Assessing Testing Strategies for Safe Return to K-12 Schools in an Underserved Population

This proposal tested the hypothesis that frequent screening testing would provide additional benefit, beyond current school-based mitigation strategies, to prevent SARS-CoV-2 transmission. This study completed a cluster randomized trial to compare the incidence of school-based SARS-CoV-2 transmission between weekly surveillance testing of students and school staff versus testing only symptomatic students and staff. In this proposal, 12 middle and high schools from five predominantly African-American school districts in the St. Louis metropolitan area were cluster randomized to screening testing plus symptomatic testing versus symptomatic testing alone. This study performed qualitative listening sessions and interviews with members of the school community including parents, teachers, administrators, and students to understand the facilitators and barriers to testing, the concerns regarding in-person school, and potential issues involving vaccine hesitancy evident in all populations and groups. This study provided critically needed, rigorous data to inform the utility of screening testing in schools and if it is important in aiding schools in the African-American community to return to in-person instruction. Additionally, the measurements of school-based transmission rates helped participating schools in the African-American community assess the impact of their mitigation strategies, demonstrated potential risk points for transmission that can be targeted for further intervention, and reassured the community on the safety of their schools. Finally, the study results aided participating researchers, school districts and communities in understanding how to mitigate concerns about in-person schooling and the reliability of the mitigation strategies (with or without screening testing) in preventing COVID-19 transmission.