was determined with the Abbott Architect immunoassay. Abbott Architectsuggested: (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.
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