Infectious Disease

Simple technologies on close-to-capacity school buses prevent the spread of SARS-CoV-2

August 27, 2021

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Ramirez reports that he is a member of the Virginia AAP School Re-opening Task Force, advising schools on re-opening during the COVID-19 pandemic. Please refer to the study for all relevant financial information from the other authors.

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Universal testing and contact tracing failed to find evidence that near-capacity school buses were the source of SARS-CoV-2 transmission at a school in Virginia, researchers reported.

“We realized early on that the data showed that schools are safe when simple techniques are used to stop the spread of disease, even when the spread of disease is high in the community.” Dana Ramirez, MD, an adjunct professor of pediatrics and emergency pediatric medicine at Eastern Virginia Medical School and Children’s Hospital of The King’s Daughters in Virginia, said the Healio Primary Care.

Reference: Ramirez DWE, et al. J. Sch. Bless you. 2021; doi: 10.1111 / josh.1305.

“My co-authors and I also found that there wasn’t a lot of data on school buses,” she said. “In addition, many school districts do not have enough bus drivers and buses if they cannot use the buses to their full capacity. Many families are simply not able to drive their children to school every day, which makes bus travel crucial. ”

Dana Ramirez

Ramirez and colleagues analyzed data from 1,154 students in grades one through twelve at an independent school in Virginia. They performed pooled saliva-based tests every 2 weeks from August 24, 2020 through February 4, 2021, and then performed weekly tests until March 19. If a test was positive, a confirmatory nasal swab test was performed. The nearly 7-month study was conducted during the highest SARS-CoV-2 transmission time in the community, according to the researchers.

15 school buses transported 462 students to school. The duration of the bus rides ranged from 36 to 74 minutes. The buses were almost full, with two students in each seat. “Simple mitigation” techniques have been used to prevent the transmission of SARS-CoV-2, such as B. physical distance of 2.5 feet or more, universal masking, and spaced window openings, the researchers wrote.

“Buses had to provide a 1-inch window opening in the middle two windows and the two windows in the last row of seats on the bus,” Ramirez and colleagues wrote in the Journal of School Health. “The buses were not loaded from the back to the front, rather older students were assigned to the back rows, while younger students were assigned to the front half of the bus. The students sat in the front row of the bus behind the bus driver, who was 4 feet from the driver with no barrier between the students and the driver. “

According to the researchers, 39 people with SARS-CoV-2 rode a school bus, including 37 students, a driver and a helper. This resulted in an additional 52 people being quarantined. However, universal testing and contact tracing failed to identify student-to-student transmissions, adult-to-student transmissions, and student-to-adult transmissions.

A larger study with more students and schools would likely find low rates of disease transmission, “but possibly not zero like this study,” said Ramirez.

She encouraged family doctors to share the following school bus transportation strategies with parents and school districts:

  • Use every row in a bus, sharing seats and siblings if possible.
  • Partially open windows, even if the weather is not favorable.
  • Create an environment that prevents children and staff from coming to school sick.
  • Make sure that school bus passengers and drivers are masked.
  • Use multiple prevention strategies in tandem.

“As schools reopen for personal learning, safe bus transport is vital to maximizing the health of students and staff, but buses must be operated at almost maximum capacity to provide fair transportation for all students,” wrote Ramirez and colleagues. “The model offered can support school administrations in planning transport processes.”

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Adam L. Hersh, MD, PhD)

Adam L. Hersh, MD, PhD

Bus travel is an important part of school operations and it is just as important to ensure that we implement effective prevention strategies in this environment as we do in the classroom.

It is likely that another study, like that of Ramirez and colleagues, or a larger one, done last school year would have produced similar results. Their results fit in with the broader evidence showing that the likelihood of SARS-CoV-2 transmission is low with high mask compliance and other prevention strategies in school settings (many studies have estimated it at around 1% or less).

Whether this low transmission rate will persist in the coming school year is uncertain for two main reasons. First, the delta variant is much more portable. Second, it remains uncertain in some school settings whether or not masks will be required or used at all. It will be crucial to continue to conduct epidemiological studies like this in school settings as the new school year begins, in order to develop and implement the best possible prevention strategies that will keep our schools open and safe.

Adam L. Hersh, MD, PhD

Associate Professor, Department of Pediatric Infectious Diseases, University of Utah Health
Associate Program Director, Pediatric Infectious Disease Scholarship Program, University of Utah Health
Member, AAP, Pediatric Infectious Diseases Society, Infectious Diseases Society of America

Disclosure: Hersh does not report any relevant financial information.

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