ABSTRACT
BACKGROUNDThe COVID-19 pandemic has greatly impacted school operations. To better understand the role of schools in COVID-19 transmission, we evaluated infections at two independent schools in Nashville, TN during the 2020-2021 school year. METHODSThe cumulative incidence of COVID-19 within each school, age group, and exposure setting were estimated and compared to local incidence. Primary attack rates were estimated among students quarantined for in-school close contact. RESULTSAmong 1401 students who attended school during the study period, 98 cases of COVID-19 were reported, corresponding to cumulative incidence of 7.0% (95% confidence interval (CI): 5.7-8.5). Most cases were linked to household (58%) or community (31%) transmission, with few linked to in-school transmission (11%). Overall, 619 students were quarantined, corresponding to >5000 person-days of missed school, among whom only 5 tested positive for SARS-CoV-2 during quarantine (primary attack rate: 0.8%, 95% CI: 0.3, 1.9). Weekly case rates at school were not correlated with community transmission. CONCLUSIONThese results suggest that transmission of COVID-19 in schools is minimal when strict mitigation measures are used, even during periods of extensive community transmission. Strict quarantine of contacts may lead to unnecessary missed school days with minimal benefit to in-school transmission.
ABSTRACT
BackgroundIn the absence of genome sequencing, two positive molecular SARS-CoV-2 tests separated by negative tests, prolonged time, and symptom resolution remain the best surrogate measure of possible re-infection. MethodsUsing a large electronic health record database, we characterized clinical and testing data for 23 patients with repeatedly positive SARS-CoV-2 PCR test results [≥]60 days apart, separated by [≥]2 consecutive negative test results. Prevalence of chronic medical conditions, symptoms and severe outcomes related to COVID-19 illness were ascertained. ResultsMedian age was 64.5 years, 40% were Black, and 39% were female. 83% smoked within the prior year, 61% were overweight/obese, 83% had immune compromising conditions, and 96% had [≥]2 comorbidities. Median interval between the two positive tests was 77 days. Among the 19 patients with 60-89 days between positive tests, 17 (89%) exhibited symptoms or clinical manifestations indicative of COVID-19 at the time of the second positive test and 14 (74%) were hospitalized at the second positive test. Of the four patients with [≥]90 days between two positive tests, two had mild or no symptoms at the second positive test and one, an immune compromised patient, had a brief hospitalization at the first diagnosis, followed by ICU admission at the second diagnosis three months later. ConclusionsOur study demonstrated a high prevalence of immune compromise, comorbidities, obesity and smoking among patients with repeatedly positive SARS-CoV-2 tests. Despite limitations, including lack of semi-quantitative estimates of viral load, these data may help prioritize suspected cases of reinfection for investigation and continued surveillance. ImportanceComprehensive characterization of clinical and SARS-CoV-2 testing data for patients with repeatedly positive SARS-CoV-2 tests can help prioritize suspected cases of reinfection for investigation in the absence of sequencing data and for continued surveillance for potential long-term health consequences of SARS-CoV-2 infection.
