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SARS-CoV-2 Positivity on or After 9 Days Among Quarantined Student Contacts of Confirmed Cases

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

Schools reopened during the fall of 2020 with various approaches to mitigate SARS-CoV-2 infection. At that time, the US Centers for Disease Control and Prevention (CDC) recommended a 14-day quarantine without testing for close contacts of anyone diagnosed with COVID-19.

However, data indicated that the incubation period for SARS-CoV-2 infection is 4 to 5 days from exposure in adults and is 6 to 7 days from exposure in children,13 suggesting that most infected students should test positive by day 9. Therefore, Alachua County, Florida, implemented SARS-CoV-2 testing on day 9 and return to school on day 10 for student contacts of confirmed COVID-19 cases. We evaluated test positivity rates for SARS-CoV-2 infection among these student contacts.

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Article Information

Corresponding Author: Eric J. Nelson, MD, PhD, MS, Emerging Pathogens Institute, University of Florida, 2055 Mowry Rd, Gainesville, FL 32611 (eric.nelson@ufl.edu).

Accepted for Publication: February 9, 2021.

Published Online: February 19, 2021. doi:10.1001/jama.2021.2392

Author Contributions: Mr Myers had full access to all the data in the study and takes responsibility for the integrity of the data and Dr Morris takes responsibility for the accuracy of the data analysis.

Concept and design: Nelson, McKune, Ryan, Lednicky, Morris.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Nelson, McKune, Ryan, Morris.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Nelson, Morris.

Administrative, technical, or material support: McKune, Ryan, Lednicky, Myers.

Supervision: McKune, Ryan, Morris.

Conflict of Interest Disclosures: None reported.

Additional Contributions: We acknowledge the data aggregation and analysis efforts of Michael Smith, RN, and Cameron Livingston, RN (both with the Alachua County Health Department); the insight and guidance of the Scientific and Medical Advisory Committee members Michael Lauzardo, MD, and Yana Banks, MD (both University of Florida faculty members); and the commitment of the School Board of Alachua County, the Florida Department of Health, the Alachua County Health Department, and the families of Alachua County to keep schools open and safe from COVID-19. No compensation was received by any of these individuals for their role in this study.

Additional Information: Testing, contact tracing, and follow-up were conducted as part of the Alachua County Health Department surveillance of SARS-CoV-2 infection in the Alachua County Schools. Deidentified data were analyzed and shared with permission from the Alachua County Health Department.

References
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Macartney  K , Quinn  HE , Pillsbury  AJ ,  et al; NSW COVID-19 Schools Study Team.  Transmission of SARS-CoV-2 in Australian educational settings: a prospective cohort study.   Lancet Child Adolesc Health. 2020;4(11):807-816. doi:10.1016/S2352-4642(20)30251-0PubMedGoogle ScholarCrossref
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Cevik  M , Tate  M , Lloyd  O , Maraolo  AE , Schafers  J , Ho  A .  SARS-CoV-2, SARS-CoV, and MERS-CoV viral load dynamics, duration of viral shedding, and infectiousness: a systematic review and meta-analysis.   Lancet Microbe. 2021;2(1):e13-e22. doi:10.1016/S2666-5247(20)30172-5PubMedGoogle ScholarCrossref
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Davies  NG , Klepac  P , Liu  Y , Prem  K , Jit  M , Eggo  RM ; CMMID COVID-19 Working Group.  Age-dependent effects in the transmission and control of COVID-19 epidemics.   Nat Med. 2020;26(8):1205-1211. doi:10.1038/s41591-020-0962-9PubMedGoogle ScholarCrossref
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Lednicky  JA , Lauzardo  M , Fan  ZH ,  et al.  Viable SARS-CoV-2 in the air of a hospital room with COVID-19 patients.   Int J Infect Dis. 2020;100:476-482. doi:10.1016/j.ijid.2020.09.025PubMedGoogle ScholarCrossref
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US Centers for Disease Control and Prevention. Options to reduce quarantine for contacts of persons with SARS-CoV-2 infection using symptom monitoring and diagnostic testing. Accessed February 12, 2021. https://www.cdc.gov/coronavirus/2019-ncov/more/scientific-brief-options-to-reduce-quarantine.html
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