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SARS-CoV-2 Acquisition and Immune Pathogenesis Among School-Aged Learners in Four K-12 Schools.

  • Author(s): Cooper, Dan M
  • Messaoudi, Ilhem
  • Aizik, Shlomit
  • Camplain, Ricky L
  • Lopez, Nanette V
  • Ardo, Jessica
  • Boden-Albala, Bernadette
  • Chau, Clayton
  • Condon, Curt
  • Golden, Charles
  • Ibraim, Izabela Coimbra
  • Jankeel, Allen
  • Kasper, Kirsten
  • Meyer, Andria
  • Stehli, Annamarie
  • Stephens, Diana
  • Weiss, Michael
  • Zulu, Michael Z
  • Ulloa, Erlinda
  • et al.

Objectives: To directly measure SARS-CoV-2 infection in diverse schools with either remote or onsite learning. Methods: 4 schools participated. Schools A and B served low-income Hispanic learners, school C special needs, and all three provided predominantly remote instruction. School D served middle and upper-middle income, White learners, with predominantly onsite instruction. 320 learners [10.5±2.1(SD); 7-17 y.o.]; 86% had phlebotomy. Testing occurred early in the fall (2020), at lower levels of COVID-19, and 6-8 weeks later during the fall-winter surge (tenfold increase in COVID-19 cases). Results: Nasal RT-qPCR for SARS-CoV-2 and 21 respiratory pathogens was performed. Phlebotomy was obtained for circulating immunity. Face covering and physical distancing fidelity was measured by direct observation. 17 learners were SARS-CoV-2 positive during the surge. School A (97% remote) had the highest infection rate (9/70, 12.9%, p<0.01) and IgG positivity rate (13/70, 18.6%). School D had the lowest infection and IgG positive rate (1/86, 1.2%). Mitigation compliance [physical distancing (mean 87.4%) and face covering (91.3%)] was high at all schools. Learners with documented SARS-CoV-2 infection had neutralizing antibodies (94.7%), broad and robust IFN-γ+ T cell responses, reduced frequencies of monocytes, and lower levels of circulating inflammatory mediators. Conclusions: Infection in the schools reflected regional rates rather than remote or onsite learning modalities. Schools can implement successful mitigation strategies across a wide range of income, school-type, and student diversity. Reduced monocyte and immune mediator concentrations coupled with robust humoral and cellular immunity may explain the generally milder symptoms in school-aged children. Table of Contents Summary: SARS-CoV-2 infection and immunobiology was measured in children at 4 diverse schools with varying degrees of onsite and remote learning. What’s Known on This Subject: At the start of the COVID-19 pandemic, schools were reflexively closed as there were fears that agreggation of school-aged children would lead to increased infection. Infectivity and immunobiology of SARS-CoV-2 in children attending schools not understood. What This Study Adds: School-associated infections reflected regional rates rather than remote or onsite learning. Successful mitigation was implemented across a diverse range of schools. Reduced immune mediator concentrations coupled with robust humoral and cellular immunity may explain the milder symptoms in school-aged children.

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