The Safer At School Early Alert HUB

Background: The purpose of this study was to enhance early detection and prevention of SARS-CoV-2 transmission in schools serving historically marginalized communities. During the COVID-19 pandemic, the challenge of balancing in-person learning with the risk of viral transmission was particularly acute in communities that rely most heavily on school-based services but were disproportionately affected by COVID-19 due to structural inequities. The Safer at School Early Alert (SASEA) program aimed to address these challenges through early detection of asymptomatic infections and equitable testing access.

Materials/Methods: This study implemented daily environmental surveillance using wastewater and surface (floor) monitoring to identify SARS-CoV-2 presence on school campuses. When a positive signal was detected, targeted responsive testing was initiated for the affected classroom or entire school. The study developed the Safer at School Early Alert-School Neighborhood Asset Portal (SASEA-SNAP), an online dashboard that provided real-time environmental monitoring data and resources to overcome structural barriers to diagnostic testing in historically marginalized communities. A toolkit was also created to help other schools adapt the model to their settings. A randomized stepped wedge trial design was used to compare schools implementing standard SASEA (control) with those using SASEA-SNAP (intervention) across schools in four diverse clusters in San Diego County. Parent-child narrative interviews were conducted with parent-student pairs to explore perceptions of COVID-19 risk, testing barriers, and understanding of environmental surveillance processes.

Outcome/Impact: The primary outcome of the study was to determine whether intervention schools achieved higher rates of diagnostic testing compared with control schools. The secondary outcome assessed whether increased access to real-time environmental data through SASEA-SNAP led to improved risk mitigation behaviors among school community members. Qualitative findings provided insights into parental and student perceptions of COVID-19 risk and the acceptability of school-based environmental surveillance. Collectively, this study demonstrated a scalable, community-engaged approach to integrating environmental monitoring with health equity focused outreach in school settings.