Feasibility of Specimen Self-collection in Young Children Undergoing SARS-CoV-2 Surveillance for In-Person Learning

Abstract

Importance: There is an urgent need to assess the feasibility of COVID-19 surveillance measures in educational settings.

Objective: To assess whether young children can feasibly self-collect SARS-CoV-2 samples for surveillance testing over the course of an academic year.

Design, setting, and participants: This prospective pilot cohort study was conducted from September 10, 2020, to June 10, 2021, at a K-8 school in San Mateo County, California. The research consisted of quantitative data collection efforts: (1) demographic data collected, (2) student sample self-collection error rates, and (3) student sample self-collection time durations. Students were enrolled in a hybrid learning model, a teaching model in which students were taught in person and online, with students having the option to attend virtually as needed. Data were collected under waiver of consent from students participating in weekly SARS-CoV-2 testing.

Main outcomes and measures: Errors over time for self-collection of nasal swabs such as contaminated swabs and inadequate or shallow swabbing; time taken for sample collection.

Results: Of 296 participants, 148 (50.0%) were boys and 148 (50.0%) were girls. A total of 87 participants (29.2%) identified as Asian; 2 (0.6%), Black or African American; 13 (4.4%), Hispanic/Latinx; 103 (34.6%), non-Hispanic White; 87 (29.2%), multiracial; and 6 (2.0%), other. The median school grade was fourth grade. From September 2020 to March 2021, a total of 4203 samples were obtained from 221 students on a weekly basis, while data on error rates were collected. Errors occurred in 2.7% (n = 107; 95% CI, 2.2%-3.2%) of student encounters, with the highest rate occurring on the first day of testing (20 [10.2%]). There was an overall decrease in error rates over time. From April to June 2021, a total of 2021 samples were obtained from 296 students on a weekly basis while data on encounter lengths were collected. Between April and June 2021, 193 encounters were timed. The mean duration of each encounter was 70 seconds (95% CI, 66.4-73.7 seconds).

Conclusions and relevance: Mastery of self-collected lower nasal swabs is possible for children 5 years and older. Testing duration can be condensed once students gain proficiency in testing procedures. Scalability for larger schools is possible if consideration is given to the resource-intensive nature of the testing and the setting's weather patterns.

Figure 1.. Surveillance Methods Used to Minimize Risk of Transmission of SARS-CoV-2 During On-Site Learning in the 2020-2021 Academic Year

^aIsolation and distance learning recommendations as a result of either exposure to a confirmed case of SARS-CoV-2 or a positive reverse transcription polymerase chain reaction (RT-PCR) test result changed during the year to reflect the US Centers for Disease Control and Prevention's latest guidelines and recommendations. Isolation period guidelines were shortened to 10 days in December 2020.

Figure 2.. Percent of Errors in Pediatric Specimen Self-collection Over Time

Frequency of errors recorded during specimen self-collection from September 2020 to March 2021. Errors occurred in 107 of 4203 student encounters (2.7%), with the highest number of errors occurring on the first day of testing (20 [10.2%]). Type of errors, such as multiple swabs required or shallow swabbing, are graphed separately. The any errors line notes all student encounters with any error on a given week. No specimens were collected from November 23, 2020, to January 3, 2021, coinciding with an extended winter closure implemented by the school study site to minimize transmission of SARS-CoV-2 amid increased community prevalence.