Abstract
BackgroundThere is a continuing risk for COVID-19 transmission in school settings while transmission is ongoing in the community, particularly among unvaccinated populations. To ensure that schools continue to operate safely and to inform implementation of prevention strategies, it is imperative to gain better understanding of the risk behaviors of staff and students. This secondary analysis describes the prevalence of COVID-19 risk behaviors in an exposed population of students and school staff in the pre-vaccine era and identifies associations between these behaviors and testing positive for SARS-CoV-2.MethodsFrom December 2020–January 2021, school staff and students exposed to confirmed COVID-19 cases in a Georgia school district were tested for SARS-CoV-2 and surveyed regarding risk behaviors in and out of school. Prevalence of risk behaviors was described by age group and school level, and associations with SARS-CoV-2 positivity were identified using chi squared tests.ResultsOverall, 717 students and 79 school staff participated in the investigation; SARS-CoV-2 positivity was 9.2%. In the 2 weeks prior to COVID-19 exposure, 24% of participants reported unmasked indoor time at school, 40% attended social gatherings with non-household members, and 71% visited out-of-school indoor locations, including 19% who ate indoors in restaurants. Frequencies of risk behaviors increased by age. Among students, 17% participated in school sports, of whom 86% participated without a mask. SARS-CoV-2 positivity was significantly associated with school sports and unmasked time in sports. Among K-5 students, positivity was associated with exposure to a teacher index case.ConclusionsThis analysis highlights the high prevalence of risk behaviors in an unvaccinated population exposed to COVID-19 in school and identifies an association between student sports participation and SARS-CoV-2 positivity. These findings illustrate the importance of school-level prevention measures to reduce SARS-CoV-2 transmission, including limiting close-contact indoor sports and promoting consistent mask use in unvaccinated individuals. Future research could explore the role of community vaccination programs as a strategy to reduce COVID-19 transmission and introductions into school settings.
Highlights
There is a continuing risk for COVID-19 transmission in school settings while transmission is ongoing in the community, among unvaccinated populations
Future research could explore the role of community vaccination programs as a strategy to reduce COVID-19 transmission and introductions into school settings
Frequencies of risk behaviors by test result among staff and results of multivariate analyses are found in the appendices (Tables S1, S2). This analysis builds on a previous investigation of inschool SARS-CoV-2 transmission to examine prevalence of risk behaviors among 717 students and 79 school staff originally identified as contacts of a COVID-19 case in a school setting
Summary
There is a continuing risk for COVID-19 transmission in school settings while transmission is ongoing in the community, among unvaccinated populations. Studies suggested that these closures may have negatively impacted student learning and the mental health of children and families, [3,4,5] and due to the importance of in-person education for children, families, and communities, many schools reopened for face-to-face instruction in the 2020/2021 academic year [6, 7] Due to their potential for high population density and frequency of close contact between students or staff, risks for introductions and transmission within the school setting persist while transmission of SARS-CoV-2 is ongoing in the community, in populations where vaccination remains low [7, 8]. Understanding the extent to which students and school staff engage in risk behaviors may contribute to developing policies and practices that could help to reduce introductions and transmission of SARS-CoV-2 in school settings in order to limit school closures and maximize opportunities for in-person learning
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