Abstract
Background The role of schools as a source of infection and driver in the coronavirus-pandemic has been controversial and is still not completely clarified. To prevent harm and disadvantages for children and adolescents, but also adults, detailed data on school outbreaks is needed, especially when talking about open schools employing evidence-based safety concepts. Here, we investigated the first significant COVID-19 school outbreak in Hamburg, Germany, after the re-opening of schools in 2020. Methods Using clinical, laboratory, and contact data and spatial measures for epidemiological and environmental studies combined with whole-genome sequencing (WGS) analysis, we examined the causes and the course of the secondary school outbreak. Findings The potential index case was identified by epidemiological tracking and the lessons in classrooms with presumably high virus spreading rates and further infection chains in the setting. Sequence analysis of samples detected one sample of a different virus lineage and 25 virus genomes with almost identical sequences, of which 21 showed 100% similarity. Most infections occurred in connection with two lesson units of the primary case. Likely, 31 students (12-14 years old), two staff members, and three family members were infected in the school or the typical household. Interpretations Sequence analysis revealed an outbreak cluster with a single source that was epidemiologically identified as a member of the educational staff. In lesson units, two superspreading events of varying degrees with airborne transmission took place. These were influenced by several parameters including the exposure times, the use of respiratory masks while speaking and spatial or structural conditions at that time.
Highlights
Introduction published maps and institutional affilSubsequently to the declaration of the coronavirus disease 2019 (COVID-19) as a pandemic by the World Health Organization (WHO) in March 2020, in many countries, schools were closed as a part of lockdown concepts
On 16 March 2020, a shutdown was put into effect in Germany, which included the closure of schools and kindergartens, assuming that these settings may play a leading role in the transmission dynamics of SARS-CoV-2 analogous to the influenza virus
This paper describes the retrospective analysis of epidemiological data, whole-genome sequencing, and the complex influences on virus transmission in the school setting
Summary
Introduction published maps and institutional affilSubsequently to the declaration of the coronavirus disease 2019 (COVID-19) as a pandemic by the World Health Organization (WHO) in March 2020, in many countries, schools were closed as a part of lockdown concepts. To prevent irreversible harm to children and adolescents, workable solutions and safe models for open schools that reduce the risk of virus transmission in and outside the school were needed. There is a need for public health research data from school outbreak investigations, including information about the detailed course, the various influencing factors, and risks for virus transmissions in schools. On 16 March 2020, a shutdown was put into effect in Germany, which included the closure of schools and kindergartens, assuming that these settings may play a leading role in the transmission dynamics of SARS-CoV-2 analogous to the influenza virus. An early investigation of outbreaks in school settings found no references for transmission among children in Ireland and concluded that schools might play a subordinate role in spreading SARS-CoV-2 [5]. In Australia, where schools stayed open during the first wave, students and teachers did not contribute significantly to virus transmissions in the Australian population after attending educational institutions [7]
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