Georgia camp outbreak shows rapid virus spread among children

COVID-19 spread quickly among unmasked youth at YMCA camp, CDC finds.

Some 260 cases of the coronavirus have been tied to attendees and staff at a North Georgia YMCA children’s camp in June, according to a report released Friday by the Centers for Disease Control and Prevention, one of the largest known superspreading events in the state.

The report details how COVID-19 spread rapidly among children and teens within the camp and raises questions about the effectiveness of safety protocols as school districts and colleges contemplate reopening for in-person instruction this fall.

YMCA Camp High Harbour, identified in the report as Camp A, suffered an outbreak at its Lake Burton location in late June. As of July 10, about 85 cases of the virus had been linked to the camp, The Atlanta Journal-Constitution previously reported, a figure that has since tripled.

The CDC study of 597 campers and staff from Georgia found the camp did not follow its guidance to require campers wear masks, though staff did.

Three-quarters of the 344 attendees and staff for whom the CDC was able to obtain test results tested positive for the virus.

The CDC said the overall attack rate of the virus was 44%, though the agency acknowledged that’s an undercount because it includes more than 250 for whom they had no results.

“This investigation adds to the body of evidence demonstrating that children of all ages are susceptible to SARS-CoV-2 infection and, contrary to early reports might play an important role in transmission,” the report said.

Brian Castrucci, CEO of the de Beaumont Foundation, a Maryland nonprofit that assists public health agencies and a former epidemiologist in Georgia, said the report is a warning for local school districts and others about the potential for spread in congregant settings.

“This should show you how actively kids can transmit it,” he said. “If you have a low prevalence in your community, you can start to do things. If you have rampant and rapid community spread, then there is no opening school, there is no opening colleges. It is not going to work.”

Ga. OK’d camps with restrictions

Gov. Brian Kemp initially allowed day camps to open for the summer as part of the state’s broader reopening plan. An executive order in May later allowed overnight camps to operate, but outlined health and hygiene guidelines, including temperature checks and a requirement for campers and staff to have a negative COVID-19 test within 12 days of the start of camp.

Though many camps opted not to open, some, including High Harbour, did.

Spokespeople for Kemp did not immediately return a message seeking comment.

“This investigation adds to the body of evidence demonstrating that children of all ages are susceptible to SARS-CoV-2 infection and, contrary to early reports might play an important role in transmission."

- New CDC report

Dr. Harry J. Heiman, clinical associate professor at the Georgia State University School of Public Health, said spread of the virus was growing in June, presenting a high likelihood the virus would spread in a camp setting.

“We know that congregate settings, particularly indoor congregant settings, are among the highest risks,” he said.

High Harbour followed the governor’s executive order, the federal report said, but the camp did not follow CDC recommendations for universal masking of campers or for increased ventilation in buildings. Staff were required to wear masks, the report said.

“Relatively large cohorts sleeping in the same cabin and engaging in regular singing and cheering likely contributed to transmission,” the CDC said. “Use of cloth masks, which has been shown to reduce the risk for infection, was not universal.”

The CDC said its investigation is ongoing and will attempt to identify specific sources of exposure, the course of the illness and “any secondary transmission to household members.”

“Physical distancing and consistent and correct use of cloth masks should be emphasized as important strategies for mitigating transmission in congregate settings,” the report said.

Statement of regret

The YMCA did not make anyone available for an interview. In a written statement, Parrish Underwood, chief advancement officer for the YMCA of Metro Atlanta, said the organization now regretted holding the camp.

“We made every effort to adhere to best practices outlined by the Centers for Disease Control (CDC) and the American Camp Association,” and the governor, Underwood said.

“Attending Camp High Harbour is a tradition numerous generations of Y families look forward to every summer,” Underwood’s statement said. “Many of these individuals reached out to our staff to express their desire for us to open our residential camps in an effort to create normalcy in their children’s lives due to the detrimental impact of COVID-19. This weighed heavily in our decision to open, a decision in retrospect we regret.”

The YMCA said it notified parents that a counselor tested positive for COVID-19 on June 24. The camp told parents they could pick up their children early. The YMCA closed its Lake Burton and Lake Allatoona locations.

The YMCA said the counselor passed required health screenings, as did all other campers and staff.

Parents who have spoken to the AJC have said they did not think the YMCA showed enough urgency. The camp was not immediately closed. Parents were given the option of picking up their children over a period of a few days before the camp closed for the season.

Fever, headaches and sore throat

The CDC study offered some caveats to the infection rates. Georgia suffered high rates of spread at the end of June, and some of the infections might have occurred prior to or after the camp.

Information about the conditions of infected campers and staff also was limited, and the report did not detail the severity of infections.

But the report said of the 136 cases with symptom data, about a quarter reported no symptoms. Of the three-quarters reporting symptoms, fever, headache and sore throat were the most common.

The median age of campers was 12 and staffers was 17. There were seven staffers between the ages of 22 and 59.

Fifty-one kids, or roughly half, of the children aged 6 to 10 tested positive. About 44% of children aged 11 to 17 tested positive and a third of the remaining people from 18 to 59 tested positive, the report said.

Cases of COVID-19 tend to be milder for children and young adults than for the elderly, but the disease isn't without risk.

There have been 12,290 confirmed cases among children 5 to 17 in Georgia, with 165 hospitalizations and one death, an analysis of state data shows.

To date, 186,352 people in Georgia have tested positive for the coronavirus, including about 4,000 announced Friday. There have been 3,752 deaths, including 81 reported on Friday.

Georgia in the ‘red zone'

Knowledge of transmission between children and adults is not well understood, but health experts have told the AJC they fear infections in children and adults can easily spread to more vulnerable people.

Though people over 60 make up the largest cohorts of hospitalizations and deaths, a recent Emory University study said children and adults under 60 are much more likely than the elderly to spread the disease to others.

Some schools are pushing forward with August opening plans, while allowing home instruction or blended in-person and distance learning.

Other systems, including Atlanta Public Schools, announced plans to delay the start of the school year and to begin instruction online amid substantial community spread of the virus.

On July 24, the CDC published guidance endorsing the full reopening of schools, citing risks to children’s health and education that could be inflicted by not having schools open for in-person instruction. That guidance came after pressure from President Trump, who has called for full reopening of schools.

The CDC guidance called for keeping students in small groups, staffed by a single teacher and to use outdoor spaces for learning. The guidance includes recommendations for masking and other hygiene protocols and plans for when a student contracts the virus.

But many independent public health experts, while acknowledging the importance of in-school instruction, have been critical of the new CDC guidance.

Heiman, the Georgia State professor, said schools often have poor ventilation. Reopening for in-person instruction endangers students and their family members and school staff.

Georgia is one of 21 states outlined in a White House task force report in the “red zone” for coronavirus spread. That report has recommended the state mandate masks and close bars, nightclubs, entertainment venues and put stricter limits on indoor dining and groups.

Kemp has so far decided not to mandate masks, though he has encouraged face coverings. He also has balked at new restrictions on the movement of business and people.

A group of more than 2,000 medical professionals have called on Kemp to implement the White House task force’s recommendations and to allow local jurisdictions to enact stricter measures.

“Many of us have said all along that unless we can get the level of COVID-19 down in communities, it is not safe to open schools and colleges,” Heiman said. “This (report) certainly reinforces that.”