Screening programs for COVID-19 are an important public health tool in slowing the spread of COVID-19 and limiting its impact on communities. Screening is especially important in settings such as schools, where minimizing spread and maximizing safety allows for more in-person learning.
As more people have become vaccinated, been infected with COVID-19, or both, the level of immunity in communities has increased, and the severity of COVID-19 has decreased. Because of this, some prevention, or mitigation, measures across the United States have been scaled back, and in some cases, abandoned. Despite this scale-back, screening remains an important public health tool, helping to limit the spread of COVID-19 in settings such as schools, hospitals, and nursing homes.
Additionally, our ability to implement screening programs rapidly and effectively is necessary for future epidemics and pandemics of dangerous infectious diseases. The infrastructure we develop now can save lives in the future.
Here we highlight two recent articles describing data, results, and lessons learned through RADx-UP projects. To explore a dashboard of RADx-UP project-generated scholarship, visit our Publications page.
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Implementation of School-Based COVID-19 Testing Programs in Underserved Populations
Despite its importance, there are many barriers to developing and implementing successful COVID-19 screening testing programs in schools. A RADx-UP project study published in a Pediatrics supplement identified the most common implementation challenges, as well as some solutions.
Study authors represent six teams working in diverse school settings and funded under the NIH RADx-UP Return to School Projects. The teams all serve low-resource and/or underserved communities, including children with developmental disabilities, and racial and ethnic minorities. The projects focus on students and staff, usually in K-12 schools. All projects used polymerase chain reaction (PCR) testing, while one study also used rapid antigen tests.
Researchers used the Consolidated Framework for Implementation Research (CFIR) to describe and group implementation barriers. They identified 20 out of the 43 CFIR constructs as significant challenges in at least one of the six testing programs. Common challenges included:
- the perceived burden of COVID-19 testing for participants
- lack of engagement with potential participants
- the difficulty of implementing an innovative program
Researchers then used the Expert Recommendations for Implementation Change (ERIC) framework to identify successful implementation strategies to overcome barriers. 45% of ERIC respondents reported that identifying champions as an important strategy. Other commonly used strategies include: modifying incentive and allowance structures, and assessing for readiness.
Haroz EE, Kalb LG, Newland JG, et al. Implementation of School-Based COVID-19 Testing Programs in Underserved Populations. Pediatrics. 2022;149(12 Suppl 2):e2021054268G. doi:10.1542/peds.2021-054268G
Associated RADx-UP project: This publication was a multi-project publication which appeared in an ABC Science Collaborative Pediatrics supplement.
SARS-CoV-2 screening testing in schools for children with intellectual and developmental disabilities
Children with intellectual and developmental disabilities (IDD) get particular benefits from the school system, including daily structure, health care services and therapy. A total of 14% of all public-school students have disabilities. Mitigation strategies such as testing and screening are even more important as these students may face an increased risk of severe COVID-19.
Researchers evaluated SARS-CoV-2 weekly screening for school staff and students on in-school transmission. The study took place at six schools within the Special School District (SSD) of St. Louis County, MO. Weekly COVID-19 screening test data was collected from November 2020 to May 2021 from 475 staff and students in six special education schools in St. Louis County’s Special School District (SSD)
All staff and students were invited to participate in the study with weekly saliva samples collected for SARS-CoV-2 screening testing. The saliva was sent for PCR testing based on an assay developed by Washington University investigators in partnership with Fluidigm. The results are from Nov. 23, 2020 to May 28, 2021, although student testing did not start until Dec. 11, 2020. Students were tested regardless of symptom status. Same-day results were made available to participants. The primary outcome was the weekly positive rate. Researchers also assessed rate of school-based transmission.
For the total study period, researchers collected and performed 7289 saliva tests. 19 staff and two students tested positive for SARS-CoV-2, with a positivity rate of 0.29% (excluding repeat positives.) The school district had a median weekly positivity rate of 0.3%, which was lower than the community positivity rates. All schools remained open regardless of diagnosed cases of COVID-19. A total of 36 participants withdrew during the study (9% withdrawal rate).
Screening testing identified half of all staff COVID-19 cases. Many of these cases were not asymptomatic, but rather individuals who had misattributed mild symptoms to allergies or sinus infection. Researchers stress the need for convenient, no cost, testing at schools as a way to increase the detection of mild COVID-19 cases.
SHERBY, M.R., WALSH, T.J., LAI, A.M. ET AL. SARS-COV-2 SCREENING TESTING IN SCHOOLS FOR CHILDREN WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES. J NEURODEVELOP DISORD 13, 31 (2021). HTTPS://DOI.ORG/10.1186/S11689-021-09376-Z
RADx-UP Project: Supporting the Health and Well-being of Children with Intellectual and Developmental Disability During COVID-19 Pandemic
Population Focus: Children with intellectual and developmental disability
Research Institution: Washington University
Principal Investigator: John N. Constantino, Christina Gurnett, Jason Newland
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