Limited SARS-CoV-2 Transmission in Australian Schools

Background: School closures have occurred globally during the COVID-19 pandemic despite limited data on transmission among children and in educational settings. We examined SARS-CoV-2 transmission among children and staff in Australian schools and early childhood education and care settings (ECECs). Methods: COVID-19 cases among school and ECEC attendees in New South Wales (NSW) from 25 January–10 April 2020 were investigated for onward transmission. All identified school/ECEC close contacts were monitored and offered SARS-CoV-2 nucleic acid testing (NAT) if symptomatic. Enhanced investigations in selected sites included NAT and SARS-CoV-2 antibody testing in symptomatic and asymptomatic contacts. Secondary attack rates (ARs) were calculated and compared with state-wide COVID-19 rates. Findings: Fifteen schools and 10 ECECs had children (n=12) or adults (n=15) attend while infectious, with 1448 contacts monitored. Of these, 43·7% (n=633/1448) had NAT and/or antibody testing, with 18 secondary cases identified (AR: 1.2%). In schools (n=3), 5 secondary cases (3 children; 2 adults) were identified (AR: 0·5%; 5/914). No secondary transmission occurred in nine of 10 ECECs among 497 contacts. However, one outbreak in an ECEC involved transmission to 6 adults and 7 children. Across all settings, 28·0% of secondary infections were asymptomatic (n=5/18; 3 infants, 1 adolescent and 1 adult). Interpretation: SARS-CoV-2 transmission rates were low in NSW educational settings during the first COVID-19 epidemic wave, consistent with mild infrequent disease in the 1·8 million child population. With effective case-contact testing and epidemic management strategies, children and teachers did not contribute significantly to COVID-19 transmission via attendance in educational settings. Funding: NSW Health funded the National Centre for Immunisation Research and Surveillance for the COVID-19 schools transmission study entitled “Enhanced investigation and analysis of education setting-related COVID-19 in NSW”.Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: The study was commissioned by the NSW Department of Health under the Public Health Act 2010 (NSW) and implemented in conjunction with approval and support from the NSW Department of Education.