Tennessee Releases Info on School-Aged COVID-19 Cases

Yesterday, Tennessee released the number of total COVID-19 cases in school-aged children (5-18) by county. This is the first time we've had the ages broken out this way. Previously the state was providing ten year age ranges (0-10 and 11-20). For the NETN region, 9.5% of cases have been school-aged children. This ranges from 0% in Unicoi to 23% of cases in Hancock county. These are total cases and not active. 

In other regional case news, Washington County had a record-high new cases (51) on July 19 followed by our second highest day on the 20th (40). The trend is similar across the region. But on the bright side, Sullivan County's active cases dropped on Wednesday for the first time since June 16. Granted they went back up one again yesterday, but we'll take the happy news when we can get it right now. The data below is through Thursday, July 23.

 

If you are a parent and reading this, you've probably been following the 14-day rate per 100,000 people charts I've been doing. Even though many of our school systems are in counties in the "red zone," there has been no talk of starting online for all yet. Johnson City Schools did move their start date from August 4 to August 10. I'd love to think the situation will improve by then, but it seems unlikely. Many of us are having to make the decision to send our kids to school in-person or online this week. It's one of the hardest decisions I've ever had to make. And I don't think there is a good choice. We are all trying to do the best we can with the information we have in deciding what's right for our families. Wherever you have landed, you will get no judgement from me. 

We know school openings won't be without risks. There will be infections. We should be worried about our teachers and staff. There appears to be some evidence that older kids are more likely to spread the virus than younger kids. A large study from South Korea found that 10-19 year-olds were just as likely to spread the virus to household contacts as adults; however young children (0-9) were the least likely to spread the virus to those that lived in their home. The rate of spread to non-household contacts was very low for both, with about 1% of these becoming infected. What this doesn't give us is a clear picture of how school would affect these numbers as schools were closed during the majority of the period studied. 

A pre-print study of European school closures and re-openings found that reopening schools to younger students has not resulted in significant increase in the growth rate of COVID-19 cases. In countries with low community transmission, the return of all students also did not result in a significant increase. However, the added return of most (primarily older) students in Germany, where there was higher levels of community transmission, has increased transmission among students, but not staff. 

A commentary I read this week from the journal Pediatrics references some interesting data. Here are the highlights: 

• All children <16 years of age diagnosed at Geneva University Hospital (N = 40) underwent contact tracing to identify infected household contacts (HHCs). In 37/40 cases, the the child developed symptoms after or concurrent with adult HHCs, suggesting that the child was not the source of infection and that children most frequently acquire COVID-19 from adults, rather than transmitting it to them.
• In China, of 68 children with confirmed COVID-19 admitted to Qingdao Women’s and Children’s Hospital from January 20 to February 27, 2020, and with complete epidemiological data, 65 (95.59%) patients were HHCs of previously infected adults. 
• In New South Wales, Australia, 9 students and 9 staff infected with SARS-CoV-2 across 15 schools had close contact with a total of 735 students and 128 staff. Only 2 secondary infections were identified, none in adult staff; 1 student in primary school was potentially infected by a staff member, and 1 student in high school was potentially infected via exposure to 2 infected schoolmates.

So what does all this tell us? Restarting schools is not without risk. It's likely to increase spread in regions with higher community transmission. That being said, younger children seem to be the least likely to spread the virus. And there are some instances of schools opening without increasing the growth rate of the virus. We know the benefits of school are great, which is why the AAP has strongly recommended kids go back to school if possible. Good luck to you and your kids. 

Here are the new cases with 14-day averages: