Sunscreen, Bug Spray, and Vaccines.

In their manuscript "Primary and Secondary Attack Rates by Vaccination Status after a SARS-CoV-2 B.1.617.2 (Delta) Variant Outbreak at a Youth Summer Camp—Texas, June 2021",[[1]] Baker and co-authors describe the value of COVID-19 vaccination before overnight camp attendance in preventing post-camp household transmission during circulation of the Delta variant of SARS-CoV-2. Camp attendee and household member vaccination protected against household transmission of COVID-19, emphasizing the value of mitigation measures in optimizing the safety of congregate activities.

In addition to the benefits of immersive experiences, time in outdoor environments, and interaction with friends and counselors, summer camps provide a safe and supportive environment that promote behavioral and mental health. With over 15,000 camps operated by over 1.1 million staff members and serving 26 million children and their families annually in the United States, summer youth camps are an important part of childhood for many [[2]].

Camps serve as a potential crossroads for several communities, as people may travel long distances to attend them; while this is important for building new social connections and strengthening bonds across distance, it also may help to disseminate infectious illnesses. Camp-associated outbreaks of infectious diseases before COVID-19 have been described; among the most common are those associated with gastroenteritis [[3]]. Amplified by the congregate setting of a camp, food- and waterborne pathogens have the potential to disseminate efficiently. Similarly, respiratory viral infections may spread easily among camp attendees and staff due to close quarters [[4]].

Numerous epidemiologically linked COVID-19 outbreaks in camp settings and their communities were investigated by local and state health departments in 2020 and 2021. Transmission and attack rates are notably reduced when mitigation and prevention strategies, including vaccination requirements, quarantine and isolation, are utilized [[5]]. A recent publication from the Centers for Disease Control and Prevention (CDC) described nine summer camps across the United States that successfully operated during the Delta surge from June–August 2021 [[6]]. These camps implemented layered mitigation strategies that effectively prevented outbreaks. Campers and staff were encouraged to practice masking and physical distancing before attending camp. Screening testing prior to arrival at camp was required and vaccinations were strongly recommended. Over 93% of age-eligible individuals at these sites received a COVID-19 vaccine. Once campers and staff members arrived at camp, frequent testing, indoor masking, and physical distancing protocols were implemented. Campers were grouped into pods where they could unmask if all pod members had a negative test. Activities were planned outdoors and mealtimes were staggered so that transmission risk was reduced. One camp also utilized wastewater testing as a cost-effective means of screening multiple participants. These strategies were largely successful; out of 7,173 campers and staff members assessed during the Delta surge, only nine laboratory-confirmed COVID-19 cases and no secondary infections were documented.

With circulation of the more highly infectious Omicron variant and evidence of waning vaccine immunity in our communities, additional mitigation measures are becoming increasingly important. Although early clinical trial data demonstrated high efficacy of the mRNA vaccines against infection, recent surveillance studies have demonstrated that newer variants are infecting vaccinated individuals at higher rates [[7]]. However, COVID-19 vaccination remains highly protective against severe disease and hospitalization [[8]], and overall vaccine efficacy against infection can be improved with boosters. During the Omicron surge, one study showed that adolescents who received a booster dose of an mRNA vaccine had substantially more protection against infection [[7]]. Data also suggest that individuals who have recovered from natural infection with the Omicron variant can benefit from primary vaccination and boosters [[9]].

Vaccination, including the administration of booster doses, is the foundation of successful mitigation. Additional measures such as indoor masking, hand hygiene, and removal of symptomatic campers and staff from camp activities prevent transmission of SARS-CoV-2 and other respiratory viruses [[5]].

Attempts to reconcile the challenges of an ongoing pandemic while sustaining safe camp operations should continue to be the focus of the camp industry as well as those of the healthcare community who serve as advisors. As we assimilate evidence from the past 2 years and apply it to camps in future sessions, we are reminded that adherence to the basic tenets of infection prevention—vaccination and boosters, hand hygiene, and isolation—is essential for safe camp participation.