Secondary attack rates in primary and secondary school bubbles following a confirmed case: Active, prospective national surveillance, November to December 2020, England.

Annabel A Powell ,Felicity Aiano,Frances Baawuah,Joanna Sturgess,Punam Mangtani,Maria Zambon,Emma Rourke,Patrick Nguipdop-Djomo,Samreen Ijaz,John Poh,Georgina Ireland,Joanna Elli,Bernadette Brent,Angie Lackenby,Zahin Amin-Chowdhury,Fiona Dawe,Meaghan Kall,Shazaad Ahmad,Joanna Garstang,Joanne Beckmann,Katherine E Halliday ,James Hargreaves,Andrew Brent ,Sir Ian Diamond,Ifeanyichukwu Okike ,Mary Ramsay ,Kevin E Brown,Sinéad Langan ,William E Oswald ,Shamez Ladhani

doi:10.1371/journal.pone.0262515

Abstract

BackgroundFollowing the full re-opening of schools in England and emergence of the SARS-CoV-2 Alpha variant, we investigated the risk of SARS-CoV-2 infection in students and staff who were contacts of a confirmed case in a school bubble (school groupings with limited interactions), along with their household members.MethodsPrimary and secondary school bubbles were recruited into sKIDsBUBBLE after being sent home to self-isolate following a confirmed case of COVID-19 in the bubble. Bubble participants and their household members were sent home-testing kits comprising nasal swabs for RT-PCR testing and whole genome sequencing, and oral fluid swabs for SARS-CoV-2 antibodies.ResultsDuring November-December 2020, 14 bubbles were recruited from 7 schools, including 269 bubble contacts (248 students, 21 staff) and 823 household contacts (524 adults, 299 children). The secondary attack rate was 10.0% (6/60) in primary and 3.9% (4/102) in secondary school students, compared to 6.3% (1/16) and 0% (0/1) among staff, respectively. The incidence rate for household contacts of primary school students was 6.6% (12/183) and 3.7% (1/27) for household contacts of primary school staff. In secondary schools, this was 3.5% (11/317) and 0% (0/1), respectively. Household contacts were more likely to test positive if their bubble contact tested positive although there were new infections among household contacts of uninfected bubble contacts.InterpretationCompared to other institutional settings, the overall risk of secondary infection in school bubbles and their household contacts was low. Our findings are important for developing evidence-based infection prevention guidelines for educational settings.

Highlights

In the pandemic, the role of children in infection and transmission of SARS-CoV-2 was unclear and, many countries closed their educational settings as part of national lockdown to control the spread of the virus [1]
Following the full re-opening of schools in England and emergence of the SARS-CoV-2 Alpha variant, we investigated the risk of SARS-CoV-2 infection in students and staff who were contacts of a confirmed case in a school bubble, along with their household members
Household contacts were more likely to test positive if their bubble contact tested positive there were new infections among household contacts of uninfected bubble contacts

Summary

Introduction

The role of children in infection and transmission of SARS-CoV-2 was unclear and, many countries closed their educational settings as part of national lockdown to control the spread of the virus [1]. School closures affect the education of children and have a profound effect on their mental, physical and social wellbeing, as well as access to social care, free school meals and school-based immunisations, all more likely to disproportionately affect the most disadvantaged and vulnerable families [2]. Despite these well-recognised consequences, parents and staff remain concerned about the risk of COVID19 in educational settings, both to themselves and their household members. Following the full re-opening of schools in England and emergence of the SARS-CoV-2 Alpha variant, we investigated the risk of SARS-CoV-2 infection in students and staff who were contacts of a confirmed case in a school bubble (school groupings with limited interactions), along with their household members

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Conclusion