Pragmatic COVID-19 prevention strategies in schools: Can test-to-stay replace home quarantine?

Reviewed by Zachary Willis, MD MPH, UNC School of Medicine, Chapel Hill, NC

Prolonged pandemic school closures strained families and were harmful to children’s physical and mental health and educational attainment. In the latest in a series of studies of COVID-19 transmission and mitigation in school settings, the ABC Science Collaborative evaluated the safety of a test-to-stay policy for COVID-19-exposed children in mask-optional schools. The investigators enrolled individuals (mostly students) who had an unmasked exposure (<6 feet) to an individual who tested positive for COVID-19 and remained asymptomatic; enrolled individuals would have routinely been excluded from school for 7-14 days. The enrolled individuals were permitted to remain in school, wearing a mask, and underwent COVID-19 antigen testing in school on the day of exposure notification and Days 3 and 5. Outcomes assessed included tertiary attack rates, i.e., individuals who were likely infected by exposed study participants, and days of school missed (vs anticipated days missed under usual policy). They found one tertiary case for every 29 individuals going through the test-to-stay protocol and prevented 86% of all anticipated missed school days. While research from this group and others has found masking in schools to be highly effective in preventing in-school COVID-19 transmission, these findings suggest that in mask-optional schools a test-to-stay strategy can likely keep students and educators in school with minimal increased risk of ongoing transmission.

Campbell MM, Benjamin DK Jr, Mann TK, et al. Test-to-Stay After SARS-CoV-2 Exposure: A Mitigation Strategy for Optionally Masked K-12 Schools. Pediatrics 2022; :e2022058200.

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