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

Background: This study assessed if frequent screening testing would provide additional benefit, beyond current school-based mitigation strategies, to prevent SARS-CoV-2 transmission. The study compared 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.

Materials/Methods: This study utilized a cluster randomized trial of 12 middle and high schools from five predominantly African American school districts in the St. Louis metropolitan area. Schools were randomized to screening testing plus symptomatic testing versus symptomatic testing alone. Qualitative listening sessions and interviews with members of the school community including parents, teachers, administrators, and students were conducted to understand the facilitators and barriers to testing, concerns regarding in-person school, and potential issues involving vaccine hesitancy.

Outcome/Impact: 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 was targeted for further intervention, and reassured the community on the safety of their schools. 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.