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. 2023 May;93(5):360-369.
doi: 10.1111/josh.13283. Epub 2022 Nov 20.

Test-to-Stay in Kindergarten Through 12th Grade Schools After Household Exposure to Severe Acute Respiratory Syndrome Coronavirus 2

Zeni Scott  1 , Diya M Uthappa  2 , Tara K Mann  3 , Hwasoon Kim  4 , M A Brookhart  5 , Laura Edwards  6 , Zsolt Rak  7 , Daniel K Benjamin Jr  8 , Kanecia O Zimmerman  9 ; ABC Science Collaborative  10
Affiliations

Test-to-Stay in Kindergarten Through 12th Grade Schools After Household Exposure to Severe Acute Respiratory Syndrome Coronavirus 2

Zeni Scott et al. J Sch Health. 2023 May.

Abstract

Background: Test-to-stay (TTS) is a strategy to limit school exclusion following an exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We evaluated the use of TTS within universally masked kindergarten through 12th grade (K-12) school settings following household SARS-CoV-2 exposure.

Methods: Three hundred twenty-two participants were enrolled. Serial rapid antigen testing was performed up to 15 days post-exposure. Analysis-eligible participants completed the 15-day testing protocol, tested positive any time during the testing window, or received a negative test on or after day 9. Primary outcomes included within-school tertiary attack rate (TAR) (test positivity among close contacts of positive TTS participants), and school days saved among TTS participants.

Results: Seventy-three of 265 analysis-eligible participants tested positive for SARS-CoV-2 (secondary attack rate of 28% [95% CI: 16-63%]). Among 77 within-school close contacts, 2 were positive (TAR = 3% [95% CI: 1-5%]). Participant absences were limited to 338 days, resulting in 82% of 1849 school days saved.

Implications for school health policy, practice, and equity: TTS facilitates continued in-person learning and can greatly reduce the number of missed school days.

Conclusions: Within universally masked K-12 schools, TTS is a safe alternative to school exclusion following household SARS-CoV-2 exposure.

Keywords: COVID-19; K-12 school communities; SARS-CoV-2; rapid antigen test; test-to-stay.

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Figures

Figure 1.
Figure 1.. Testing and Masking Timeline
Testing and masking timeline for: A) participants in TTS; compared to B) January 2022 CDC quarantine guidelines in the absence of TTS. CDC, Centers for Disease Control and Prevention; TTS, test-to-stay
See this image and copyright information in PMC

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