Test‐to‐Stay in Kindergarten Through 12th Grade Schools After Household Exposure to Severe Acute Respiratory Syndrome Coronavirus 2

Abstract

BACKGROUND Test‐to‐stay (TTS) is a strategy to limit school exclusion following an exposure to severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). We evaluated the use of TTS within universally masked kindergarten through 12th grade (K‐12) school settings following household SARS‐CoV‐2 exposure. METHODS Three hundred twenty‐two participants were enrolled. Serial rapid antigen testing was performed up to 15 days post‐exposure. Analysis‐eligible participants completed the 15‐day testing protocol, tested positive any time during the testing window, or received a negative test on or after day 9. Primary outcomes included within‐school tertiary attack rate (TAR) (test positivity among close contacts of positive TTS participants), and school days saved among TTS participants. RESULTS Seventy‐three of 265 analysis‐eligible participants tested positive for SARS‐CoV‐2 (secondary attack rate of 28% [95% CI: 16‐63%]). Among 77 within‐school close contacts, 2 were positive (TAR = 3% [95% CI: 1‐5%]). Participant absences were limited to 338 days, resulting in 82% of 1849 school days saved. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY TTS facilitates continued in‐person learning and can greatly reduce the number of missed school days. CONCLUSIONS Within universally masked K‐12 schools, TTS is a safe alternative to school exclusion following household SARS‐CoV‐2 exposure.

Safety of SARS-CoV-2 test-to-stay in daycare: a regression discontinuity in time analysis

“…Furthermore, the mentioned studies were conducted during the predominance of one respective SARS-CoV-2 VOCs. [8][9][10][11][12][13][14][15][16] In contrast, our analyses spanned a period during which four distinct SARS-CoV-2 VOCs have emerged (Alpha, Delta, BA.1, and BA.2). These variants show distinct virological features that could affect the effectiveness of infection control measures (e.g., incubation period or basic reproduction number).…”

“…Our main results on safety are in line with previous reports on test-to-stay approaches. [8][9][10][11][12][13][14][15][16] However, those studies were primarily conducted in schools with children and adolescents older than 6 years, and they incorporated the use of facemasks. In contrast, the here analyzed screening was conducted in the absence of the use of facemasks and in an age-group less capable of sticking to hygiene rules.…”

“…7 Test-to-stay approaches supplanted the conventional practice of post-exposure quarantine by frequent serial testing for 5-10 subsequent days and reduced the burden of post-exposure quarantine. [8][9][10][11][12][13][14][15][16] Safety of test-to-stay approaches, expressed as equivalence in infections as compared to quarantine approaches, was addressed by several studies. [8][9][10][11][12][13][14][15][16] These reports are mostly restricted to screenings in schools and included the use of facemasks.…”

“…[8][9][10][11][12][13][14][15][16] Safety of test-to-stay approaches, expressed as equivalence in infections as compared to quarantine approaches, was addressed by several studies. [8][9][10][11][12][13][14][15][16] These reports are mostly restricted to screenings in schools and included the use of facemasks. Thus, evidence on safety of test-to-stay concepts in daycare facilities, without the use of facemasks, and in an age-group less capable of sticking to hygiene rules, is limited.…”