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School buses can run at full capacity even when communities are experiencing high coronavirus caseloads, according to a new study out of Eastern Virginia Medical School and the children’s hospital.
The study looked at one school in Virginia and its virus cases over a seven-month period. During that time, 37 students and two adults from the school who rode the buses contracted COVID-19.
Despite the potential of exposing people on buses — and forcing 52 into quarantines — no bus riders got the virus from infected students, according to the study.
“We know that there wasn’t transmission because there wasn’t anybody else who was positive,” said Dr. Dana Ramirez, a physician at Children’s Hospital of The King’s Daughters.
Though she was expecting the number to be low — the available data indicated as much — Ramirez was encouraged to see no cases of person-to-person spread.
“That, in and of itself, was really a surprise,” she said.
The small study involved a private school that monitored 1,154 students with nasal swab testing every two weeks between August 2020 and this past March. The school had 15 nearly full buses shuttling 462 students, with two students in every seat.
Some were sitting just 2 ½ feet apart, but all passengers wore masks and the buses’ windows were kept cracked, regardless of the weather.
The findings could help guide other school districts with their bus systems this fall, providing a model for lowering COVID-19 risks, even if they can’t comply with the Centers for Disease Control and Prevention’s recommendation of spacing passengers 6 feet apart.
In the spring of last year, Ramirez started working with a Virginia American Academy of Pediatrics task force advising schools on how to reopen safely amid the pandemic. Earlier in the public health crisis, data demonstrated that schools were safe for children, even if community transmission was high, as long as infectious disease prevention techniques were used.
A study from Wisconsin published by the CDC showed that outbreaks linked to classrooms, where mask-wearing was high, were extremely rare. Among 191 cases identified in students and staff, only seven were related to transmission in school.
But Ramirez, along with co-authors Drs. Martin Klinkhammer and Leah Rowland, who also work for the medical school and children’s hospital, noticed there wasn’t much research on school transportation, a concerning issue for schools too strapped to double their fleets.
When the pediatricians learned a private school implemented its own safety protocol for running buses last fall, they asked to study it. The school, which the authors haven’t identified because it asked to remain anonymous, agreed to share data.
The school ran its own testing and followed up on positive diagnoses with “contact tracing,” disease detective work that involves notifying other people who could have been exposed.
The CHKD Department of Pediatrics and the medical school’s review board approved the research. It was published last week in the Journal of School Health. Right now, many Virginia school systems don’t have enough buses or drivers to operate unless the vehicles are packed with students at full capacity, Ramirez said.
“If you only had half-full buses, you’d need twice as many, and that just doesn’t exist,” she said. “And then we’ve got families out there who are just not able to drive their kids to school each day for multiple reasons, and that makes the bus transportation even more crucial.”
The researchers said the study shows schools can do simple things to decrease the risk of transmission, such as requiring masks, seating siblings close together, having assigned seats so it’s easier to track exposure, and maintaining a culture that supports students and employees staying home when they’re not feeling well.
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The safety strategies used by the school are being discussed in school districts throughout the country, Ramirez said.
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But one of the limitations of the study was when it was conducted. The authors don’t know whether the strategies would have the same effectiveness against the more contagious delta variant, which has recently become the dominant strain in Virginia.
“We know that masking works to help prevent the spread of disease, and we know that ventilation helps to prevent the spread of disease,” Ramirez said. “I certainly expect that both of those things will be useful in preventing the spread of the delta variant, but I don’t know any more than anybody else does.”
The buses each had 11 to 13 rows, about 2 ½ feet apart, with 22 to 26 seats. Students were distanced as much as possible, but two-thirds of the routes were full and required passengers to sit in almost every seat, according to the study.
Buses were required to provide a 1-inch opening in several windows for ventilation. Students were assigned to the same seats each day so that it would be easier to investigate cases. Buses were not loaded back to front, but older students were assigned to back rows, and younger students were assigned to the front half.
Ramirez said despite the recent surge in cases, she hopes the research will help schools offer in-person education.
“The detriment that we’re seeing to kids by being out of school is just incredible,” she said.
Elisha Sauers, 757-839-4754, elisha.sauers@pilotonline.com