COVID-19 at a Georgia Summer Camp, June 2020: 44% of Attendees Infected

Little was known in mid-2020 about how SARS-CoV-2 spread among young people. An outbreak at a Georgia overnight camp showed it could spread fast.

The camp

• June 17–20: orientation for 138 trainees and 120 staff.
• June 21: the first session began, with 363 campers and three senior staff joining the staff.
• The camp followed Georgia's executive order letting overnight camps open from May 31, which required everyone to show a negative viral test taken within 12 days before arriving.
• It adopted most of CDC's suggestions for youth camps: cabin cohorts (up to 26 people), staggered use of shared spaces, distancing outside cabins, and extra cleaning. Staff wore cloth masks.
• It did not require masks for campers, or open windows and doors for ventilation. Campers took part in indoor and outdoor activities, including vigorous singing and cheering every day.

The outbreak

On June 23, a teenage staff member left camp after developing chills the night before, and tested positive the next day. The camp began sending campers home on June 24 and closed on June 27. The Georgia Department of Public Health, notified June 25, advised every attendee to get tested, quarantine, and isolate if positive.

Among the 597 Georgia residents who attended (27 from other states were left out):

• Campers' median age was 12 (range 6–19); staff and trainees' 17 (range 14–59).
• 344 had test results, and 260 (76%) of them were positive.
• The attack rate — positives out of all attendees, tested or not — was 44% (260 of 597), likely an underestimate:

• The longer people stayed, the higher the rate; staff had the highest, 56%.
• The 31 cabins held an average of 15 people (1–26). Among 28 cabins with at least one case, the median cabin attack rate was 50% (22%–70%).
• Of 136 cases with symptom information, 36 (26%) had no symptoms. The rest most often reported fever (65%), headache (61%) and sore throat (46%).

What it shows

• The virus spread efficiently in a youth overnight setting, with high attack rates at every age, despite most recommended precautions.
• Children of all ages can be infected, and — contrary to early reports — may play an important role in spreading the virus.
• Silent infections were common and may have fueled undetected spread.
• Large cabin groups, daily singing and cheering, and no masks for campers likely helped it spread, against a backdrop of substantial community transmission.
• Distancing and consistent, correct use of cloth masks matter in group settings.

Limits

• The attack rates are likely underestimates: some people were not tested, and negative results are not reliably reported in Georgia.
• COVID-19 was rising in Georgia in June and July, so some infections may have happened before or after camp.
• Individual adherence to distancing and masks could not be measured.

Sources

Based on Szablewski CM, Chang KT, Brown MM, et al., "SARS-CoV-2 Transmission and Infection Among Attendees of an Overnight Camp — Georgia, June 2020," MMWR Morbidity and Mortality Weekly Report, volume 69, Centers for Disease Control and Prevention; a work of the United States government in the public domain.