School & District Management

‘Test to Stay': New Approach Keeps COVID-Exposed Students in Class

By Catherine Gewertz — October 06, 2021 7 min read
An employee of a new Lufthansa coronavirus quick test center shows the test devices at the airport in Munich, Germany on Nov. 12, 2020. Lufthansa starts the first test runs for comprehensive Covid-19 antigen rapid tests on selected routes between Munich and Hamburg.
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Fed up with all the instructional time lost to COVID-19 quarantines, schools are increasingly taking a new tack: They’re letting students and staff members who’ve been exposed to the virus stay in school.

At first blush, it might seem counterintuitive to let known “close contacts” of an infected person mix with their peers or colleagues. But research and daily practice have given schools reason to try it.

They’re discovering that they can safely keep nearly all exposed students and staff in school if they monitor them with frequent COVID tests. Relatively few schools are using these “test-to-stay” programs, but more are joining them weekly.

“It’s no longer a blanket approach, just quarantining everyone who’s been exposed,” said Mara Aspinall, a healthcare consultant and Arizona State University professor who’s been studying COVID testing in schools. “Districts are taking a variety of approaches now to try to keep more kids in school.”

Georgia’s Marietta City school district offers a glimpse of the impact a test-to-stay program can have:

  • In mid-August, the third week of the school year, the district sent home 983 of its 8,900 students—those who were unvaccinated and had been in close contact with an infected person.
  • The following week, with the help of a new mask mandate, that number fell to 308.
  • By the third week in September, when a test-and-stay program was in place, and community virus rates had also fallen, only 66 students were in home quarantine.

Under Marietta’s program, staff or students who are exposed to COVID-19 at school may take rapid-antigen tests each morning for seven days, at a drive-through in a church parking lot. They get results in 15 to 30 minutes and can proceed to school if they’re negative. Those who don’t want to test daily can ride out their quarantine at home.

Superintendent Grant Rivera said he’s relieved to see so few staff and students sent home now. “It’s important that we maximize instructional time and minimize interruptions,” he said.

Fed up with mass quarantines, districts are looking for new approaches

Rivera’s sentiment is widely shared 18 months into a pandemic that has upended schooling coast to coast. Those disruptions are fueling interest in using COVID tests to spot and manage outbreaks, but also, more recently, to minimize home quarantining. This fall, schools nationally have sent home tens of thousands of students, sometimes closing entire classrooms or schools.

Many went further than medical authorities say they need to, exiling every student and teacher who’d been a “close contact”—within six feet of an infected person for 15 minutes total in a 24-hour period. But the Centers for Disease Control and Prevention says many close contacts can skip quarantine, such as those who are asymptomatic and vaccinated.

Schools may be suffering from quarantine overload, but most haven’t embraced COVID surveillance testing as a tactic to combat it, even with $11 billion in federal money available for such programs, and President Joe Biden urging schools to get in the testing game. In a nationally representative survey of school and district leaders by the EdWeek Research Center in early September, 52 percent said they don’t require any COVID testing of students or staff, a number that hasn’t budged since April.

The logistics of running a large-scale testing program can be daunting, experts say. Districts must often siphon some of their own staff time to help contracted test-providers. And the much-publicized shortage of rapid antigen tests has been a problem as well.

Delta drives more interest in school-based COVID testing

But companies that set up large-scale testing programs say more school districts have expressed interest in surveillance testing since the Delta variant took hold in late summer. Anne Haslerud, the vice president of recruiting and enrollment for Affinity Empowering, which helps schools in 27 states set up pooled PCR testing through a federally funded program, said she’s seen interest rise “at a nice steady pace” since then.

The test-to-stay model appears to be driving a share of that interest. Andrew Kobylinski, the CEO of Primary.Health, which works with California and other states to expand rapid testing, said test-to-stay “is definitely gaining” popularity in schools.

Five states—California, Illinois, Kansas, Louisiana, and Massachusetts—have recently created statewide policies permitting school districts to use versions of the test-to-stay model. Utah piloted the approach last year, and enacted a law this year requiring schools to use test-to-stay.

But the CDC isn’t on board with the practice yet. The agency recommends that schools conduct weekly COVID testing of unvaccinated staff and students in areas where transmission risk is substantial. But in August guidance to parents, it said it doesn’t have enough data yet to recommend test-to-stay models, and it recommends that close contacts not be allowed into schools. The CDC did not respond to EdWeek’s request for elaboration.

One study, published in the journal Lancet last month, is offering ammunition to test-to-stay advocates. Researchers conducted a randomized controlled trial in 200 schools in the United Kingdom last spring, as Delta circulated. Half the schools sent home close contacts, while the other half kept them in school and monitored them daily with rapid antigen tests for seven days.

Researchers found no statistically significant difference in infection rates between the two groups. They concluded that daily testing “should be considered for implementation as a safe alternative to home isolation” following school-based exposure to COVID-19.

Several ‘modified quarantine’ approaches are gaining ground

The UK study also found that only 2 percent of those who were exposed to COVID-19 at school eventually tested positive, a statistic that’s encouraging some districts to try the test-to-stay approach.

That number also highlights another dynamic that’s shaping test-to-stay programs: eligibility. Some test-to-stay programs limit participation to those who were exposed at school, since the likelihood of testing positive from such an exposure is so low.

Test-to-stay is just one type of “modified quarantine” districts are exploring.

Some districts don’t modify quarantine with testing at all; they allow close contacts to come to school as long as they wear a mask. Among those who use testing, some, such as Marietta City, require daily swabs to get onto campus, while others test twice a week or less often.

That lag time can create complications, as West Contra Costa Unified school district, in California, learned. Earlier this year, the district tried a test-to-stay program, which required its 3,300 staff members—and encouraged its 26,000 students—to take a PCR test. People flocked to the program.

But the promised 48-hour turnaround time for results stretched into as much as five days, said Superintendent Chris Hurst. That gap created a window of risk: people who’d been exposed were in school, circulating among others for several days, while they waited for results.

Turnaround time in test results is key

Last month, the district changed testing providers, and now does weekly rapid-antigen testing, with results in 15 to 30 minutes, Hurst said. Currently it’s home-quarantining all close contacts, but intends to move soon to twice-weekly testing, and will allow those with negative results to come to school, Hurst said.

“If I had it to do again, I’d go right to rapid-antigen tests,” Hurst said.

West Contra Costa’s experience highlights a few key issues with test-to-stay programs, and surveillance COVID testing in general.

One is that turnaround time matters. Molecular tests, such as the individual, lab-processed PCR, are viewed as the gold standard because of their accuracy, and can have an important role in school testing programs. But tests that provide quick results are important when immediate decisions are riding on them.

Kobylinski, from Primary.Health, said he thinks many school and district leaders have been using lab-processed PCR tests because rapid antigen tests have been in short supply. But experts anticipate that issue will lessen as supply catches up with demand.

Staffing can be a problem. Laura Faherty, a pediatrician and RAND Corp. researcher who’s studied early adopters of COVID testing, said even vendors who contract with states are having periodic problems supplying enough staff to school testing sites.

And districts often have to complement a vendor’s staff with their own. Rivera said he dedicates five to six central-office staffers to testing daily; a few to assist at the site, and a couple more to connect with families via text and email.

Uptake varies significantly. While staff and students in West Contra Costa jumped at the chance to be tested, participation among eligible families in Marietta City has hovered between 20 percent and 40 percent, Rivera said. The biggest reason parents cite is not knowing about the program, so the district is stepping up its outreach efforts.

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A version of this article appeared in the October 20, 2021 edition of Education Week as ‘Test to Stay’: New Approach Keeps COVID-Exposed Students in Class

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