ABSTRACT
At the start of the COVID-19 pandemic, most US K-12 schools shutdown and millions of students began remote learning. By September 2020, little guidance had been provided to school districts to inform fall teaching. This indecision led to a variety of teaching postures within a given state. In this report we examine Ohio school districts in-depth, to address whether on-premises teaching impacted COVID-19 disease outcomes in that community. We observed that counties with on-premises teaching had more cumulative deaths at the end of fall semester than counties with predominantly online teaching. To provide a measure of disease progression, we developed an observational disease model and examined multiple possible confounders, such as population size, mobility, and demographics. Examination of micropolitan counties revealed that the progression of COVID-19 disease was faster during the fall semester in counties with predominantly on-premises teaching. The relationship between increased disease prevalence in counties with on-premises teaching was not related to deaths at the start of the fall semester, population size, or the mobility within that county. This research addresses the critical question whether on-premises schooling can impact the spread of epidemic and pandemic viruses and will help inform future public policy decisions on school openings.
ABSTRACT
ImportanceScalable programs for school-based SARS-CoV-2 testing and surveillance are needed to guide in-person learning practices and inform risk assessments in K-12 settings. ObjectivesTo characterize SARS-CoV-2 infections in staff and students in an urban public school setting and evaluate test-based strategies to support ongoing risk assessment and mitigation for K-12 in-person learning. Design, Setting, and ParticipantsThe pilot program engaged three schools for weekly saliva PCR testing of staff and students participating in in-person learning over a 5-week period. Wastewater, air, and surface samples were collected weekly and tested for SARS-CoV-2 RNA to determine surrogacy for case detection and interrogate transmission risk of in-building activities. Main Outcomes and MeasuresSARS-CoV-2 detection in saliva and environmental samples and risk factors for SARS-CoV-2 infection. Results2,885 supervised self-collected saliva samples were tested from 773 asymptomatic staff and students during November and December, 2020. 46 cases (22 students, 24 staff) were detected, representing a 5.8- and 2.5-fold increase in case detection rates among students and staff, respectively, compared to conventional reporting mechanisms. SARS-CoV-2 RNA was detected in wastewater samples from all pilot schools, as well as in air samples collected from two choir rooms. Sequencing of 21 viral genomes in saliva specimens demonstrated minimal clustering associated with one school. Geographic analysis of SARS-CoV-2 cases reported district-wide demonstrated higher community risk in zip codes proximal to the pilot schools. Conclusions and RelevanceWeekly screening of asymptomatic staff and students by saliva PCR testing dramatically increased SARS-CoV-2 case detection in an urban public-school setting, exceeding infection rates reported at the county level. Experiences differed among schools, and virus sequencing and geographic analyses suggest a dynamic interplay of school-based and community-derived transmission risk. Environmental testing for SARS-CoV-2 RNA in air and surface samples enabled real-time risk assessment of in-school activities and allowed for interventions in choir classes. Wastewater testing demonstrated the utility of school building-level SARS-CoV-2 surveillance. Collectively, these findings provide insight into the performance and community value of test-based SARS-CoV-2 screening and surveillance strategies in the K-12 educational setting. KEY POINTSO_ST_ABSQuestionC_ST_ABSDo test-based programs reduce SARS-CoV-2 risk in K-12 schools? FindingsWeekly school-based saliva PCR testing at three urban public schools doubled case detection among staff and students over symptom-based strategies, exceeding county-level case rates. SARS-CoV-2 was detected in school wastewater samples each week, as well as air and surface samples related to choir classrooms. MeaningRoutine SARS-CoV-2 testing removes infected staff and students from school who are not identified through conventional case detection. With rigorous infection control and environmental monitoring, this helps mitigate risk during school operations. Furthermore, screening in K-12 schools may provide insight into disease burdens of undertested communities.
