key: cord-0745014-e9xx6mhg authors: Thompson, D. A.; Abbasizanjani, H.; Fry, R.; Marchant, E.; Griffiths, L. J.; Akbari, A.; Hollinghurst, J.; North, L.; Lyons, J.; Torabi, F.; Davies, G.; Gravenor, M. B.; Lyons, R. A. title: Staff-Pupil SARS-CoV-2 Infection Pathways in Schools: A Population Level Linked Data Approach date: 2021-02-08 journal: nan DOI: 10.1101/2021.02.04.21251087 sha: 1d1b4fed62641eaaa48478ad7a94f3785464759a doc_id: 745014 cord_uid: e9xx6mhg Abstract Background: Better understanding of the role that children and school staff play in the transmission of SARS-CoV-2 is essential to guide policy development on controlling infection whilst minimising disruption to children's education and wellbeing. Methods: Our national e-cohort (n=500,779) study used anonymised linked data for pupils, staff and associated households linked via educational settings. We estimated the risk of testing positive for SARS-CoV-2 infection for staff and pupils over the period August-December 2020, dependent on measures of recent exposure to known cases linked to their educational settings. Results: The total number of cases in a school was not associated with a subsequent increase in the risk of testing positive (Staff OR per case 0.92, 95%CI 0.85, 1.00; Pupils OR per case 0.98, 95%CI 0.93, 1.02). Amongst pupils, the number of recent cases within the same year group was significantly associated with subsequent increased risk of testing positive (OR per case 1.12, 95%CI 1.08 - 1.15). These effects were adjusted for a range of demographic covariates, and in particular any known cases within the same household, which had the strongest association with testing positive (Staff OR 39.86, 95%CI 35.01, 45.38, pupil OR 9.39, 95%CI 8.94 - 9.88). Conclusions: In a national school cohort, the odds of staff testing positive for SARS-CoV-2 infection were not significantly increased in the 14-day period after case detection in the school. However, pupils were found to be at increased risk, following cases appearing within their own year group, where most of their contacts occur. Strong mitigation measures over the whole of the study period may have reduced wider spread within the school environment. S t a f f -P u p i l S A R S -C o V -2 I n f e c t i o n P a t h w a y s i n S c h o o l s : A P o p u l a t i o n L e v e l L i n k e d D a t a A p p r o a c What is known: • Evidence of the role schools play in the transmission of SARS-CoV-2 is limited • Higher positivity rates are observed in school staff compared to pupils • Lack of evidence on transmission pathways transmission into and within schools What this study adds: • First UK national level study of transmission between pupils and staff in a school environment during the SARS-CoV-2 pandemic. • Schools opening September-December 2020 was not associated with an increased subsequent risk of testing positive in staff • Pupils were found to be at increased risk of testing positive, following cases appearing within their own year group A b s t r a c t B a c k g r o u n d : B e t t e r u n d e r s t a n d i n g o f t h e r o l e t h a t c h i l d r e n a n d s c h o o l s t a f f p l a y i n t h e t r a n s m i s s i o n o f S A R S -C o V -2 i s e s s e n t i a l t o g u i d e p o l i c y d e v e l o p m e n t o n c o n t r o l l i n g i n f e c t i o o l e o f t h e s t u d y p e r i o d m a y h a v e r e d u c e d w i d e r s p r e a d w i t h i n t h e s c h o o l e n v i r o n m e n t . I n t r o d u c t i o n T h e r o l e s c h o o l s p l a y i n t h e t r a n s m i s s i o n o f s e v e r e a c u t e r e s p i r a t o r y s y n d r o m e c o r o n a v i r u s 2 ( S A R S -C o V -2 ) r e q u i r e s f u r t h e r r o b u s t e v i d e n c e . T h e r e i s o n g o i n g d e b a t e r e g a r d i n g c l o s u r e s a n d r e l a t e d c o n c e r n s o f t h e n e g a t i v e i m p a c t s a n d w i d e n i n g i n e q u a l i t i e s i n c h i l d r e n ' s h e a l t h , w e l l b e i n g , e d u c a t i o n a l a t t a i n m e n t , a s w e l l a s o n f a m i l y i n c o m e a n d t h e o v e r a l l e c o n o m y . S i n c e t h e W o r l d H e a l t h O r g a n i z a t i o n d e c l a r e d t h e S A R S -C o V -2 o u t b r e a k a g l o b a l p a n d e m i c o n M a r c h 1 1 t h 2 0 2 0 ( 1 ) , e d u c a t i o n f o r c h i l d r e n a n d y o u n g p e o p l e h a s v a r i e d f r o m o n l i n e , i n -p e r s o n a n d h y b r i d l e a r n i n g , w i t h w i d e v a r i a n c e o f m e a s u r e s i m p l e m e n t e d f o r d i f f e r e n t g r o u r t i n c r e a s e d t r a n s m i s s i o n a m o n g s t s c h o o l s t a f f a n d s c h o o l -a g e d c h i l d r e n , p a r t i c u l a r l y a g e d 1 2 a n d a b o v e ( s e c o n d a r y s c h o o l a g e ) t o w a r d s t h e e n d o f 2 0 2 0 , a g a i n s t a b a c k g r o u n d o f h i g h c o m m u n i t y p r e v a l e n c e . H o w e v e r , t h e e v i d e n c e b a s e i s s t i l l l i m i t e d a n d d o e s n o t c o v e r t h e d y n a m i c s o f t r a n s m i s s i o n a n d i n f e c t i o n f r o m h o u s e h o l d s t o s c h o o l s , a n d w i t h i n t h e s c h o o l s e t t i n g . T h i s s t u d y c o n t r i b u t e s t o t h i s b o d y o f e v i d e n c e t h r o u g h a n a l y s e s o f p o p u l a t i o n -l e v e l d a t a h e l d w i t h i n t h e S e c u r e A n o n y m i s e d I n f o r m a t i o n L i n k a g e ( S A I L ) D a t a b a n k ( 9 -1 1 ) . B y l i n k i n g d a t a o n a l l s t a f f , p u p i l s a n d a s s o c i a t e d h o u s e h o l d c o n t a c t s i n W a l e s , w e a i m e d t o i m p r o v e u n d e r s t a n d i n g o f l i k e l y t r a n s m i s s i o n p a t h w a y s i n t o a n d t h r o u g h e d u c a t i o n a l s e t t i n g s . W e a s s e s s e d t h e l i k e l i h o o d o f t e s t p o s i t i v i . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted February 8, 2021. P a t i e n t P u b l i c I n v o l v e m e n t A l l p r o p o s a l s t o u s e a n o n y m i s e d d a t a i n S A I L a r e s c r u t i n i s e d b y a n i n d e p e n d e n t I n f o r m a t i o n G o v e r n a n c e R e v i e w P a n e l ( I G R P ) t h a t i n c l u d e s m e m b e r s o f t h e p u b l i c p r i o r t o t h e c o m m e n c e m e n t o f t h e r e s e a r c h . . . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted February 8, 2021. ; https://doi.org/10.1101/2021.02.04.21251087 doi: medRxiv preprint . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted February 8, 2021. ; . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted February 8, 2021. ; https://doi.org/10.1101/2021.02.04.21251087 doi: medRxiv preprint e n t s f o r a g e , s e x , r e s i d e n t i a l s e t t l e m e n t t y p e , n u m b e r o f p u p i l s a n d s t a f f w i t h i n t h e l i n k e d s c h o o l , a n d n u m b e r o f p e o p l e w i t h i n l i n k e d h o u s e h o l d a r e i n c l u d e d i n t h e m o d e l s . O d d s r a t i o s c a l c u l a t e d p e r i n d i v i d u a l c a s e o f k n o w n e x p o s u r a n d s p e c i a l s c h o o l s h a d a h i g h e r o d d s o f a S A R S -C o V -2 p o s i t i v e t e s t c o m p a r e d w i t h m i d d l e a n d s e c o n d a r y s c h o o l s , a n d s t a f f h a d h i g h e r o d d s o f a p o s i t i v e o u t c o m e c o m p a r e d t o t h e r e f e r e n c e l e v e l o f p u p i l s ( O R 2 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted February 8, 2021. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted February 8, 2021 . s c h o o l s t a f f c o m p a r e d t o p u p i l s ( 5 , 6 , 2 2 ) a n d m a y r e f l e c t t h e h i g h e r p o p u l a t i o n -b a s e d r a t e s o b s e r v e d i n a d u l t . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) T h i s s t u d y h a s e x a m i n e d p l a u s i b l e t r a n s m i s s i o n p a t h w a y s w i t h i n a s c h o o l e n v i r o n m e n t a n d n o t t h e r i s k o f s t a f f o r p u p i l s b e c o m i n g m o d e r a t e l y o r s e r i o u s l y i l l f r o m C O V I D -1 9 . A s t h e r e i s a p a u c i t y o f e v i d e n c e o n t h e e f f e c t i v e n e s s o f t h e v a c c i n e s o n t h e r e d u c t i o n o f t r a n s m i s s i o n i t i I G R P ) . 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