No magic bullet: limiting in-school transmission in the face of variable SARS-CoV-2 viral loads
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Published version
Date
2022
Authors
Van Egeren, Debra
Stoddard, Madison
Malakar, Abir
Ghosh, Debayan
Acharya, Antu
Mainuddin, Sk
Majumdar, Biswajit
Luo, Deborah
Nolan, Ryan P.
Joseph-McCarthy, Diane
Version
Published version
OA Version
Citation
D. Van Egeren, M. Stoddard, A. Malakar, D. Ghosh, A. Acharya, S. Mainuddin, B. Majumdar, D. Luo, R.P. Nolan, D. Joseph-McCarthy, L.F. White, N.S. Hochberg, S. Basu, A. Chakravarty. 2022. "No magic bullet: Limiting in-school transmission in the face of variable SARS-CoV-2 viral loads." Frontiers in Public Health, Volume 10, pp.941773-. https://doi.org/10.3389/fpubh.2022.941773
Abstract
In the face of a long-running pandemic, understanding the drivers of ongoing SARS-CoV-2 transmission is crucial for the rational management of COVID-19 disease burden. Keeping schools open has emerged as a vital societal imperative during the pandemic, but in-school transmission of SARS-CoV-2 can contribute to further prolonging the pandemic. In this context, the role of schools in driving SARS-CoV-2 transmission acquires critical importance. Here we model in-school transmission from first principles to investigate the effectiveness of layered mitigation strategies on limiting in-school spread. We examined the effect of masks and air quality (ventilation, filtration and ionizers) on steady-state viral load in classrooms, as well as on the number of particles inhaled by an uninfected person. The effectiveness of these measures in limiting viral transmission was assessed for variants with different levels of mean viral load (ancestral, Delta, Omicron). Our results suggest that a layered mitigation strategy can be used effectively to limit in-school transmission, with certain limitations. First, poorly designed strategies (insufficient ventilation, no masks, staying open under high levels of community transmission) will permit in-school spread even if some level of mitigation is present. Second, for viral variants that are sufficiently contagious, it may be difficult to construct any set of interventions capable of blocking transmission once an infected individual is present, underscoring the importance of other measures. Our findings provide practical recommendations; in particular, the use of a layered mitigation strategy that is designed to limit transmission, with other measures such as frequent surveillance testing and smaller class sizes (such as by offering remote schooling options to those who prefer it) as needed.
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License
© 2022 Van Egeren, Stoddard, Malakar, Ghosh, Acharya, Mainuddin, Majumdar, Luo, Nolan, Joseph-McCarthy, White, Hochberg, Basu and Chakravarty. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.