Transmission of SARS-CoV-2 by children attending school. Interim report on an observational, longitudinal sampling study of infected children, contacts, and the environment

Cordery, R.; Reeves, L.; Zhou, J.; Rowan, A. G.; Watber, P.; Rosadas, C.; Crone, M. A.; Freemont, P.; Mosscrop, L.; Cowley, A.; Zelent, G.; Bisset, K.; LeBlond, H.; Regmi, S.; Mindlin, M.; Lamagni, T.; Barclay, W.; Taylor, G. P.; Sriskandan, S.

Background. Transmission of SARS-CoV-2 by children and young people in school settings has not been directly evaluated, nor the main mechanisms of transmission identified. The study set out to undertake sequential longitudinal sampling of infected children, their contacts, and the environment. Methods. Cases of COVID-19 were identified through statutory notification and matched to schools reporting cases. Cases of COVID-19 and their contacts from school and home were longitudinally sampled and tested for SARS-CoV-2. Surfaces and air in the home and school environment were also subject to longitudinal sampling and testing. Results Onward transmission of virus to immediate classroom members who participated in the study was not detected. Evidence of more widespread transmission among children remaining in school was not identified with the exception of one unexpected cluster of three asymptomatic cases in one school. Children infected with SARS-CoV-2 in this study shed viral RNA for up to 10 days from symptom onset, with levels peaking at 5-8 days. Viral RNA was identified in the environment around children who were actively shedding virus in the home, but limited contamination was identified in schools. Variant of Concern B1.1.7 was identified in later cases studied. Summary After 3 months, this small study has not found evidence to suggest COVID-19 is commonly transmitted by children within schools. A minority of infections may be subject to stochastic events that can lead to transmission. Further prospective and retrospective studies are required to identify factors associated with such events .