Evaluation of “Test to Return” after COVID ‐19 Diagnosis in a Massachusetts Public School District

  1. Sandra B. Nelson
  2. Isaac Ravi Brenner
  3. Elizabeth Homan
  4. Sarah Bott Lee
  5. Christine Bongiorno
  6. Nira R. Pollock
  7. Andrea Ciaranello

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Abstract

BACKGROUND

Per Centers for Disease Control and Prevention guidance, students with COVID‐19 may end isolation after 5 days if symptoms are improving; some individuals may still be contagious. Rapid antigen testing identifies possibly infectious virus. We report on a test‐to‐return (TTR) program in a Massachusetts school district to inform policy decisions about return to school after COVID‐19.

METHODS

During the 2021‐2022 Omicron BA.1 surge, students with COVID‐19 could return on day 6‐10 if they met symptom criteria and had a negative rapid test; students with positive rapid tests and those who declined TTR remained isolated until day 11. TTR positivity rates were compared by grade level, vaccination status, symptom status, and day of infection.

RESULTS

31.4% of students had a positive TTR rapid test; there were no differences by grade or vaccination status. Ever‐symptomatic students were more likely to have a positive rapid test (75/174 [43.1%] vs 18/104 [17.3%]). For ever‐symptomatic students, TTR positivity decreased by day of infection.

CONCLUSIONS

A substantial proportion of students may still be contagious 6 days after onset of COVID‐19 infection. TTR programs may increase or reduce missed school days, depending on when return is otherwise allowed (day 6 or 11). The impact of TTR programs on school‐associated transmission remains unknown.

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  1. Version published to 10.1111/josh.13357
  2. ScreenIT

    SciScore for 10.1101/2022.02.11.22270843: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This study is subject to several limitations. First, students had only one opportunity to participate in TTR; some may have pre-tested or delayed TTR to ensure a negative school-administered test. If all persons meeting time and symptom criteria had tested on day 5 or 6, the positivity rate would likely have been higher. Second, the correlation between RAT and culture-positivity is not yet understood for the Omicron variant, although preliminary data suggests that RAT remains sensitive when viral load is high by RT-PCR.8 Implementation of TTR programs in schools has both advantages and costs. Compared to schools that allow return on day 6 without TTR, schools with TTR programs may have fewer school-associated transmissions, but more missed school days. However, as an alternative to isolation through day 10, TTR programs will reduce the number of missed school days. While TTR programs may identify those individuals who still carry replication-competent virus, spread in schools has been rare when masks are worn consistently; further, the risk of school-associated transmission during days 6-10 is not known. When return occurs prior to day 11 without TTR, districts should assume that some students could still be infectious. For students on days 6-10, strict adherence to masking (consistent with CDC guidance) and safe distance during unmasked periods, including lunchtime, are essential.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  3. Version published to 10.1101/2022.02.11.22270843v1 on medRxiv