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Transmission Dynamics of COVID-19 Outbreaks Associated with Child Care Facilities – Salt Lake City, Utah, April-July 2020

Our take —

The goal of this study was to understand transmission from pediatric cases and care givers who were exposed in child care settings to non-facility contacts. Contact tracing data from 184 individuals at three child care facilities in Salt Lake City, Utah were examined. Transmission was documented between pediatric cases and their non-facility contacts, despite all pediatric cases showing mild or no symptoms ,with a within facility attack rate of 21.8%, and an overall attack rate of 20.7%.

Study design

Case Series

Study population and setting

Between April 1 and July 10, 2020, 22 COVID-19 cases were reported among the 101 facility staff members and attendees from three child care facilities in Salt Lake City, Utah (10 adult, 12 pediatric). Contact tracing for these 22 cases was undertaken for contacts (n=162). Contacts were defined as anyone who was within 6 feet of a known positive case for 15 minutes, less than or equal to two days before the individual’s symptom onset. Including facility staff members, attendees, and their contacts, a total of 184 individuals had a known epidemiologic link one of these three facilities.

Summary of Main Findings

A total of 31/184 confirmed COVID-19 cases were detected, including over 40% of these among children (13/31). The attack rates were 13/110 (11.8%) among children and 18/74 (24.3%) among adults. Twelve of thirteen of the cases among children were acquired in child-care facilities, and all cases had mild or no symptoms. Documented transmission was traced between these pediatric cases and 26% of non-facility contacts (12/46). One parent of an attendee was hospitalized. The facility attack rates within facility A, facility B, and facility C were 17% (2/12), 100% (5/5), and 18% (15/84), respectively. When adding in contacts outside of the care facilities (e.g. family members), overall attack rates for facility A, facility B, and facility C were 7% (2/27), 36% (12/33), and 19% (24/124), respectively.

Study Strengths

Detailed contact tracing and testing was available, allowing for the documentation of transmission links between pediatric cases and non-facility contacts.


Eligibility for testing changed during this period, and initially only those with symptoms were eligible for testing. This may have resulted in an underestimate in the total number of cases over time. Additionally, the index case for facility C was not identified, so it is possible that cases associated with this site originated from a source outside of the facility.

Value added

This study provides additional evidence about the role children may play in onward transmission, despite the fact that COVID-19 is often less severe in children.

This review was posted on: 2 October 2020