We conducted a mixed-methods study of educational settings to assess COVID-19 mitigation policies. We observed variable adherence to policies and minimal COVID-19 transmission. What's Known on This Subject:The Centers for Disease Control outlined policies to mitigate COVID-19 spread in K-12 schools (to facilitate safe reopening). School promotion of these policies has been associated with limited school-based transmission, and lower in-school transmission compared to community rates. What This Study Adds:We directly observed adherence to COVID-19 mitigation policies in educational settings. We found variable adherence to policies and minimal COVID-19 transmission (despite high community incidence). We detail barriers and potential strategies for implementing COVID-19 mitigation policies.

Background and Objectives: Testing strategies for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in school settings are needed to assess the efficacy of infection mitigation strategies and inform school reopening policies. We hypothesized that supervised serial self-collected non-nasopharyngeal testing in summer camp settings would be acceptable and feasible. Methods: We performed a cohort study at two urban day camps for kindergarten-8th graders in June and July 2020. Eligible participants were campers, up to two adult household contacts, and camp staff. We assessed participation rates for providing, at two time points, supervised, self-collected anterior nares samples for reverse transcription polymerase chain reaction (RT-PCR) and saliva samples for antibody testing. We qualitatively assessed testing feasibility and adherence to stated camp infection mitigation strategies. Results: 76% (186/246) of eligible participants consented. The cohort completing both rounds of testing (n=163) comprised 67 campers, 76 household contacts, and 20 staff. Among those present, 100% of campers and staff completed test collection at both time points. Testing was feasible to implement, including staff participation supervising camper test collection. No virus was detected by RT-PCR; seven participants had antibodies. Observed adherence to stated camp mitigation policies for masking, physical distancing, and stable cohorting was generally high. Conclusions: Supervised, self-collected serial anterior nasal and saliva-based SARS-CoV-2 testing was acceptable, with successful repeated participation by children ages 5-14. This strategy for testing and the observed infection mitigation practices comprise potential core components for safe school reopening.

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