Education Week - October 20, 2021 - 4

'Test to Stay': New Approach Keeps
COVID-Exposed Students in Class
More schools are adopting " test-to-stay " programs to keep students who
are close contacts in school and minimize disruption to their learning
By Catherine Gewertz
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 health care consultant and Arizona
State University professor who's
been studying COVID-19 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 COVID19
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 use new tactics
Rivera's sentiment is widely
shared 19 months into a pandemic
that has upended schooling coast
to coast. Those disruptions are fuantine
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
More schools in the United States are using rapid-antigen tests, similar to the one shown in this photo, to minimize the
need for home quarantines after staff and students are exposed to COVID-19.
eling interest in using COVID-19
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-19 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-19 testing of students
or staff, a number that hasn't
budged since April.
The logistics of running a largescale
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.
4 | EDUCATION WEEK | October 20, 2021 | www.edweek.org
But companies that set up largescale
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 testto-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-19 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-tostay
programs: eligibility. Some testto-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 quarto
rapid-antigen tests, " Hurst said.
West Contra Costa's experience
highlights a few key issues with testto-stay
programs, and surveillance
COVID-19 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 labprocessed
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-19 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.
Matthias Schrader/AP

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Education Week - October 20, 2021

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