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

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• School Health Programs

Background:

• Quarantine policies for close contacts of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in schools can lead to significant learning loss.
• Alternative strategies are needed to mitigate transmission while preserving in-person education.

Purpose of the Study:

• To evaluate the safety and efficacy of a test-to-stay program as an alternative to quarantine for unvaccinated individuals with in-school SARS-CoV-2 exposure.
• To measure secondary and tertiary transmission rates and the number of school days preserved.

Main Methods:

• A test-to-stay program was implemented in North Carolina schools, offering serial rapid antigen testing to asymptomatic unvaccinated students and staff exposed to SARS-CoV-2.
• Participants underwent testing for up to 7 days post-exposure, with data collected on exposure details, symptoms, and school absences.
• Secondary and tertiary transmission rates, along with preserved school days, were the primary outcomes.

Main Results:

• The study enrolled 367 participants, with 357 completing follow-up. The secondary attack rate was 1.7% (95% CI: 0.6%-4.7%).
• No tertiary cases of SARS-CoV-2 were identified among participants.
• The test-to-stay program preserved 1628 (92%) of potentially missed school days.

Conclusions:

• A test-to-stay strategy is a safe and effective alternative to traditional quarantine for unvaccinated individuals following in-school SARS-CoV-2 exposure.
• This approach significantly reduces school days missed without increasing transmission within the school setting.