We’re not talking about a sample of, like, four kids here. It’s a sample of 344, who were at camp for all of six days before the facility was overrun by COVID-19.
This feels like a Bill Paxton “game over, man” moment for schools reopening this fall, but there are glimmers of hope. We’ll get to them in a second.
The threshold finding, though, is that there’s no reason to believe kids are unusually immune from infection or from transmitting the virus to others based on this data. They may be less susceptible to severe illness, but if what we’re worried about with schools is seeding community outbreaks in the fall that’ll ravage the adult population, then, yeah, it looks like those worries are justified.
During June 17–20, an overnight camp in Georgia (camp A) held orientation for 138 trainees and 120 staff members; staff members remained for the first camp session, scheduled during June 21–27, and were joined by 363 campers and three senior staff members on June 21. Camp A adhered to the measures in Georgia’s Executive Order* that allowed overnight camps to operate beginning on May 31, including requiring all trainees, staff members, and campers to provide documentation of a negative viral SARS-CoV-2 test ≤12 days before arriving. Camp A adopted most components of CDC’s Suggestions for Youth and Summer Camps to minimize the risk for SARS-CoV-2 introduction and transmission. Measures not implemented were cloth masks for campers and opening windows and doors for increased ventilation in buildings. Cloth masks were required for staff members…
These findings demonstrate that SARS-CoV-2 spread efficiently in a youth-centric overnight setting, resulting in high attack rates among persons in all age groups, despite efforts by camp officials to implement most recommended strategies to prevent transmission. Asymptomatic infection was common and potentially contributed to undetected transmission, as has been previously reported (1–4). This investigation adds to the body of evidence demonstrating that children of all ages are susceptible to SARS-CoV-2 infection (1–3) and, contrary to early reports (5,6), might play an important role in transmission (7,8). The multiple measures adopted by the camp were not sufficient to prevent an outbreak in the context of substantial community transmission. Relatively large cohorts sleeping in the same cabin and engaging in regular singing and cheering likely contributed to transmission (9). Use of cloth masks, which has been shown to reduce the risk for infection (10), was not universal. An ongoing investigation will further characterize specific exposures associated with infection, illness course, and any secondary transmission to household members. Physical distancing and consistent and correct use of cloth masks should be emphasized as important strategies for mitigating transmission in congregate settings.
The total number of people at the camp, including staffers, counselors, and so forth, was 597. Only 344 were tested, though, so the “attack rate” depends on which sample you use. Among the entire population, it’s scarily high. Among the population who were tested, it’s “game over, man” high.
Note that the age group with the highest rate of infection is the youngest children, where a clear majority ended up with COVID-19. A South Korean study that made waves a few weeks ago created some hope that younger kids were less susceptible to getting the disease, as that data showed that they’re much less likely than adults to transmit the virus to others. That doesn’t directly conflict with the CDC’s results — it may be that little ones are catching the virus but not passing it on as much — but certainly they’re not immune. To the contrary.
Glimmers of hope? Well, as noted in the excerpt, none of the campers were wearing masks. Maybe ubiquitous mask use by kids would have cut the infection rates way down, although if you’re optimistic about getting America’s millions of schoolchildren to wear masks all day long then that makes one of us. Transmission might also have been accelerated by all the “singing and cheering” going on; ever since scientists concluded that the virus is being spread through the air, they’ve warned that projecting one’s voice could increase transmission by releasing more viral particles. (Remember the superspreader event in Washington state at a choir practice?) That’s part of the reason why they want bars shut down: In addition to all the socializing that goes on, people tend to speak more loudly over the din of chatter, music, etc. If you’re optimistic about getting America’s millions of schoolchildren to keep their voices down all day long then that makes one of us.
In fact, there are reasons to think the study is underestimating how bad this outbreak was. The CDC notes that the “attack rates presented are likely an underestimate because cases might have been missed among persons not tested or whose test results were not reported.” Conceivably the true attack rate is north of 76 percent. And although campers weren’t wearing masks, camp staff were required to wear them. How’d that work out for them? Among 117 staffers, 66 got infected — an attack rate of 56 percent, the highest of any cohort tested. Masks don’t seem to have done anything to protect them, at least in this environment.
A new study published a few days ago in the JAMA offers the flip side of the CDC study. The takeaway from the CDC data is that reopening schools might mean many infections. The takeaway from the JAMA data is that closing schools this past spring might have prevented many infections.
Their projection found that, if schools had stayed open, there could have been roughly 424 more coronavirus infections and 13 more deaths per 100,000 residents over the course of 26 days.
Extrapolate that to the American population, and the country might have seen as many as 1.37 million more cases and 40,600 more deaths, explained Samir Shah, the director of hospital medicine at Cincinnati Children’s Hospital Medical Center and one of the authors of the paper.
“These numbers seem ridiculously high and it’s mind-boggling to think that these numbers are only … in the first several weeks,” said Shah. “That’s bonkers.” He warned, though, that those numbers should be taken with a grain of salt. While their statistical model attempts to pinpoint the impact of schools staying open or being closed, the method can’t actually establish any sort of causal relationship.
Big caveat: The study doesn’t claim that school closings definitively prevented anything. States were shutting everything down at the time; schools were one of those things. Maybe the lockdown in toto prevented infections and deaths, with some unknown percentage of those attributed to school closures. Maybe it wasn’t even the lockdowns per se but rather the scare that the lockdowns put into Americans that reduced infections. “It’s quite possible — and probable — that people changed their behavior because they thought, ‘Oh my goodness, there’s this new virus and it’s so scary they’re closing schools,’” said one pediatrician to Stat.
The city with the biggest public-school system in America announced its school plans this morning. We’ll reopen public schools for part-time in-person instruction, said Bill de Blasio, if and only if New York’s positivity rate is at three percent or lower in September. It’s at one percent right now but it could get to three in a hurry. As for what happens if schools reopen and there’s an outbreak, de Blasio and his school chancellor have devised a dizzying protocol. It’s good that they’ve thought this through but it’s easy to imagine schools in total chaos trying to follow these rules, shuffling kids around to try to prevent further infections:
That reminds me of professional baseball trying to reschedule the season on the fly as teams are put on ice for days when infections emerge on their rosters. At some point the logistics are too difficult and you shut down.
In spite of everything, experts recognize that it’s important to try to get kids back into class if possible. Bill Gates endorsed the idea a few days ago and Anthony Fauci endorsed it again this morning, citing the “downstream unintended consequences on families” if we keep schools closed. In fact, he told teachers on Tuesday that they’ll be “part of the experiment of the learning curve of what we need to know” about how infectious kids are. So, uh, good luck with that, everyone. Best wishes on your “experiment.”