COVID-19 Testing to Sustain In-Person Instruction and Extracurricular Activities in High Schools — Utah, November 2020–March 2021

Abstract

On May 21, 2021, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr).Cessation of kindergarten through grade 12 in-person instruction and extracurricular activities, which has often occurred during the COVID-19 pandemic, can have negative social, emotional, and educational consequences for children (1,2). Although preventive measures such as masking, physical distancing, hand hygiene, and improved ventilation are commonly used in schools to reduce transmission of SARS-CoV-2, the virus that causes COVID-19, and support in-person instruction (3-6), routine school-based COVID-19 testing has not been as widely implemented. In addition to these types of standard preventive measures, Utah health and school partners implemented two high school testing programs to sustain extracurricular activities and in-person instruction and help identify SARS-CoV-2 infections: 1) Test to Play,* in which testing every 14 days was mandated for participation in extracurricular activities; and 2) Test to Stay, † which involved school-wide testing to continue in-person instruction as an alternative to transitioning to remote instruction if a school crossed a defined outbreak threshold (3). During November 30, 2020-March 20, 2021, among 59,552 students tested through these programs, 1,886 (3.2%) received a positive result. Test to Play was implemented at 127 (66%) of Utah's 193 public high schools and facilitated completion of approximately 95% of scheduled high school extracurricular winter athletics * Test to Play, which required testing every 14 days for participants in high school extracurricular activities, is described in the Utah COVID-19 School Manual (https://coronavirus-download.utah.gov/School/COVID-19_School_Manual_ FINAL.pdf ) and was mandated by Utah State Public Health Order 2020-25 (https://coronavirus-download.utah.gov/Health/UPHO_2020-25_Statewide_ COVID-19_Restrictions.pdf ), effective November 30, 2020. † Beginning August 2020, schools were advised to transition to remote instruction for 14 days when the number of school-associated cases among students and staff members crossed a specified outbreak threshold. During August-December 2020, the outbreak threshold was 15 school-associated cases during the previous 14 days. Under Test to Stay (https://coronavirus-download.utah.gov/School/ COVID-19_School_Manual_FINAL.pdf ), which began January 4, 2021, the outbreak threshold of cases during the previous 14 days changed to 1% of the school population for schools with >1,500 students and staff members and 15 cases for schools with ≤1,500 students and staff members, and the period of advised remote instruction after crossing the outbreak threshold changed to 10 days. Beginning March 24, 2021 (after the study period), per Utah Senate Bill 107 (https://le.utah.gov/~2021/bills/static/SB0107.html), the outbreak threshold changed again, such that a school would be required to conduct Test to Stay if student cases during the previous 14 days reached 2% of the school's student population for ...

Guidance for Implementing COVID-19 Prevention Strategies in the Context of Varying Community Transmission Levels and Vaccination Coverage

“…Such populations are especially well-suited for sentinel monitoring efforts to detect the early introduction and spread of COVID-19, particularly in areas with low vaccination coverage or where layered prevention strategies are not in use. CDC considers the capacity to monitor COVID-19 incidence in the following populations particularly useful due to their high risk of exposure or severe illness: students and staff members of kindergarten-grade 12 schools and institutions of higher education, health care workers, residents and staff members of long-term care facilities, incarcerated persons, homeless persons, and workers in high-density work sites (18)(19)(20)(21)(22)(23).…”

Implementation of School-Based COVID-19 Testing Programs in Underserved Populations

“…Despite the potential burden of regular testing, school-based COVID-19 testing has been found to enhance mitigation efforts, detect asymptomatic cases, limit in-school spread, and maximize in-person learning days. 4,[9][10][11]20 Communicating the value of testing to stakeholders--in both educational and public health terms--is critical to generating buy-in and participation. Finding testing models that are both effective and easy to implement are key to wide scale uptake.…”

“…During the 2020-2021 school year, accumulated evidence demonstrated that if mitigation measures are followed, including masking, physical distancing, and vaccinations for those eligible, schools can safely maintain in-person learning while simultaneously not contributing to community spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). [1][2][3][4] COVID-19 symptomatic and screening testing has also been recommended as an additional measure to detect cases and reduce the likelihood of SARS-CoV-2 transmission in schools. 5 Given the significant social support, nutritional assistance, and healthcare benefits afforded by in-person education, keeping schools open and safe from COVID-19 is a significant public health priority for the 2021-2022 school year.…”

School Operation for the 2021-2022 Academic Year in the Context of the COVID-19 Pandemic

“…There are substantial logistical and equity concerns that need to be taken into consideration (Table 3). If studied, consideration should be given to using the strategy to promote equity of access to participate in close contact clubs and sports (Test-to-Play strategy) 73 and in situations where screening and/or adherence to public health measures may be more challenging (e.g., students with special needs), without exacerbating inequities based on race, ethnicity or wealth. A COVID-19 Science Advisory Table Science Brief on asymptomatic screen testing for schools is forthcoming.…”

“…67 In high community risk scenarios, the use of rapid antigen screen testing may be considered in order to maintain function of extra-curricular clubs and athletics, particularly those associated with significant aerosol dispersion indoors, such as choir, wind instruments, football and wrestling ("Test-To-Play" strategy, see Testing section). 73 Of note, rapid antigen screen testing is most effective alongside other mitigation measures, including distancing, masking, efforts to improve air quality, and outdoor activities and play. 125 The following table summarizes recommendations for in-person curricular and extracurricular programs offered through school settings.…”