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Data collected from 38 states from August 3 – November 15, 2020 showed more than 250,000 confirmed student and staff cases of SARS-CoV-2 in K-12 schools1. Yet, analysis of COVID-19 case data in USA schools has been extremely limited2,3. To date, no large-scale or state-wide analyses by school level and grade has been published, opening a wide gap in understanding COVID-19 in American schools. A large-scale assessment of available data and trends could provide a baseline for understanding the virus in the K-12 learning environment and dispel misconceptions about the prevalence of COVID-19 in schools.Table of Contents SummaryUsing the most comprehensive database of K-12 COVID-19 case data in the country, Florida provides clues for understanding student and staff cases in schools.What’s known on this subjectFlorida schools began reopening to in-person instruction in August have reported more than 18,000 student and staff cases of COVID-19 as of November 14, 2020. Incidence of COVID-19 cases in K-12 students and staff is of urgent public health concern.What this study addsCOVID-19 cases reported in Florida schools were most influenced by community case rates, district mask policies, and percent of students attending face-to-face. Student case rates were highest in high schools (12.5 per 1,000).

Limited research on the prevalence and characteristics of SARS-CoV-2 (COVID-19) in K-12 environments has led to a flurry of speculative, qualitative, non-data-driven analysis with potentially dangerous implications for public health policy. Twenty-four US states provide, at a minimum, outbreak data in K-12 schools. Student enrollment across Florida’s 67 districts totals more than 2.67 million, with five of the ten most populated districts in the country in the state. This study uses Florida as a case study in COVID-19 trends in schools. With no state-wide mask mandate, varying levels of virtual-instruction participation, and a range of rural, suburban, and urban environments, Florida represents the wide range of learning environments and COVID-19 approaches to mitigation observed across the country. The Covid Monitor began tracking case data in K-12 schools in July 2020, and has since reported more than 200,000 confirmed cases of the virus in the K-12 environment nationwide – the largest date repository for cases in schools. The Covid Monitor’s national database allows for analysis of the characteristics and trends of cases in schools over time. The results may inform decisions about continued in-person and virtual learning access and promotion across the United States, as well as mitigation measures related to reopening policies across districts responsive to model results. These results also provide a baseline for monitoring trends and evaluating mitigation strategies.Table of Contents SummaryUsing the most comprehensive database of K-12 COVID-19 case data in the country, Florida provides clues for understanding student and staff cases in schools.What’s known on this subjectFlorida schools began reopening to in-person instruction in August and reported 15,393 student and staff cases of COVID-19 as of November 14, 2020. Incidence of COVID-19 cases in K-12 students and staff is of urgent public health concern.What this study addsCOVID-19 cases reported in Florida schools were most influenced by community case rates and percent of students attending face-to-face. Student case rates were highest in high schools (4.5 per 1,000); staff case rates were highest in elementary levels (4.5-4.8).

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BACKGROUND Florida school case data provides an opportunity to examine the extent to which COVID-19 has been detected and reported in schools through reporting of cases by day, by school level, by location, for both students and staff. Student enrollment across Florida’s 67 districts totals more than 2.67 million, with five of the ten most populated districts in the country within Florida’s public-school system. Schools in Florida’s mix of urban, suburban and rural districts, in addition to the variety of policies ranging from availability of virtual instruction to mandatory-mask mandates, make it an ideal case study for examining larger trends in COVID-19’s prevalence in American schools. This data could help inform decisions makers evaluating mitigation strategies and access to virtual learning, as well as build upon current knowledge of COVID-19 in American society. OBJECTIVE Florida schools began reopening to in-person instruction in August have reported more than 18,000 student and staff cases of COVID-19 as of November 14, 2020. Incidence of COVID-19 cases in K-12 students and staff is of urgent public health concern. METHODS During August 10 – November 14, 2020, laboratory-confirmed cases of COVID-19 in 10,088 students and 4,507 staff in K-12 schools were confirmed by either the Florida Department of Health, or directly from the 43 independently-reporting school districts in the state. School case data, collected daily, and school enrollment data for both in-person (including hybrid) and virtual learning were obtained by public records request to each of Florida’s 67 districts for each week of the study period. Data regarding mask policies were obtained either from each district’s reopening plan, or from public records request. No assessment of school case data or rates with consideration of age groups and mask policies at this scale or with this level of granularity were discovered after an exhaustive search. The Centers for Disease Control (CDC) provides guidance for safely reopening schools, based primarily on the rate of community spread within a given district or county. County COVID-19 case rates were calculated based on new cases over a 14-day period at a rate per 1,000 people based on data reported by the Florida Department of Health. RESULTS During August 10 – November 14, 2020, the state-wide incidence rate (cases per 1,000 students enrolled in face-to-face or hybrid instruction) in Florida high school students (12.5) was 70% higher than younger cohorts (7.4). School data by grade level (e.g. elementary, middle, high) shows trends consistent with earlier findings by the CDC regarding case rates between younger and older adolescents. Staff rates are higher than student rates in all school environments except high schools. The proportion of student to staff cases in Florida schools was closest in the elementary setting (60% students – 40% staff) compared to the high school setting (82% students – 18% staff). CONCLUSIONS Case incidence varies significantly between school grade levels and between students and staff. Staff rates are higher than student rates in all school environments except high schools, and staff benefit most by mandatory-mask mandates. The rate of cases within schools is highly correlated with cases within a community, more than the size of the district by total enrollment. Percent enrollment in face-to-face instruction is a secondary influencer of case incidence rates in schools. In areas with higher pediatric community case rates compared to school case rates, districts may be under-reporting school case totals for students, or “disqualifying” student cases based on when a student tested and whether the case could be directly linked to the school environment. More research is needed to further understand the wealth of data available regarding COVID-19 incidence in Florida, and to develop proper mitigation strategies to confront this unprecedented challenge. CLINICALTRIAL N/A