By Stan Deresinski, MD, FACP, FIDSA
Clinical Professor of Medicine, Stanford University
SYNOPSIS: Multiple SARS-CoV-2 transmission clusters were identified in schools in a Georgia school district, with educators often being the index cases. The Centers for Disease Control and Prevention has provided recommendations for safely opening schools.
SOURCE: Gold JAW, Gettings JR, Kimball A, et al; Georgia K-12 School COVID-19 Investigation Team. Clusters of SARS-CoV-2 infection among elementary school educators and students in one school district — Georgia, December 2020-January 2021. MMWR Morb Mortal Wkly Rep 2021;70:289-292.
Cases of COVID-19, either self-reported or identified by local public health personnel, occurring between Dec. 1, 2020, and Jan. 22, 2021, in eight public elementary schools in a single district in Georgia were evaluated to determine the patterns of transmission. Nine clusters involving at least three epidemiologically linked cases were identified at six of the schools. These cases involved 13 educators and 32 students. In two clusters, transmission from one educator to another preceded educator-to-student transmission, and these accounted for 15 of the 31 student cases. In addition, 18 (26%) of 69 household contacts who were tested were positive for SARS-CoV-2. If household members are included, the median cluster size was six (range, 3-16). The index case was an educator in four clusters, a student in one cluster, and the index case was indeterminate in the remainder. Investigation determined that inadequate social distancing as a consequence of space limitations had occurred in each of the nine transmission clusters and that student mask use was inadequate in five of the nine clusters.
The issue of reopening of K-12 schools during the COVID-19 pandemic is the subject of much heat and less light. The Centers for Disease Control and Prevention (CDC) has published recommendations to safely open schools.1 These recommendations include the consistent implementation of mitigation strategies, including mask use, physical distancing, handwashing and respiratory etiquette, cleaning and maintenance of facilities, and collaboration with the health department for contact tracing, together with isolation and quarantine. Additional activities for consideration include testing of symptomatic students and personnel and, in selected instances, screening asymptomatic people.
The CDC also recommends vaccination of staff and educators (who were found to constitute critical elements in networks of transmission in the Georgia cases) as soon as supplies allow. Most students are not currently eligible for vaccination. In this regard, it is of interest to note that the governor of California now has set aside 10% of vaccine doses for educators.
- Centers for Disease Control and Prevention. Operational strategy for K-12 schools through phased mitigation. Updated Feb. 26, 2021.