Integrating epidemiological and clinical predictors of SARS-CoV-2 infection in students and school staff in the state of São Paulo

  1. Fredi A. Diaz Quijano
  2. José Mário Nunes da Silva
  3. Tatiana Lang D’Agostini
  4. Jéssica Pires de Camargo
  5. Nathalia Cristina Soares Franceschi de Moraes
  6. Ricardo Haddad
  7. Maria Cecília Gomes Pereira
  8. Dimas Tadeu Covas
  9. Regiane A. Cardoso de Paula

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Abstract

Background

There is a great deal of uncertainty concerning which contexts would be safe for returning to school and about individual criteria that would reduce contact between the infected and susceptible people in the school setting. Therefore, the purpose of this study was to estimate the prevalence of infection by SARS-CoV-2 in students and school staff; and to identify predictors of infection, including both municipal epidemiological indicators and individual variables reported by the participants.

Methods

This was a virological survey carried out among students (over 14 years old) and school staff in São Paulo state, between epidemiological weeks 43 to 49 of the year 2020. A self-administrated questionnaire including sociodemographic and clinical information was applied. Moreover, a nasopharynx swab was performed for virological testing (RT-PCR). We evaluate the relationship of COVID-19 epidemiological indicators of the residence municipality with the odds of SARS-CoV-2 infection. For this, a composite index relating recent mortality and previous incidence (RM/PI) was proposed based on the ratio of deaths recorded in the second and third week counted back to the sum of cases during the previous seven weeks (weeks 4 to 10 counted back). We obtained a multiple model using random-effects logit regression integrating epidemiological indicators and individual variables.

Results

In total, 3436 participants were included, residents of 72 municipalities. The overall prevalence of infection was 1.7% (95%CI: 1.3%-2.2%). SARS-CoV-2 infection was independently associated with loss of smell, a history of pulmonary disease, and a recent trip outside the municipality. Moreover, the RM/PI index consistently predicted the SARS-CoV-2 infection (adjusted OR: 1.45; 95%CI 1.02-2.04). Based on these associations, we proposed a classification in four groups with different SARS-Cov-2 infection prevalence (0.54%, 1.27%, 3.8%, and 4.13%).

Conclusion

Epidemiological and individual variables allowed classifying groups according to the infection probability in a school population of the state of São Paulo. This classification could help guide the return to classes in situations in which epidemiological control is evident, maintaining basic protection measures and increasing vaccination coverage.

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  1. ScreenIT

    SciScore for 10.1101/2021.06.21.21259213: (What is this?)

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

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Data analysis: Demographic and clinical were entered in an electronic database, and then analyzed using Excel and STATA (version 15.0, Stata Corp LP, College Station, TX).
    Excel
    suggested: None
    STATA
    suggested: (Stata, RRID:SCR_012763)

    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.

    Results from scite Reference Check: We found no unreliable references.

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  2. Version published to 10.1101/2021.06.21.21259213v1 on medRxiv