[Mandatory Testing in Schools can Significantly Reduce Underreporting of COVID-19 Infections Among Students with...

Aim of the study The aim of this was to study investigate the effectiveness of mandatory Covid-19 tests for in-classroom teaching in reopened schools as a containment measure in the pandemic. In Bavaria, mandatory testing at schools was implemented directly after the Easter vacations in 2021. For the first week after the vacations, this resulted in a natural experiment that allowed us to quantify the impact of the new testing strategy on reported Covid-19 cases.Methods We compared changes in the reported 7-day incidence of new infections between districts with in-classroom teaching at school and districts with closed schools. During the calendar week 15, districts with reported incidences below 100 were allowed to reopen schools and have in-classroom teaching if mandatory COVID-19 testing was performed at school with rapid antigen tests. We do not have data on the rapid test results; however, positive test results in the rapid antigen test were verified by a PCR test, and cases of positive PCR test results were reported at the district level by age groups. In the calendar weeks 13 and 14, all schools in Bavaria were closed due to Easter vacations. Taking into account a latency period of about 3-4 days and a reporting period of 1-2 days, this means that any additional increase in reported incidences for districts with in-class teaching and mandatory testing in the week after the vacation cannot be attributed to transmissions at schools, but reflects the reduction of underreporting due to the newly implemented testing strategy.Results Reported incidence increased by a factor of 6.6 for 5-11 year old and by 1.7 for 12-20 year old pupils in districts with in-classroom teaching and mandatory testing at schools. This increase was accompanied by a reduction in underreporting and was significant compared to districts with school closure. Given the situation of a natural experiment, this increase in the reported incidence among school children can be attributed to the testing strategy. For the same time period, no differences in reported incidences were found for the other age groups.Conclusion In-class teaching with mandatory testing in reopened schools changes the role of schools in the pandemic. Our analyses show that reopening schools with a mandatory testing approach is beneficial from an epidemiologic perspective as it can strongly reduce the dark figure of COVID-19 cases among children.