RESUMEN
Because of the importance of schools to childhood development, the relationship between in-person schooling and COVID-19 risk has been one of the most important questions of the COVID-19 pandemic. Previous work using data from the United States in winter 2020-21 showed that in-person schooling carried some risk for household members, and that mitigation measures reduced this risk. However, in-person schooling behavior and the COVID-19 landscape changed radically over the 2021 spring semester. Here we use data from a massive online survey to characterize changes in in-person schooling behavior and associated risks over that period. We find a significant increase in the frequency of in-person schooling and a reduction in mitigation, and that in-person schooling is associated with increased reporting of COVID-19 outcomes, even among vaccinated individuals (though the absolute risk among the vaccinated is greatly reduced). Moreover, vaccinated teachers working outside the home were less likely to report COVID-19-related outcomes than unvaccinated teachers reporting no work outside the home. Adequate mitigation measures appear to eliminate the excess risk associated with in person schooling.
RESUMEN
BackgroundRelatively few COVID-19 cases and deaths have been reported through much of sub-Saharan Africa, including South Sudan, although the extent of SARS-CoV-2 spread remains unclear due to weak surveillance systems and few population-representative serosurveys. MethodsWe conducted a representative household-based cross-sectional serosurvey in Juba, South Sudan. We quantified IgG antibody responses to SARS-CoV-2 spike protein receptor-binding domain and estimated seroprevalence using a Bayesian regression model accounting for test performance. ResultsWe recruited 2,214 participants from August 10 to September 11, 2020 and 22.3% had anti-SARS-CoV-2 IgG titers above levels in pre-pandemic samples. After accounting for waning antibody levels, age, and sex, we estimated that 38.5% (32.1 - 46.8) of the population had been infected with SARS-CoV-2. For each RT-PCR confirmed COVID-19 case, 104 (87-126) infections were unreported. Background antibody reactivity was higher in pre-pandemic samples from Juba compared to Boston, where the serological test was validated. The estimated proportion of the population infected ranged from 30.1% to 60.6% depending on assumptions about test performance and prevalence of clinically severe infections. ConclusionsSARS-CoV-2 has spread extensively within Juba. Validation of serological tests in sub-Saharan African populations is critical to improve our ability to use serosurveillance to understand and mitigate transmission.
