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Clusters of SARS-CoV-2 Infection Among Elementary School Educators and Students in One School District – Georgia, December 2020-January 2021

Our take —

This outbreak investigation of 63 COVID-19 cases and SARS-CoV-2 transmission within eight public elementary schools in Cobb Country, Georgia aimed to characterize transmission between December 1, 2020 and January 22, 2021. Semi-structured interviews were conducted with the parents of students, educators, and school administration to collect information on symptoms and potential exposures. Nine clusters were identified across six schools, and included cases among 13 educators, 32 students, and 18 household members of persons with a school-associated case. The median cluster size was six cases, with a range of 3-16. Two clusters involved probable educator-to-educator transmission, four clusters involved probable student-to-student transmission, and eight clusters involved probable educator-to-student transmission. The period of this outbreak investigation overlapped with a holiday and school break, which is often associated with travel, gatherings, and activities outside of the school; this was not considered in the report despite its potential role in the outbreak. Despite multiple clusters identified, overall few cases were reported across the 8 schools during this period, and student-to-student transmission appeared to be especially low and tended to involve inadequate physical distancing and/or masking. Preventions measures such as vaccination, improved physical distancing, and improved mask wearing may help to reduce transmission events in the future.

Study design

Other

Study population and setting

This study was an outbreak investigation of COVID-19 cases and SARS-CoV-2 transmission within eight public elementary schools in Cobb Country, Georgia. The outbreak investigation occurred between December 1, 2020 and January 22, 2021 and was led by the Cobb and Douglas Public Health (CDPH), the Georgia Department of Public Health (GDPH), and CDC. The investigation included approximately 24 school days within a school district that includes approximately 2600 students and 700 staff. COVID-19 cases among educators and students were either self-reported or identified by local public health officials, and were defined as a positive SARS-CoV-2 reverse transcription–polymerase chain reaction or antigen test result in a person who attended school in-person. Semi-structured interviews were conducted with the parents of students, educators, and school administration to collect information on symptoms and potential exposures. Close contacts were defined as those exposed to an index patient at school within 6 ft for >15 minutes per day during a 24-hour period while the index patient was infectious. The infectious period of an index case was 48 hours before to 10 days after symptom onset or, if asymptomatic, 48 hours before to 10 days after specimen collection.

Summary of Main Findings

Nine clusters were identified among 6 of the 8 elementary schools participating in this investigation. In each of the nine clusters, three or more epidemiologically linked COVID-19 cases were identified. The nine clusters included cases among 13 educators, 32 students, and 18 household members of persons with a school associated case. The median cluster size was six cases, with a range of 3-16. Among 69 household members of persons with school associated cases tested, 18 (26%) tested positive for SARS-CoV-2. Two of the clusters were determined to have potential educator-to-educator transmission, four clusters involved probable student-to-student transmission, and eight clusters involved probable educator-to-student transmission. All nine transmission clusters involved potential challenges in physical distancing, and five involved inadequate mask use.

Study Strengths

This outbreak investigation leverages data from interviews conducted with the parents of students, educators, and administrators to help characterize transmission within the school as well as among household members.

Limitations

There are several limitations to this outbreak investigation. Primarily, the period of this outbreak investigation overlapped with a holiday and school break, during which is often associated with travel, gatherings, and activities outside of the school. However, the considerations and potential impact of this school break and holiday were not discussed in this report, despite its potential role in the outbreak. The semi-structured interviews were used to characterize transmission and identify potential exposures. However, these interviews were conducted with the parents of students and may be subject to reporting bias from either the parent or the information obtained from the student by the parent. Therefore, student-to-student transmission may be underrepresented in this study. Further, testing of asymptomatic cases was not done, which may underestimate the number of cases.

Value added

This outbreak investigation helped to characterize transmission within elementary schools and identify potential opportunities for improved mitigation strategies.

This review was posted on: 14 May 2021