Minimal in-school SARS-CoV-2 transmission with strict mitigation protocols at two independent schools in Nashville, TN

  1. Lauren S. Peetluk
  2. Peter F. Rebeiro
  3. Kathryn M. Edwards
  4. Ritu Banerjee
  5. Simon A. Mallal
  6. David M. Aronoff
  7. Loren Lipworth
  8. Sophie E. Katz

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Abstract

BACKGROUND

The COVID-19 pandemic has greatly impacted school operations. To better understand the role of schools in COVID-19 transmission, we evaluated infections at two independent schools in Nashville, TN during the 2020-2021 school year.

METHODS

The cumulative incidence of COVID-19 within each school, age group, and exposure setting were estimated and compared to local incidence. Primary attack rates were estimated among students quarantined for in-school close contact.

RESULTS

Among 1401 students who attended school during the study period, 98 cases of COVID-19 were reported, corresponding to cumulative incidence of 7.0% (95% confidence interval (CI): 5.7-8.5). Most cases were linked to household (58%) or community (31%) transmission, with few linked to in-school transmission (11%). Overall, 619 students were quarantined, corresponding to >5000 person-days of missed school, among whom only 5 tested positive for SARS-CoV-2 during quarantine (primary attack rate: 0.8%, 95% CI: 0.3, 1.9). Weekly case rates at school were not correlated with community transmission.

CONCLUSION

These results suggest that transmission of COVID-19 in schools is minimal when strict mitigation measures are used, even during periods of extensive community transmission. Strict quarantine of contacts may lead to unnecessary missed school days with minimal benefit to in-school transmission.

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  1. ScreenIT

    SciScore for 10.1101/2021.11.09.21266140: (What is this?)

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

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    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: We detected the following sentences addressing limitations in the study:
    Similar findings were recently reported by Zimmerman and colleagues, who found a higher number of COVID-19 clusters among students attending private schools, compared to those in public schools.(14) Limitations: There are several limitations of this study to consider. First, the data were retrospectively reviewed for this report. Although detailed data were collected at each school throughout the school year, the final data were not adjudicated until the time of this analysis. Some cases may have gone undiagnosed or unreported during the study period, particularly if they were asymptomatic or only mildly symptomatic and not tested for SARS-CoV-2, which is more common among younger children.(1) Second, data from Davidson County, which were used as a comparator group may not reflect the current distribution of school-aged children in Tennessee, given their reliance on 2019 census data, and may underestimate the rate of COVID-19 among school-aged children given their reliance on passive surveillance. Surveillance data commonly underreports disease activity, given reliance on passive data collection, which may explain why we see a slightly higher rate of COVID-19 reported to the two independent schools, where active case finding occurred. Finally, data for this study were collected through early February 2021, prior to widespread rollout of COVID-19 vaccinations and when there were limited local data on variants of concern. It is not yet clear what impact household and teacher va...

    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.

    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.

  2. Version published to 10.1101/2021.11.09.21266140v1 on medRxiv