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

Abstract

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 competition events.^§ Test to Stay was conducted at 13 high schools, saving an estimated 109,752 in-person instruction student-days.^¶ School-based COVID-19 testing should be considered as part of a comprehensive prevention strategy to help identify SARS-CoV-2 infections in schools and sustain in-person instruction and extracurricular activities.

FIGURE 1

COVID-19 incidence among children aged 5–10 years (N = 311,812), 11–13 years (N = 161,991), and 14–17 years (N = 209,578), by week — Utah, July 5, 2020–March 14, 2021^,,, Abbreviation: UDOH = Utah Department of Health. * Total new cases per 100,000 persons in the previous 7 days, calculated using 2018 population data. https://ibis.health.utah.gov ^† In August 2020, Utah schools opened for in-person instruction in 40 of 41 school districts. ^§ On November 9, 2020, Utah State Public Health Order 2020-21 limited participation in organized extracurricular activities to high school football practice or games. https://coronavirus-download.utah.gov/Health/UPHO-2020-21-Temporary-Statewide-COVID-19-Restrictions.pdf, https://coronavirus-download.utah.gov/School/COVID-19_School_Manual_FINAL.pdf ^¶ 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.

FIGURE 2

Number of school-based SARS-CoV-2 rapid antigen tests performed and percentage positive among students participating in Test to Play (A) and Test to Stay (B), by week or date of testing event and high school (for Test to Stay) — Utah, November 30, 2020–March 20, 2021 * Abbott BinaxNOW rapid antigen nasal swab test kits were provided at no cost to the Utah Department of Health by the U.S. Department of Health and Human Services. https://www.fda.gov/media/141570/download ^† 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. Each of the 13 schools that conducted Test to Stay is represented by a unique letter (A–M). With the exception of the second high school G event, Test to Stay events were conducted over 1 or 2 days and all student testing reported by these schools during the events was counted as Test to Stay. Multiday Test to Stay events are indicated on the first day of the event. High school G conducted a Test to Stay event during January 25–26 after crossing the outbreak threshold. Subsequently, high school G conducted modified, follow-up Test to Stay testing during February 8–March 9; all Test to Stay testing among students reported by this school during this period is represented as a single, additional event. High school K conducted a Test to Stay event when the school was approaching, but had not reached, the outbreak threshold.