SARS-CoV-2 Acquisition and Immune Pathogenesis Among School-Aged Learners in Four K-12 Schools

BackgroundUnderstanding SARS-CoV-2 infection in children is necessary to reopen schools safely. MethodsWe measured SARS-CoV-2 infection in 320 learners [10.5 {+/-} 2.1(sd); 7-17 y.o.] at four diverse schools with either remote or on-site learning. Schools A and B served low-income Hispanic learners; school C served many special-needs learners; and all provided predominantly remote instruction. School D served middle- and upper-income learners, with predominantly on-site instruction. Testing occurred in the fall (2020), and 6-8 weeks later during the fall-winter surge (notable for a tenfold increase in COVID-19 cases). Immune responses and mitigation fidelity were also measured. ResultsWe found SARS-CoV-2 infections in 17 learners only during the surge. School A (97% remote learners) had the highest infection (10/70, 14.3%, p<0.01) and IgG positivity rates (13/66, 19.7%). School D (93% on-site learners) had the lowest infection and IgG positivity rates (1/63, 1.6%). Mitigation compliance [physical distancing (mean 87.4%) and face covering (91.3%)] was remarkably high at all schools. Documented SARS-CoV-2-infected learners had neutralizing antibodies (94.7%), robust IFN-{gamma}+ T cell responses, and reduced monocytes. ConclusionSchools can implement successful mitigation strategies across a wide range of student diversity. Despite asymptomatic to mild SARS-CoV-2 infection, children generate robust humoral and cellular immune responses. Key PointsO_LISuccessful COVID-19 mitigation was implemented across a diverse range of schools. C_LIO_LISchool-associated SARS-CoV-2 infections reflect regional rates rather than remote or on-site learning. C_LIO_LISeropositive school-aged children with asymptomatic to mild SARS-CoV-2 infections generate robust humoral and cellular immunity. C_LI

SYSTEMATIC OBSERVATION OF COVID-19 MITIGATION (SOCOM): ASSESSING FACE COVERING AND DISTANCING IN SCHOOLS

IntroductionDuring the COVID-19 pandemic, some K-12 schools resumed in-person classes with varying degrees of mitigation plans in the fall of 2020. Physical distancing and face coverings can minimize SARS-CoV-2 spread, the virus that causes COVID-19. However, no research has focused on mitigation strategy adherence during school days. Thus, we sought to develop a systematic observation protocol to capture COVID-19 mitigation strategy adherence in school environments: The Systematic Observation of COVID-19 Mitigation (SOCOM). MethodsWe extended previously validated and internationally used tools to develop the SOCOM training and implementation protocol to assess physical distancing and face covering behaviors. SOCOM was tested in diverse indoor and outdoor settings (classrooms, lunchrooms, physical education [PE], and recess) among diverse schools (elementary, secondary, and special needs). ResultsFor the unique metrics of physical-distancing and face-covering behaviors, areas with more activity and a maximum of 10-15 students were ideal for accurately capturing data. Overall proportion of agreement was high for physical distancing (90.9%), face covering (88.6%), activity type (89.2%), and physical activity level (87.9%). Agreement was lowest during active recess, PE, and observation areas with [≥]20 students. ConclusionsMillions of children throughout the US are likely to return to school in the months ahead despite the current surge of COVID-19 cases. SOCOM is a relatively inexpensive tool that can be implemented by schools to determine mitigation strategy adherence and assess changes to protocols to help students return to school safely and slow the spread of COVID-19 and can be used for research purposes.