Dive Brief:

• Schools are increasingly implementing test-to-stay policies as a COVID-19 mitigation strategy, said Leah Perkinson, manager of pandemics at the Rockefeller Foundation. Perkinson is leading the foundation’s efforts to create a national COVID-19 testing program in K-12 schools and is currently working with about 30,000 schools in the foundation’s Learning Network across 26 states and Washington, D.C.
• No guidance has been released yet on test-to-stay plans by the Centers for Disease Control and Prevention, even though the federal agency has stated it views test-to-stay “as a promising practice.” The CDC defines test to stay as a mitigation method “comprised of regular testing and contact tracing to allow close contacts to remain in the classroom, while maintaining other layered prevention strategies.”
• Several school health experts, including Perkinson, agree test-to-stay is an effective mitigation strategy to keep schools open when used with other safety measures, including universal masking, vaccinations and social distancing. 

Dive Insight:

With the severity of the new omicron variant still unknown, Perkinson said test-to-stay could be a valuable mitigation layer for districts to prevent the spread of COVID-19. 

“The main point here is, at the end of the day, what we want to do is increase in-person school days, so test to stay is a good strategy for decreasing unnecessary quarantining,” Perkinson said.

Perkinson noted the CDC is working to study the practice’s effectiveness and said any guidance CDC can release would be helpful. 

“CDC is working with multiple jurisdictions implementing test to stay to evaluate the effectiveness of this strategy,” the CDC stated on its website. 

Various test-to-stay models exist, Perkinson said. Some programs only ask unvaccinated students to get tested while others allow any student or staff member to seek testing regardless of vaccination status, typically if there’s been a close contact exposure. 

The 2,200-student Regional School Unit 22 in Hampden, Maine, implemented a test-to-stay program at the beginning of the 2021-22 school year. About 1,500 students, regardless of vaccination status, get weekly pool testing, according to Brittany Layman, the district health and wellness coordinator.

Pool testing entails 15 to 20 students have their individual short nasal swab samples tested together in one tube. If COVID-19 is detected in a pool, then the school retests the group to try to find the student that tested positive. 

Layman said her district has been working with the local CDC agency in Maine, and the program has been a successful mitigation strategy detecting 16% of the total positive cases in the district. 

“We kept school open. We have not closed our schools,” Layman said. “We haven’t had to shut down or go remote because of lack of staff or too many quarantining students, because we have so many kids coming back and able to stay in school. So, we’re really proud of that.”

The funding is there for schools to improve on COVID-19 testing policies, such as through the $10 billion made available by the CDC’s Epidemiology and Laboratory Capacity cooperative agreement, Perkinson said. There’s also money available for school testing through the Elementary and Secondary School Emergency Relief fund, Perkinson added.

“Every school across the United States should be able to do testing if they want to. The funding is there to do it,” Perkinson said. 

But testing for COVID-19 in schools is still an innovative approach, and new innovations take time to gain traction, she said. However, it is important districts have the support of their administrators, superintendent, school board and parents, Perkinson said. The best way to do that is through constant and open communication, she added. 

For schools considering a test-to-stay program, Perkinson said, it’s vital to use an automated software system that can track students' COVID-19 status, particularly in larger districts.

The 96,000-student Jefferson County Public Schools in Louisville, Kentucky, has implemented an optional test-to-stay program starting in mid-October that allows unvaccinated students to get tested for seven consecutive days after being exposed to COVID-19 while attending school. 

To provide families with easier access to COVID testing, the district has set up school buses as mobile testing sites in the evening for the 2,500 students who volunteered to be in the test-to-stay program. The district has also set up evening drive-thru testing sites throughout the city, said Eva Stone, JCPS’ health manager.

Stone said test-to-stay is a great mitigation strategy to keep students learning in person, adding that the total positivity rate has consistently remained below 3% among those in JCPS' test-to-stay program.