CDC endorses ‘test-to-stay’ strategy
Policy aims to keep kids in school after exposure to virus
The Centers for Disease Control and Prevention said Friday that unvaccinated students exposed to the coronavirus no longer need to miss school if they repeatedly test negative for the virus in the days after, allowing them to remain in class and school activities.
The new guidance, known as the “test to stay” protocol, would ease the burden on children who have been expected to stay home if a close contact tests positive for the virus and on parents who have had to scramble to retrieve children from school or find day care.
Although some schools and districts are already using the “test-to-stay” approach, the CDC has not previously endorsed it, citing a lack of evidence. On Friday, the agency released studies from two counties, one in California and the other in Illinois, that effectively tested the test-to-stay protocol and found that it worked.
The studies were conducted before the fast-moving omicron variant began spreading in the United States. Scientists are still investigating many basic questions about the variant, some of which could affect the assessment of in-school transmission risks.
The policy, hinted at in the winter COVID-19 plan that President Joe Biden unveiled earlier this month, still calls on students to wear masks and socially distance, and applies only to those who remain asymptomatic as they test for the virus. Until now, unvaccinated students were expected to quarantine at home for as long as two weeks after exposure.
Vaccinated students with exposures have generally been allowed to remain in school as long as they are asymptomatic and wear a mask. The CDC recommends that vaccinated people get tested five to seven days after close contact with someone who has a suspected or confirmed case of the virus.
The agency Friday released studies from the two counties that effectively tested the test-to-stay protocol. In Los Angeles, students at schools that did not participate in the pilot program, and who had to quarantine, lost an estimated 92,455 in-person school days between Sept. 20 and Oct. 31, while students exposed to the virus in schools trying out the program lost no days. Schools that used test-to-stay also did not see increases in virus rates among students.
In Lake County, Illinois, researchers estimated that up to 8,152 in-person learning days were saved between August and October in schools that participated in the program. Of the 16 students in the program who tested positive for the virus in the two weeks after exposure, none appeared to transmit it to others at school, the report said.
The California students were tested twice in the week after exposure; the Illinois students were tested four times.
Dr. Rochelle Walensky, the CDC director, said at a White House news conference Friday that the protocol was “promising” and “now proven.” She added that because “test to stay” was only studied in schools, the CDC did not yet have evidence about its effectiveness in other settings.
Public health experts cheered the move, saying it struck the right balance between keeping children safe and allowing them to continue with in-person learning.
“The test-to-stay programs are really good at balancing the costs and benefits,” said Zoe McLaren, a health policy expert at the School of Public Policy at the University of Maryland, Baltimore County. She added, “What the test-tostay program does is help us keep COVID cases down, while also trying to make sure we keep kids in school as much as possible, which I think is really important.”
Research suggests that the risk of in-school transmission is relatively low when schools take a variety of precautions, including requiring masks and improving ventilation. But that research, like the two studies the CDC released Friday, was conducted before the omicron variant emerged.
Meanwhile, Pfizer said Friday it was changing plans and testing three doses of its COVID-19 vaccine in babies and preschoolers after the usual two shots didn’t appear strong enough for some of the children.
Pfizer announced the change after a preliminary analysis found 2- to 4-year-olds didn’t have as strong an immune response as expected to the very low-dose shots the company is testing in the youngest children.
It’s disappointing news for families anxious to vaccinate their tots. Pfizer had expected data on how well the vaccines were working in children under 5 by year’s end, and it’s not clear how long the change will delay a final answer.
Pfizer and its partner BioNTech said if the threedose study is successful, they plan to apply for emergency authorization in the first half of 2022.
A kidsize version of Pfizer’s vaccine is available for 5- to 11-year-olds, one that’s a third of the dose given to people 12 and older.
For children younger than 5, Pfizer is testing an even smaller dose, just 3 micrograms or a tenth of the adult dose.