Analysis of contact tracing data in Salt Lake County, Utah, identified outbreaks of COVID-19 in three small to large child care facilities linked to index cases in adults and associated with transmission from children to household and nonhousehold contacts. In these three outbreaks, 54% of the cases linked to the facilities occurred in children. Transmission likely occurred from children with confirmed COVID-19 in a child care facility to 25% of their nonfacility contacts.
Mitigation strategies§ could have helped limit SARS-CoV-2 transmission in these facilities. To help control the spread of COVID-19, the use of masks is recommended for persons aged ≥2 years.¶ Although masks likely reduce the transmission risk (5), some children are too young to wear masks but can transmit SARS-CoV-2, as was seen in facility B when a child aged 8 months transmitted SARS-CoV-2 to both parents.
The findings in the report are subject to at least three limitations. First, guidance for contact tracing methodology changed during the pandemic and could have resulted in differences in data collected over time. Second, testing criteria initially included only persons with typical COVID-19 signs and symptoms of fever, cough, and shortness of breath, which could have led to an underestimate of cases and transmission. Finally, because the source for the outbreak at facility C was unknown, it is possible that cases associated with facility C resulted from transmission outside the facility.
COVID-19 is less severe in children than it is in adults (6,7), but children can still play a role in transmission (8,9). The infected children exposed at these three facilities had mild to no symptoms. Two of three asymptomatic children likely transmitted SARS-CoV-2 to their parents and possibly to their teachers. Having SARS-CoV-2 testing available, timely results, and testing of contacts of patients in child care settings regardless of symptoms can help prevent transmission and provide a better understanding of the role played by children in transmission. Findings that staff members worked while their household contacts were ill with COVID-19–compatible symptoms support CDC guidance for child care programs recommendations that staff members and attendees quarantine and seek testing if household members are symptomatic (4). This guidance also recommends the use of face masks, particularly among staff members, especially when children are too young to wear masks, along with hand hygiene, frequent cleaning and disinfecting of high-touch surfaces, and staying home when ill to reduce SARS-CoV-2 transmission.
