On March 14, 2020, a child in Oregon, Wisconsin, got sick the day after her school closed in response to the COVID-19 pandemic. As part of an innovative study monitoring for influenza in the Oregon School District, her whole family performed what is now a familiar exercise for many: a nasal swab.
The samples came back negative for flu – and for 14 other respiratory viruses. Tests for SARS-CoV-2, the virus that causes COVID-19, weren’t yet available. The family recovered, and their samples were kept in a freezer along with all the samples from the district.
More than a year later, with SARS-CoV-2 tests widely available, the study’s leaders re-tested hundreds of such samples taken from children and family members before and after the pandemic reached the U.S. The 11-year-old was the only child positive for COVID-19, as were both of her parents. This became the first-known case of household transmission of the disease in Wisconsin.
Since 2015, the study that captured this early transmission, Oregon Child Absenteeism Due to Respiratory Disease Study (ORCHARDS), has been helping Oregon families and schools track and understand seasonal influenza and other respiratory illnesses. With thousands of home visits under their belts and the trust of the community, they were primed to help monitor the spread of COVID-19 as well.
Now, with a new three-year, $3 million grant from the Centers for Disease Control and Prevention, ORCHARDS will have the opportunity to continue helping schools and families navigate COVID-19 and other illnesses as in-person instruction resumes. And they’ll continue to learn about the spread of COVID-19 in children and their families outside of any visit to a hospital, which is understudied.
“We’re entering this really tumultuous period, as children – only some of whom can be vaccinated – are returning to school,” says study leader Jon Temte, a University of Wisconsin-Madison School of Medicine and Public Health professor and associate dean. “By going out an additional three years now, we’ll be able to document what happens in terms of SARS-CoV-2, influenza, and other respiratory illnesses during this evolving pandemic period.”
Long before the COVID-19 pandemic, the ORCHARDS study began by trying to understand the community spread of flu and other viruses in schoolchildren and their families. These illnesses spread easily among children, lead to absences from class, and can affect vulnerable family members.
The researchers partnered with the Oregon School District in part because Temte, study manager Shari Barlow and other team members live in the district and their children have attended school there. The district has helped recruit families by sharing information about the study through mailings, emails and during annual registration. Now, anytime a parent calls in to report a child sick, they hear a message encouraging them to provide samples to the researchers.
Before COVID-19 forced a change in the ORCHARDS protocol, participating families received results of influenza testing – often within just a few hours – which they used to understand the risk to other members of the household. That information helped families seek antiviral medication, which, if given early, could prevent the flu from spreading or make illness much milder. Currently, all family members are tested for influenza and SARS-CoV-2, which can help to guide isolation and quarantine – all without a trip to the clinic.
“What’s unique is that entry into the study is through the school district, not a doctor’s office,” says Temte. The system captures milder illnesses and doesn’t depend on parents having the ability to reach a clinic during the day. “What this provides us with is a more realistic view of what respiratory infections look like in the community.”
Participation in the study is open to all students and their families in the district, from 4K through 12th grade. In a typical school year, the research team makes about 500 home visits, in a district that enrolls roughly 4,000 students. Since the study began, they’ve made almost 3,000 visits.
To further encourage participation, the study has distributed more than $130,000 in gift cards to local Oregon businesses to families since the research began. The school district has also earned $172,000 for its help advertising the study and collecting key data. Added to the knowledge and resources provided from the testing itself, these tangible benefits have further cemented the study as an important contributor to the community.
Originally, the researchers wondered whether they could predict the prevalence of flu based solely on school absentee data. Since schools already collect that information, a strong correlation could give public health officials timely information about respiratory infections in the community.
“And we’ve found that influenza can be identified with school data alone. Overall, these tools work quite well for influenza,” says Temte.
Over time, the study has grown to meet multiple goals. Several graduate students have trained with ORCHARDS. The team has been able to document unforeseen trends, like COVID-19 and the sudden disappearance of most respiratory diseases when schools closed during the pandemic. And families have grown more invested, learning about respiratory viruses and hygiene well before the pandemic made these issues a global concern.
“There have been all these unmeasured extra benefits from the study,” says Temte. “And it’s been so enjoyable to see them develop.”