Children and staff who repeatedly test negative for COVID-19 after contact with someone who has the illness can safely remain in school if universal masking programs are in place, according to a new study.
The finding of the “test to stay” report from the ABC Science Collaborative at Duke University provides a safe alternative to quarantining people who have been exposed to COVID-19 and enables schools to remain open without interruptions. The North Carolina Department of Health and Human Services will use the research to consider revising its guidelines on quarantine for schools across the state.
“Implementation of ‘test-to-stay’ reduced missed days of school during quarantine by more than 90%…”
The research, coming as the country faces the Omicron variant, provides a more practical and focused approach to the “test-to-stay” protocols that the Centers for Disease Control and Prevention recently endorsed, which require testing of anyone within three feet of an infected person at school despite both parties being masked.
ABC Science researchers have raised concerns that this widespread “test-to-stay” approach is likely to overwhelm resource-limited schools and result in insurmountable logistical hurdles.
By contrast, the ABC Science Collaborative’s focused “test-to-stay” approach only requires testing if at least one of the exposed people is unmasked.
This focused approach reduces testing by about 80%. The transmission is still very low at 1.7% and testing volume is such that most schools can complete the testing at each school, thereby serving more vulnerable children.
“The focused ‘test-to-stay’ protocol substantially reduced student absences from school after in-school exposure to COVID-19, keeping more kids in school and on a consistent educational routine,” says Danny Benjamin, co-chair of the ABC Science Collaborative and professor in the pediatrics department at Duke University School of Medicine.
“Our research has taught us that ‘test-to-stay’ is a focused, practical way for children to avoid being out of the classroom after an exposure and can be a win-win strategy for keeping our children and schools safe without overwhelming the system,” Benjamin says.
North Carolina schools and school districts were eligible to participate in the ABC Science study if they had a universal masking policy and approval from their local board of education and local health department. People at participating schools were eligible if they were identified as a close contact by the local health department and were required to quarantine following an in-school, unmasked COVID-19 exposure. They could participate in “test-to-stay” if they were asymptomatic and consented to participate in the “test-to-stay” research study. Close contacts were given the option to quarantine according to local policies.
Researchers gave participants in the study a SARS-CoV-2 rapid test at school when they were identified as a close contact and received testing every other day up to four times during the first seven days after the known exposure. Participants remained in school if they tested negative and were asymptomatic. A positive COVID-19 test or the development of symptoms on any day after exposure required isolation according to state public health guidelines.
Over the course of a six-week duration, researchers performed more than 880 tests among more than 360 participants.
“There were no instances in the ABC Science Collaborative ‘test-to-stay’ study where an exposed child became infected and went on to infect other children or adults within the school building,” says Kanecia Zimmerman, co-chair of the ABC Science Collaborative and Test-to-Stay principal investigator, and a pediatrician at Duke University School of Medicine.
“Implementation of ‘test-to-stay’ reduced missed days of school during quarantine by more than 90%, saving 1,628 days of in-person learning over the course of the study.”
Funding in part came from the Rapid Acceleration of Diagnostics Underserved Populations (RADx-UP); the National Institutes of Health; the Trial Innovation Network; and the National Institute of Child Health and Human Development.
Source: Duke University
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