No magic bullet: Limiting in-school transmission in the face of variable SARS-CoV-2 viral loads
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Abstract
In the face of a long-running pandemic, understanding the drivers of ongoing SARS-CoV-2 transmission is crucial for the rational management of COVID-19 disease burden. Keeping schools open has emerged as a vital societal imperative during the pandemic, but in-school transmission of SARS-CoV-2 can contribute to further prolonging the pandemic. In this context, the role of schools in driving SARS-CoV-2 transmission acquires critical importance. Here we model in-school transmission from first principles to investigate the effectiveness of layered mitigation strategies on limiting in-school spread. We examined the effect of masks and air quality (ventilation, filtration and ionizers) on steady-state viral load in classrooms, as well as on the number of particles inhaled by an uninfected person. The effectiveness of these measures in limiting viral transmission was assessed for variants with different levels of mean viral load (ancestral, Delta, Omicron). Our results suggest that a layered mitigation strategy can be used effectively to limit in-school transmission, with certain limitations. First, poorly designed strategies (insufficient ventilation, no masks, staying open under high levels of community transmission) will permit in-school spread even if some level of mitigation is present. Second, for viral variants that are sufficiently contagious, it may be difficult to construct any set of interventions capable of blocking transmission once an infected individual is present, underscoring the importance of other measures. Our findings provide practical recommendations; in particular, the use of a layered mitigation strategy that is designed to limit transmission, with other measures such as frequent surveillance testing and smaller class sizes (such as by offering remote schooling options to those who prefer it) as needed.
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SciScore for 10.1101/2022.03.25.22272956: (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
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:In this study, we have used mathematical modeling to demonstrate the strengths and limitations of a layered mitigation strategy in limiting in-school transmission while keeping schools open. We examined the impact of risk mitigation measures (masking, ionizers, ventilation, filtration) on limiting spread within a classroom when an infected person is present. Our findings underscore the critical importance of layered mitigation …
SciScore for 10.1101/2022.03.25.22272956: (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
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:In this study, we have used mathematical modeling to demonstrate the strengths and limitations of a layered mitigation strategy in limiting in-school transmission while keeping schools open. We examined the impact of risk mitigation measures (masking, ionizers, ventilation, filtration) on limiting spread within a classroom when an infected person is present. Our findings underscore the critical importance of layered mitigation strategies in limiting in-school transmission. With that said, all of the examined measures can be readily defeated by sufficiently high viral loads, a biological change that has already been observed during the pandemic (for example between the Wuhan strain and the Delta variant). This is a crucial point: minimal effective measures for the disease as it is at present may have an increased risk of failure in the face of new variants of SARS-CoV-2. Our findings also indicate that the risk of transmission in schools may be hard to predict in certain settings (such as in the turbulent airflow patterns of a well-ventilated room). As a corollary, our work points to the central importance of relying on measures to limit the likelihood of having an infected person in the classroom: testing and isolation, limiting class sizes, and targeted closures when community transmission is high. The ongoing COVID-19 pandemic shows no signs of permitting a return to pre-pandemic life, with high rates of transmission leading to rapid viral evolution. The course of the pande...
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.
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- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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