New covid testing model aims to keep kids in school

An increasing number of school districts are turning to coronavirus testing to keep more children in the classroom and avoid disrupting the work lives of their parents.

The resource-intensive approach — sometimes known as “test to stay” or modified quarantine — allows students who have been exposed to the virus to stay in school as long as they take frequent covid-19 tests, which are typically provided by the schools, and adhere to other precautions.

Experts agree that children who are infected with the virus should isolate at home, but the question of what to do about their classmates poses a dilemma.

Allowing children who have been exposed to the virus to remain in school does pose a transmission risk, and the Centers for Disease Control and Prevention says that it “does not have enough evidence” to support the approach. Instead, it recommends that close contacts who have not been fully vaccinated quarantine for as long as 14 days. Vaccinated close contacts can remain in the classroom as long as they are asymptomatic and wear masks, according to the agency’s guidance.

“At this time, we do not recommend or endorse a test-to-stay program,” the CDC said in a statement. “However, we are working with multiple jurisdictions who have chosen to use these approaches to gather more information.”

The CDC guidelines mean that in some cases, especially in classrooms where students are not vaccinated, masked or socially distanced, a single case of covid-19 can force a dozen or more students out of school. New York City’s school guidelines are even more stringent, stipulating that all unvaccinated students must quarantine for seven to 10 days if one of their classmates contracts the virus.

With the academic year barely underway, some districts in Florida, Louisiana, Missouri and other covid-19 hot spots have already had to quarantine hundreds or even thousands of students. In mid-August, Mississippi had nearly 30,000 students in quarantine, according to data reported to the state.

In contrast to the CDC guidelines, a new study published in The Lancet suggests that the test-tostay approach can be safe. The randomized, controlled trial included more than 150 schools in Britain and found that case rates were not significantly higher at schools that allowed close contacts of infected students or staff members to remain in class with daily testing than at those that required at-home quarantines.

About 2% of school-based close contacts ultimately tested positive for the virus, researchers found, which meant that schools were keeping 49 uninfected students out of class every time one student tested positive.

“When you put that in the broader context of what we’re doing in society, it’s putting a pretty strong penalty on young people, I think,” said Dr. Bernadette Young, an infectious disease expert at the University of Oxford and a lead author of the paper.

Over the summer, the United Kingdom announced that children identified as close contacts no longer needed to quarantine, although it encouraged them to be tested for the virus.

As school officials in the U.S. embark on a third academic year during the pandemic, many say the time has come for a new approach.

“The philosophy of this is how can we keep healthy kids in school and sick kids at home?” said Isaac Seevers, the superintendent of the Lebanon district in Ohio, which is preparing to start a test-to-stay program. “I think there’s some real optimism that this is a game-changer for how we learn to live with covid.”

BAD EXPERIENCES

Melissa True Gibbs, a mother of two teenagers in Sandy, Utah, prefers not to think about last fall. “It was hell,” she said.

In August, her soccer-playing daughter, Lydia, and theater-loving son, Brody, trudged off to Alta High School.

By late September, with covid-19 cases on the rise, the school shut its doors and transitioned to online learning. Two weeks later, it shifted to a hybrid schedule — in which students went to school on some days and learned from home on others — and then back to in-person and then back to hybrid and then back to entirely online as case numbers rose again.

“My kids are pretty resilient,” True Gibbs said. “But man, that first half of that year, I saw things happening with my kids that scared me. They weren’t emotionally well, they weren’t mentally well; they were struggling.”

Many other schools in Utah were having similar experiences. So as winter approached, officials developed a test-to-stay protocol. Small schools that had 15 cases or larger ones that had a 1% infection rate could either switch to online learning or hold a mass testing event. Students who tested negative could return to class, while those who were infected, or whose families did not consent to the testing, would stay at home.

Thirteen schools, including Alta High, conducted test-to-stay events early this year. Just 0.7% of the schools’ 13,809 students tested positive, researchers reported in May.

“That made us feel really confident that continuing in-person learning in these schools was the right call,” said Dr. Adam Hersh, an expert in pediatric infectious diseases at the University of Utah.

The program saved more than 100,000 in-person student-days last winter, researchers found.

Some states, including Illinois, Kansas, California and Massachusetts, have now outlined their own test-to-stay or modified quarantine protocols, as have some local districts elsewhere. More than 2,000 schools in Massachusetts are using the state’s procedure, which allows close contacts to stay in school as long as they are asymptomatic, wear masks and test negative for the virus daily for seven days after exposure.

Test-to-stay programs are most feasible when paired with other safety measures, including masking, experts said. Utah, which required masks in schools last year, has banned such mandates this year, and some districts have decided not to do any testing unless they hit the outbreak threshold, said Kendra Babitz, the state’s covid-19 testing director.

Robust testing is a “really important” strategy for supporting in-person learning, Hersh said. “But it’s operationally challenging. So to the extent that we can reduce the frequency with which we need to be concerned about close-contact exposures, and all that goes with that, we’re going to be creating much more sustainable learning environments.”