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SARS-CoV-2 infection and transmission in educational settings: a prospective, cross-sectional analysis of infection clusters and outbreaks in England

Our take —

This prospective study uses national active surveillance data to describe SARS-CoV-2 infections and outbreaks in educational settings in England from June 1 to July 17, 2020 (summer half-term) following re-opening. Educational institutions permitted to open during this time were early year settings, primary schools, and secondary schools, with smaller classroom sizes and other prevention control efforts implemented, including establishing contact ‘bubbles’ and close monitoring with isolation and quarantine following case diagnosis. Results showed very low rates of SARS-CoV-2 infection and outbreaks in these settings in this period. Overall, there were 343 cases confirmed (130 in children, 213 in staff members) across a median of 38,000 early year settings, 15,600 primary schools, and 4,000 secondary schools which were open daily—with a median total daily attendance of 928,000 students. The results may be generalizable to other settings where rates of community transmission are low and extensive transmission interventions are implemented.

Study design

Prospective Cohort

Study population and setting

On March 20, 2020, schools in England were closed as part of lockdown. Beginning on May 10, lockdown was slowly eased, and educational institutions began re-opening on June 1, with strict infection protocols such as physical distancing, frequent handwashing, and smaller class sizes divided into distinct social bubbles (i.e., staff and children who do activities together) that do not mix with other bubbles. Institutions allowed to re-open on June 1 included nurseries, preschools, reception, primary years 1 & 6, and children of any age whose parents were key workers. Re-opening was extended to secondary years 10 & 12 beginning on June 15. Educational institutions for individuals ≥ 18 years, and a few institutions in geographical areas with high COVID-19 prevalence remained closed. Whenever there was a suspected or confirmed case or outbreak of COVID-19, a local team from Public Health England (PHE), a national agency tasked with monitoring and managing COVID-19 in the country, undertook a risk assessment to decide on any additional investigations or measures to be carried out. Rates of infection were tracked among staff and students and were compared to overall trends in England over the same time period.

Summary of Main Findings

During the study period, a median of 38,000 early year settings, 15,600 primary schools, and 4,000 secondary schools were open daily—with a median total daily attendance of 928,000 students. Between June 1 and August 2, there were 5,038 laboratory confirmed cases among persons aged 0-18 years in England, making up 11% of the 45,778 total lab-confirmed cases in the country during this period. The national COVID-19 case rate rose from 3.8 cases/100,000 population to 5.6 cases/100,000 population within this age group during that period. The rates of SARS-CoV-2 infection were low in educational settings, with 177 events confirmed by PHE during this period, including 113 (64%) single cases, nine (5%) coprimary cases, and 55 (31%) confirmed outbreaks. This translated to 343 cases confirmed (130 in children, 213 in staff members). Staff had higher infection rates than children and staff-to-staff transmission was most common while student-to-student transmission was rare. For every case introduced in an educational setting, the risk of outbreak was 40% in early years setting, 26% in primary schools, and 39% in secondary schools. Infection and outbreak rates were highest in primary schools, likely due to higher number of persons in that setting.

Study Strengths

Definition of COVID-19 was based on laboratory confirmation, and data was based on active surveillance across educational settings in England.

Limitations

Because only a few educational settings were selected for wider testing following PHE determination made on a case-by-case basis, the total number of cases confirmed among students and staff may be an underestimate, though likely still extremely low. Furthermore, exclusion of some groups from the calculations of event and/or case rates (e.g., those in a small number of settings for mixed age groups, vulnerable children and children of key workers who attended school but were not part of the school years selected for re-opening) may lead to bias if those excluded had substantially different rates that those included in the analysis. The protocols in place to reduce risk were numerous, only a small proportion of all students attended class, and rates of infection overall in England were low during the study, so the generalizability of this experience may be limited. In addition, secondary educational institutions were only observed for one month, providing very little data to inform our understanding of risk among students in those age groups.

Value added

This study provides national information on SARS-CoV-2 cases and outbreaks between June 1 and July 17, 2020 across early year education settings, primary schools, and secondary schools in England following intensive interventions to reduce risk of transmission following re-opening after the first national lockdown.

This review was posted on: 28 January 2021