The Feasibility of School Music Trips With Safe Cohorts During the COVID-19 Pandemic

During the COVID-19 pandemic, schools were intermittently closed (1) and extracurricular activities (such as school trips) were forbidden (2). The position statement of the German National Academy of Sciences Leopoldina regarding possible increases in mental abnormalities in adolescents underlines the relevance of the speedy and safe re-introduction of school related leisure time activities. Because of the respiratory transmission of SARS-CoV-2, restarting musical group activities was seen as controversial.

Our prospective longitudinal study aimed to test the concept of a safe cohort in the context of a school music trip for students/pupils and teachers. Furthermore, we studied the study population’s physical and mental health, participants’ individually estimated risk of becoming infected with SARS-CoV-2, their fear of infection, and their experience of the trip.

Methods

The study period was from 12 August 2021 to 25 August 2021. Participation was subject to written consent. Before outward journey and after the return journey, pooled PCR tests were carried out (method see [3]). Rapid antigen tests were administered before and during the trip every second day. The primary endpoint was the occurrence of infection with SARS-CoV-2 during the observation period. Additionally a digital survey was undertaken on the outward journey and after the return, whose variables regarding physical and mental health were defined as secondary endpoints (see introduction). We used the software package IBM Statistics 26 to analyze our pseudonymized data on the basis of an exploratory approach. The GAD-7 score was calculated and evaluated on the basis of the method of Spitzer et al. The study had ethics approval from the ethics committee at Charité-Universitätsmedizin Berlin (EA2/091/20).

Results

No infections with SARS-CoV-2 occurred during or after the trip (Table 1 shows the characteristics of the participants). Contacts with SARS-CoV-2 positive cases took place during the study period only in individual cases, a total of 1.9% (2/105), [−1; 5] in students and 5.9% (1/17), [−7; 18] in teachers. Students reported much more commonly that they wore face coverings in the school building and undertook antigen rapid tests more than teachers. Teachers on average used less than one test per week (M=0.47 [0.2; 0.7]), whereas at least 81.6% (80/98), [74; 89] of the student cohort undertook rapid tests every second day. The complete vaccination status was given respectively as the main reason for not testing (teachers: 42.1% [8/19], [17; 66]; student cohort: 8.5% [9/105], [3; 14]).

Table 1

Baseline characteristics and information on mask wearing in the school environment

An increase in physical symptoms was seen especially for head colds (p=0.004) and cough (p=0.001) in the student cohort (Table 2). The evaluation of mental symptoms using the Wilcoxon signed rank test showed a reduction in the GAD-7 anxiety score in 10 students (10.2% [10/98], [4; 16]), and no change in 84 students (85.7% [84/98], [78; 92]). The anxiety score in the teacher cohort remained largely unchanged (Table 2). A clear reduction in the individually perceived risk of infection with SARS-CoV-2 was seen in teachers after participating in the trip (p=0.035). 99.1 % (106/107), [97; 100] of students and all teachers (17/17), [1; 1] reported that they would be happy to participate in another such music trip.

Table 2

Physical symptoms and anxiety symptoms (GAD-7)

Discussion

Limited PCR capacities in the face of rising incidence rates constitute a potential limitation for the feasibility of such a trip. By planning the trip in the summer, participants benefited from the seasonally low 7-day incidence rates (4). These were 36.4 at the start of the music trip in the district of the participating schools (Steglitz-Zehlendorf) (4, 5). We assume, however, that incidence rates have a subordinate role in the feasibility in principle. This is being studied in a second cohort with the increasing dominance of the omicron variant and high incidence rates. In spite of adherence to hygiene measures, the spread of pathogens if introduced cannot be completely ruled out in the travelers (see the increase in respiratory symptoms in the student cohort). Undertaking such trips in periods of low incidence rates and the non-occurrence of positive cases can therefore continue to be considered protective factors.

Our results underline the feasibility of a school music trip in a safe (PCR negative and isolated en route) cohort and show a reduction in the fear of infection with SARS-CoV-2 among teachers, as well as a positive experience from the trip in spite of pandemic restrictions.

Samipa Pudasaini, Kira Louisa Boldt, Jennifer Hitzek, Linus Möckel,
Anna Slagman, Stefanie Theuring, Frank Mockenhaupt, Martin Möckel

Charité – Universitätsmedizin Berlin, Division of Emergency and Acute Medicine, Campus Mitte and Virchow, Berlin (Pudasaini, Boldt, Hitzek, Möckel, Slagman, Möckel)

Charité – Universitätsmedizin Berlin, Institute of Tropical Medicine and International Health, Berlin (Theuring, Mockenhaupt)

Acknowledgment

We thank Tamara Dietrich, Gloria Münch, and Natalie-Viviane Ulrich-Möckel for their support in preparing and carrying out the tests; Dr Martin Burggaller for leading the design and implementation of the hygiene concept; Prof Dr Jörg Hofmann for carrying out pooled PCR tests, and Senator Sandra Scheeres, Secretary of State Beate Stoffers, and Holger Schmidt for giving permission for the study and for advisory activities in the hygiene panel.

Conflict of interest statement
The authors declare that no conflicts of interest exist.

Manuscript received on 30 December 2021, revised version accepted on 11 April 2022.

Translated from the original German by Birte Twisselmann, PhD.

Cite this as:
Pudasaini S, Boldt KL, Hitzek J, Möckel L, Slagman A, Theuring S, Mockenhaupt F, Möckel M: The feasibility of school music trips with safe cohorts during the COVID-19 pandemic. Dtsch Arztebl Int 2022; 119: 542–3. DOI: 10.3238/arztebl.m2022.0201

References

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2. Robert Koch-Institut: Präventionsmaßnahmen in Schulen während der COVID-19-Pandemien. 2020. www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Praevention-Schulen.pdf?__blob=publicationFile (last accessed on 29 October 2021).

3. Möckel M HJ, Edelmann A, Schwarzer R, et al.: Konzept und Validierung einer SARS-CoV-2-Pooltestung bei Mitarbeitenden der Notaufnahmen. Das Krankenhaus 2020.

4. Robert Koch-Institut: 7-Tage-Inzidenzen nach Bundesländern und Kreisen (fixierte Werte) sowie Gesamtübersicht der pro Tag ans RKI übermittelten Fälle und Todesfälle. 2021. www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Daten/Fallzahlen_Kum_Tab.html (last accessed on 29 October 2021).

5. Landesamt für Gesundheit und Soziales: Lagebericht 14.08.2021. 2021. https://data.lageso.de/lageso/corona/archiv/berlin-website-2021-08-14.html (last accessed on 29 October 2021).