Does SARS-CoV-2 spread in school settings?

New study examines whether the SARS-CoV-2 coronavirus is common in schools.

The global SARS-CoV-2 pandemic has drastically changed the way of life in most countries. With a vaccine likely to be many months away from widespread availability, the focus has shifted to how we can live with the virus. One of the more difficult areas in this regard is the educational environment. While many university courses can be largely offered online, educational institutions for younger students are less suited to distance or online teaching. Therefore, understanding the risks of SARS-CoV-2 SPREAD in schools is vital to continuously protect students and teachers. A study recently published in The Lancet Child & Adolescent Health examines transmission in Australian educational institutions during the early months of the pandemic (1).

The study monitored schools and institutions for early childhood and education (ECEC) in New South Wales, Australia. A total of 3,103 schools and 4,600 ECEC were included. The monitoring for index cases in these environments lasted from January 25 to April 9, 2020. In total, there were over 140,000 employees and over 1.2 million students. Distance learning was recommended for all students from March 22nd through the end of the semester on April 9th.

Primary cases were defined as the initial infection cases in this setting. A secondary case was defined as one where the transmission was likely to have taken place in this setting. All close contacts with a confirmed case were recommended to be quarantined at home for 14 days. During this time, they were monitored over the phone frequently and tested if symptoms occurred. When a case was discovered, the school or ECEC closed immediately, but only temporarily and usually reopened within 48 hours.

There were a total of 41 cases within a school or ECEC during the study period. Of these, 19 occurred in children under 18 years of age, 12 of which were primary cases. Similarly, there were 22 in adults, of which 15 were primary cases. In particular, the first case in an educational setting did not occur until March 5. For comparison, as of May 1, New South Wales had a total of 3,033 confirmed cases. 97 of them were children. As a result, approximately one in five pediatric cases attended educational institutions while they were infected. The majority of the remaining cases in children were related to household attitudes.

This study has important implications for continuing education in the COVID-19 era. The decision to encourage distance learning from March 23rd was reflected in a sharp decline in school attendance rates and a corresponding elimination of cases related to elementary and secondary school settings. This underscores the clear positive effects of distance learning in containing the spread of SARS-CoV-2.

However, this is not a viable long-term solution. Instead, this study also shows how effective detection and contact tracing techniques can facilitate resumption of personal school activities. A total of 25 school or ECEC settings were found to have a confirmed case, but secondary carryover occurred in only four of these settings. It is also highlighted that improvements can be made in preventing transmission between employees. Although staff made up only 10% of school goers, they made up more than 50% of cases in the education sector.

Improving staff protection measures combined with effective tracking and tracing procedures can enable a return to normal school practices while minimizing the risk of COVID-19 transmission. However, it is important to note that this research was conducted in a location with low SARS-CoV-2 levels in the community. Further research is needed before these results can be adjusted for other settings where the incidence rate is much higher.

Written by Michael McCarthy

1. Macartney K., Quinn HE, Pillsbury AJ, Koirala A., Deng L., Winkler N. et al. Transmission of SARS-CoV-2 in the Australian educational setting: a prospective cohort study. The Lancet Child & Adolescent Health.

Image by pedro_wroclaw from Pixabay