Test-to-Stay After SARS-CoV-2 Exposure: A Mitigation Strategy for Optionally Masked K-12 Schools.

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Pediatric Health

Background:

• High community transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) posed challenges to maintaining in-person learning.
• School policies for managing close contacts of infected individuals impacted student attendance and educational continuity.

Purpose of the Study:

• To evaluate the impact of a test-to-stay (TTS) program on within-school transmission of SARS-CoV-2.
• To assess the effectiveness of TTS in reducing missed school days in kindergarten through 12th grade (K-12) schools.
• To determine the rate of school-acquired infections associated with TTS implementation.

Main Methods:

• A test-to-stay (TTS) program was implemented for close contacts of individuals with confirmed SARS-CoV-2 infection.
• Eligible participants remained in school if asymptomatic and testing negative via rapid antigen tests at specified intervals.
• Primary outcomes measured included within-school tertiary attack rate and school days saved.

Main Results:

• A tertiary attack rate of 10% was observed among close contacts participating in the TTS program.
• Approximately 89% of potentially missed school days were saved through the implementation of TTS.
• An estimated 1 additional school-acquired case occurred for every 21 TTS participants kept in school.

Conclusions:

• The test-to-stay (TTS) strategy substantially reduced missed school days in K-12 schools, even during periods of high community SARS-CoV-2 transmission.
• TTS offers a viable approach to maintain in-person schooling while mitigating within-school transmission.
• The findings support the use of TTS programs as a component of school-based infection control strategies.