Implementation of SARS-CoV2 Screening in K-12 Schools Using In-School Pooled Molecular Testing and Deconvolution by...

Area of Science:

• Public Health
• Infectious Disease Surveillance
• Diagnostic Testing

Background:

• Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) testing is crucial for safe in-person K-12 schooling.
• Barriers to widespread testing include cost, logistics, and uncertain effectiveness.
• Novel pooled testing strategies are needed to overcome these implementation challenges.

Purpose of the Study:

• To assess the operational and analytical feasibility of a novel pooled SARS-CoV2 testing program in Massachusetts K-12 public schools.
• To evaluate the effectiveness of in-school 'pod pooling' and antigen rapid diagnostic test (Ag RDT) based deconvolution.

Main Methods:

• Collected and tested 187,597 anterior nasal swabs pooled from 5-10 individuals across 738 schools over 3 months.
• Utilized reverse transcription-PCR (RT-PCR) for primary pool testing.
• Employed BinaxNOW Ag RDT for reflex testing and deconvolution of positive pools.

Main Results:

• Achieved a pool positivity rate of 0.8% with 98.2% of pools testing negative.
• 92.5% of positive pools with cycle threshold (Ct) ≤30 were successfully deconvoluted using reflex testing.
• 25.8% of deconvolution attempts required additional testing, indicating a need for optimized protocols.

Conclusions:

• Pooled SARS-CoV2 testing with in-school pooling and RT-PCR/Ag RDT deconvolution is operationally feasible at scale for K-12 schools.
• The strategy requires adequate staffing and benefits from low pool positivity rates for optimal efficiency.
• This approach supports safe in-person school attendance by enabling widespread screening of students and staff.