Household COVID-19 risk and in-person schooling

  1. Justin Lessler
  2. M. Kate Grabowski
  3. Kyra H. Grantz
  4. Elena Badillo-Goicoechea
  5. C. Jessica E. Metcalf
  6. Carly Lupton-Smith
  7. Andrew S. Azman
  8. Elizabeth A. Stuart

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Abstract

Severe COVID-19 in children is rare, but many schools remain closed because the transmission risk that school contact poses to adults and the wider community is unknown. Observing the heterogeneity of approaches taken among U.S. school districts, Lessler et al. investigated how different strategies influence COVID-19 transmission rates in the wider community using COVID-19 Symptom Survey data from Carnegie Mellon and Facebook. The authors found that when mitigation measures are in place, transmission within schools is limited and infection rates mirror that of the surrounding community.

Science , abh2939, this issue p. 1092

Article activity feed

  1. Version published to 10.1126/science.abh2939
  2. NCRC

    Our take

    This study used data from the COVID-19 Symptom Survey administered on Facebook. Among 576,051 reports of families in the US with school aged children, of which about half were attending some in-person schooling, the risk of living in a family with a child attending school in-person was associated with increased risk of COVID-like illness. This risk increased with the age of the child, but decreased with more mitigation measures, suggesting that in-person schooling can be made safe. In the absence of combination prevention measures, this study provides evidence that in-person school attendance may contribute to household spread; efforts to implement mitigation efforts while vaccination rollout continues are a priority in order to reopen schools safely.

    Study design

    prospective-cohort

    Study population and setting

    Evidence around whether transmission of SARS-CoV-2 occurs in schools has been challenging to generate. To answer this question, the authors used the COVID-19 Symptom Survey administered on Facebook which describes schooling behaviors and SARS-CoV-2 outcomes. Data from 2,142,887 respondents from November 24 to December 23, 2020 and January 11 to February 10, 2021 was analyzed. Of these, 576,051 had at least one child in school living in the household, of which in about half of households the child was attending either full or part time in-person schooling.

    Summary of main findings

    The study results showed that the risk of COVID-19-like illness was higher (adjusted OR 1.38, 95% CI 1.30-1.47) among those living with a child attending in person school compared to those who did not, and that the effect increased with increasing grade level of the child. Reports of mitigation measures at the school decreased the risk, with the strongest reduction associated with daily symptoms screens, teacher masking, and closure of extra-curricular activities. Implementation of 7 or more mitigation measures lead to almost no increased risk. In teachers, in-person teaching was associated with more COVID-19-related outcomes, but the risk was similar to that of other professions.

    Study strengths

    The study used a large survey database that included respondents all over the United States. The authors were able to control for a number of geographic differences between areas, including background incidence rates, that could potentially confound results.

    Limitations

    Because the survey was administered through Facebook, results may not be fully generalizable to every part of the United States. Further the data are self-reported and may be subject to some mismeasurement. Finally, bias due to residual confounding remains possible as those areas that implemented the most mitigation measures may have had different risks before mitigation, even after adjusting for measured confounders.

    Value added

    This study is the largest to date in the US on transmission in schools, and suggests that in-person schooling does increase risk, but the risk can be minimized with strong mitigation measures.

  3. ScreenIT

    SciScore for 10.1101/2021.02.27.21252597: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your code and data.

    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.
    • Thank you for including a protocol registration statement.

    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 10.1101/2021.02.27.21252597v1 on medRxiv