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. 2022 May 1;149(5):e2021056045.
doi: 10.1542/peds.2021-056045.

Test-to-Stay After Exposure to SARS-CoV-2 in K-12 Schools

Melissa M Campbell  1   2 , Daniel K Benjamin  1   2   3 , Tara Mann  1 , Alex Fist  1 , Hwasoon Kim  1 , Laura Edwards  1 , Zsolt Rak  1 , M Alan Brookhart  4 , Kevin Anstrom  1 , Zack Moore  5 , Elizabeth Cuervo Tilson  5 , Ibukunoluwa C Kalu  1   2 , Angelique E Boutzoukas  1   2 , Ganga S Moorthy  1   2 , Diya Uthappa  6 , Zeni Scott  2 , David J Weber  7 , Andi L Shane  8 , Kristina A Bryant  9 , Kanecia O Zimmerman  1   2   3 ; ABC SCIENCE COLLABORATIVE
Affiliations

Test-to-Stay After Exposure to SARS-CoV-2 in K-12 Schools

Melissa M Campbell et al. Pediatrics. .

Abstract

Objectives: We evaluated the safety and efficacy of a test-to-stay program for unvaccinated students and staff who experienced an unmasked, in-school exposure to someone with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Serial testing instead of quarantine was offered to asymptomatic contacts. We measured secondary and tertiary transmission rates within participating schools and in-school days preserved for participants.

Methods: Participating staff or students from universally masked districts in North Carolina underwent rapid antigen testing at set intervals up to 7 days after known exposure. Collected data included location or setting of exposure, participant symptoms, and school absences up to 14 days after enrollment. Outcomes included tertiary transmission, secondary transmission, and school days saved among test-to-stay participants. A prespecified interim safety analysis occurred after 1 month of enrollment.

Results: We enrolled 367 participants and completed 14-day follow-up on all participants for this analysis. Nearly all (215 of 238, 90%) exposure encounters involved an unmasked index case and an unmasked close contact, with most (353 of 366, 96%) occurring indoors, during lunch (137 of 357, 39%) or athletics (45 of 357, 13%). Secondary attack rate was 1.7% (95% confidence interval: 0.6%-4.7%) based on 883 SARS-CoV-2 serial rapid antigen tests with results from 357 participants; no tertiary cases were identified, and 1628 (92%) school days were saved through test-to-stay program implementation out of 1764 days potentially missed.

Conclusion: After unmasked in-school exposure to SARS-CoV-2, even in a mostly unvaccinated population, a test-to-stay strategy is a safe alternative to quarantine.

Trial registration: ClinicalTrials.gov NCT05052580.

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Conflict of interest statement

M. Alan Brookhart serves on scientific advisory committees for AbbVie, Amgen, Atara Biotherapeutics, Brigham and Women’s Hospital, Gilead, and Vertex; he receives consulting fees and own equity in NoviSci/Target RWE. Angelique Boutzoukas receives salary support through the US government National Institute of Child Health and Human Development (NICHD) T32 training grant (1T32HD094671). Kanecia Zimmerman reports funding from the National Institutes of Health (NIH) and US Food and Drug Administration (FDA). Daniel Benjamin reports consultancy for Allergan, Melinta Therapeutics, Sun Pharma Advanced Research Co. Kristina Bryant is an investigator on multicenter clinical trials funded by Enanta, Gilead, and Pfizer, including a trial of COVID-19 vaccine in children.

Figures

Figure 1.
Figure 1.
Diagram of eligible students. Diagram of eligible students in 6 universally masked NC school districts participating in test-to-stay program.
Figure 2.
Figure 2.
In-school exposure encounters. In-school exposure encounters by activity and/or location among test-to-stay participants.
See this image and copyright information in PMC

References

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    1. Centers for Disease Control and Prevention (CDC). Guidance for COVID-19 prevention in K-12 schools. Available at: https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/k-.... Updated November 5, 2021. Accessed December 16, 2021.

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