Authors

John Crowe, Omaha Public School District
Andy T. Schnaubelt, University of Nebraska Medical CenterFollow
Scott SchmidtBonne, Omaha Public School District
Kathleen Angell, University of Nebraska Medical CenterFollow
Julia Bai, University of Nebraska Medical CenterFollow
Teresa Eske, Omaha Public School District
Molly Nicklin, Omaha Public School District
Catherine Pratt, University of Nebraska Medical CenterFollow
Bailey White, University of Nebraska Medical CenterFollow
Brodie Crotts-Hannibal, University of Nebraska - Lincoln
Nicholas Staffend, University of Nebraska Medical CenterFollow
Vicki L. Herrera, University of Nebraska Medical CenterFollow
Jeramie Cobb, Omaha Public School District
Jennifer Conner, University of Nebraska Medical CenterFollow
Julie Carstens, University of Nebraska Medical CenterFollow
Jonell Tempero, University of Nebraska Medical Center
Lori Bouda, Omaha Public School District
Matthew Ray, Omaha Public School District
James V. Lawler, University of Nebraska Medical CenterFollow
Walter S. Campbell, University of Nebraska Medical CenterFollow
John-Martin Lowe, University of Nebraska Medical CenterFollow
Joshua L. Santarpia, University of Nebraska Medical CenterFollow
Shannon Bartelt-Hunt, University of Nebraska - Lincoln
Michael R. Wiley, University of Nebraska Medical CenterFollow
David Brett-Major, University of Nebraska Medical CenterFollow
Cheryl Logan, Omaha Public School District
M. Jana Broadhurst, University of Nebraska Medical CenterFollow

Document Type

Article

Journal Title

JAMA Network Open

Publication Date

2021

Volume

4

Abstract

Importance: Scalable programs for school-based SARS-CoV-2 testing and surveillance are needed to guide in-person learning practices and inform risk assessments in kindergarten through 12th grade settings.

Objectives: To characterize SARS-CoV-2 infections in staff and students in an urban public school setting and evaluate test-based strategies to support ongoing risk assessment and mitigation for kindergarten through 12th grade in-person learning.

Design, Setting, and Participants: This pilot quality improvement program engaged 3 schools in Omaha, Nebraska, for weekly saliva polymerase chain reaction testing of staff and students participating in in-person learning over a 5-week period from November 9 to December 11, 2020. Wastewater, air, and surface samples were collected weekly and tested for SARS-CoV-2 RNA to evaluate surrogacy for case detection and interrogate transmission risk of in-building activities.

Main Outcomes and Measures: SARS-CoV-2 detection in saliva and environmental samples and risk factors for SARS-CoV-2 infection.

Results: A total of 2885 supervised, self-collected saliva samples were tested from 458 asymptomatic staff members (mean [SD] age, 42.9 [12.4] years; 303 women [66.2%]; 25 Black or African American [5.5%], 83 Hispanic [18.1%], 312 White [68.1%], and 35 other or not provided [7.6%]) and 315 students (mean age, 14.2 [0.7] years; 151 female students [48%]; 20 Black or African American [6.3%], 201 Hispanic [63.8%], 75 White [23.8%], and 19 other race or not provided [6.0%]). A total of 46 cases of SARS-CoV-2 (22 students and 24 staff members) were detected, representing an increase in cumulative case detection rates from 1.2% (12 of 1000) to 7.0% (70 of 1000) among students and from 2.1% (21 of 1000) to 5.3% (53 of 1000) among staff compared with conventional reporting mechanisms during the pilot period. SARS-CoV-2 RNA was detected in wastewater samples from all pilot schools as well as in air samples collected from 2 choir rooms. Sequencing of 21 viral genomes in saliva specimens demonstrated minimal clustering associated with 1 school. Geographical analysis of SARS-CoV-2 cases reported district-wide demonstrated higher community risk in zip codes proximal to the pilot schools.

Conclusions and Relevance: In this study of staff and students in 3 urban public schools in Omaha, Nebraska, weekly screening of asymptomatic staff and students by saliva polymerase chain reaction testing was associated with increased SARS-CoV-2 case detection, exceeding infection rates reported at the county level. Experiences differed among schools, and virus sequencing and geographical analyses suggested a dynamic interplay of school-based and community-derived transmission risk. Collectively, these findings provide insight into the performance and community value of test-based SARS-CoV-2 screening and surveillance strategies in the kindergarten through 12th grade educational setting.

ISSN

2574-3805

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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Epidemiology Commons

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