Severe Acute Respiratory Syndrome Coronavirus 2 Transmission in a Georgia School District—United States, December 2020–January 2021
Jenna R. Gettings, Jeremy A.W. Gold, Anne Kimball, Kaitlin Forsberg, Colleen Scott, Anna Uehara, Suxiang Tong, Marisa Hast, Megan Swanson, Elana Morris, Emeka Oraka, Olivia Almendares, Ebony S. Thomas, Lemlem Mehari, Jazmyn McCloud, Gurleen Roberts, Deanna Crosby, Abirami Balajee, Eleanor Burnett, Rebecca J. Chancey, Peter W. Cook, Morgane Donadel, Catherine Espinosa, Mary E. Evans, Katherine E. Fleming-Dutra, Catalina Forero, Esther A. Kukielka, Yan Li, Paula L. Marcet, Kiren Mitruka, Jasmine Y. Nakayama, Yoshinori Nakazawa, Michelle O’Hegarty, Caroline Pratt, Marion E. Rice, Roxana M. Rodríguez Stewart, Raquel Sabogal, Emanny Sánchez, Andrés Velasco-Villa, Mark K. Weng, Jing Zhang, Grant Rivera, Tonia Parrott, Rachel S. Franklin, Janet Memark, Cherie Drenzek, Aron J. Hall, Hannah L. Kirking, Jacqueline E. Tate, Snigdha Vallabhaneni
Abstract
BACKGROUND: To inform prevention strategies, we assessed the extent of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission and settings in which transmission occurred in a Georgia public school district. METHODS: During 1 December 2020-22 January 2021, SARS-CoV-2-infected index cases and their close contacts in schools were identified by school and public health officials. For in-school contacts, we assessed symptoms and offered SARS-CoV-2 reverse-transcription polymerase chain reaction (RT-PCR) testing; performed epidemiologic investigations and whole-genome sequencing to identify in-school transmission; and calculated secondary attack rate (SAR) by school setting (eg, sports, elementary school classroom), index case role (ie, staff, student), and index case symptomatic status. RESULTS: We identified 86 index cases and 1119 contacts, 688 (61.5%) of whom received testing. Fifty-nine of 679 (8.7%) contacts tested positive; 15 of 86 (17.4%) index cases resulted in ≥2 positive contacts. Among 55 persons testing positive with available symptom data, 31 (56.4%) were asymptomatic. Highest SARs were in indoor, high-contact sports settings (23.8% [95% confidence interval {CI}, 12.7%-33.3%]), staff meetings/lunches (18.2% [95% CI, 4.5%-31.8%]), and elementary school classrooms (9.5% [95% CI, 6.5%-12.5%]). The SAR was higher for staff (13.1% [95% CI, 9.0%-17.2%]) vs student index cases (5.8% [95% CI, 3.6%-8.0%]) and for symptomatic (10.9% [95% CI, 8.1%-13.9%]) vs asymptomatic index cases (3.0% [95% CI, 1.0%-5.5%]). CONCLUSIONS: Indoor sports may pose a risk to the safe operation of in-person learning. Preventing infection in staff members, through measures that include coronavirus disease 2019 vaccination, is critical to reducing in-school transmission. Because many positive contacts were asymptomatic, contact tracing should be paired with testing, regardless of symptoms.