COVID-19 outbreak at a kids' summer camp may be stark warning

A recent report about the closure of an overnight summer camp following a large outbreak of COVID-19 raises questions about the extent to which children contribute to the spread of the new coronavirus.

As summer break draws to a close for many individuals in the Northern hemisphere, the question that remains on people’s minds is: To what extent can children contribute to the spread of the new coronavirus?

The evidence so far has been mixed.

A recent study in the journal JAMA Pediatrics compared the levels of viral RNA from swab tests and found that children aged 5 years and older have about the same amount of viral RNA as people over the age of 18.

Importantly, the authors also saw that children younger than 5 had even greater levels of viral RNA. They suggest that “young children can potentially be important drivers of SARS-CoV-2 spread in the general population.” However, they do admit that their study did not look at infectious virus.

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On the other hand, a rapid review by the National Collaborating Centre for Methods and Tools at McMaster University in Hamilton, Canada, concluded that “young children are not a major source of transmission.”

When children did acquire the virus, the source was more likely to be community spread or an adult in the same household, rather than transmission from one child to another. The authors state that the quality of this evidence is moderate.

That said, the Centers for Disease Control and Prevention (CDC) released a report last week about an outbreak that forced an overnight camp in Georgia to close at the end of June.

Virus spreads to over 40% of attendees 

Within 2 days of the camp opening at the end of June, a teenage staff member began showing symptoms of COVID-19. They received a positive SARS-CoV-2 test result the following day.

On the same day, camp officials started sending the campers (the youngest of whom were 6 years old) home. They closed the camp 3 days later.

The Georgia Department of Public Health recommended that all attendees receive a SARS-CoV-2 test.

A team from the Georgia Department of Public Health, the CDC COVID-19 Response Team, and the Epidemic Intelligence Service at the CDC subsequently analyzed 344 test results. This was out of a total of the 597 attendees who were Georgia residents.

This allowed the team to calculate the attack rate, which is the incidence proportion or the risk.

“The overall attack rate was 44% (260 of 597), 51% among those aged 6–10 years, 44% among those aged 11–17 years, and 33% among those aged 18–21 years,” the authors write in their report.

The attack rates increased as the attendees spent increasing amounts of time at the camp. At 56%, it was highest among staff members.

Symptom data were available for 136 cases, of which 36 were asymptomatic. Of the remaining 100, 65% included fever, 61% included headaches, and 46% included a sore throat.

Limitations and implications

The authors point out that the attack rate was likely higher than they were able to calculate, as they only had the test results for 57% of the attendees.

They also cannot say for certain whether some of the confirmed cases occurred as a result of acquiring the virus at the camp or before arriving.

They did ask all attendees to supply a negative test result within a period of 12 days before arrival. However, it is plausible that someone contracted the virus after taking the test and before coming to the camp.

The researchers also did not have any data on how well the individuals adhered to prevention measures, such as physical distancing and mask use. Although the staff and trainees had a requirement to wear masks, the campers did not.

“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,” explain the authors of the report.

“The multiple measures adopted by the camp were not sufficient to prevent an outbreak in the context of substantial community transmission,” they add. “Relatively large cohorts sleeping in the same cabin and engaging in regular singing and cheering likely contributed to transmission.”

The team recommends an emphasis on physical distancing and the correct use of face coverings for gatherings.

What these data mean for the upcoming school year is not clear. In the meantime, children, parents, caregivers, and teachers alike are looking to public health officials to balance the risks and develop mitigation strategies to keep their communities safe.

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