New Guidance for Using Covid-19 Testing Strategies to Reopen America’s Schools Safely

October 14, 2020 – As schools across the country strive to safely return to in-person classes, a new report by the Duke-Margolis Center for Health Policy and the Johns Hopkins Center for Health Security with support from The Rockefeller Foundation provides the first application of a detailed framework to provide guidance to America’s school administrators on how best to screen for, and stop or reduce the spread of, Covid-19 (SARS-CoV-2) in their schools. The report, Risk Assessment and Testing Considerations for Reducing SARS-CoV-2 Transmission in K-12 Schools, is the first-of-its-kind to offer a risk assessment and testing guidance that can be adapted to reflect the risk of Covid-19 in a school’s community. It also considers the benefits of transmission reduction alongside the costs of testing and of managing “false positive” results. As availability increases for rapid-result Covid-19 tests and supporting confirmatory lab tests, this groundbreaking report, which builds upon the Duke Margolis report released last month with support from The Rockefeller Foundation, can help schools integrate screening tests with other mitigation measures in an effective strategy to protect against the spread of the virus at school and in the wider community.

To test and refine this approach, The Rockefeller Foundation signed a memorandum of understanding with the U.S. Department of Health and Human Services, which will send at least 120,000 Abbott BinaxNOW tests to initially support the 5 pilot areas: Louisville, Ky.; Los Angeles; New Orleans; Tulsa, Okla.; and Rhode Island. In conjunction with the Foundation’s support for state and local governments to share experiences and lessons learned through applicable National Institutes of Health RADx studies, these pilots will provide real-world insights about best practices for schools across the country on how to effectively integrate testing into school settings for K-12 students and teachers.

“Reopening schools should be a national priority – it is essential for the educational, social, and emotional development of our children and it represents an important milestone in our response to Covid-19, both from a public health and economic perspective,” says Dr. Rajiv J. Shah, President of The Rockefeller Foundation. “This is an extraordinary opportunity to take a scientific, data-driven approach to reopen our schools, while protecting our communities and ensuring that parents can get back to work and communities are safe and open for business.”

Creating an Early Warning System

Identifying Covid-19 in children can be challenging. Studies suggest that most children are asymptomatic to Covid-19 or have mild symptoms, making it difficult to use traditional screening methods for temperature or other visible symptoms to identify potential cases. With rapid testing, schools can create an early warning system to stop outbreaks before they spread to others in the school and the wider community.

“School-related outbreaks can have substantial impacts for students, household members, teachers, and the wider community,” said Dr. Mark McClellan, Director of the Duke-Margolis Center for Health Policy. “As the use of rapid testing increases, it’s critical to develop evidence-based guidance to help schools find the most effective ways to incorporate testing into their efforts to reopen safely and avoid contributing to community outbreaks.”.

Building off the testing framework published in September, the report recommends that testing protocols should be customized for individual school districts based on the risk assessment and includes strategies for schools in low, medium, and high-risk areas. The recommendations also consider community priorities, test performance, and communication. To develop a testing strategy to fit local needs, the report proposes a two-part process:

First, school administrators should assess the level of risk in the community that considers the likelihood of a case in the school building, the likelihood that a case will become an outbreak, and the consequences of transmission.

Once a risk assessment has been conducted, the report provides strategies for using testing to reduce the risk of outbreaks in schools based on community prevalence, test performance, and the school’s goals.

The report recommends that school administrators implement testing protocols as part of a larger Covid-19 mitigation strategy for K-12 schools. “To reduce transmission within schools, testing frequency, and quick turnaround time for test results are more important than a highly accurate test alone,” said Dr. Caitlin Rivers, Senior Scholar, Johns Hopkins Center for Health Security. “Most importantly, testing should not be the only approach to reducing risk in schools. By combining rapid testing with protective measures like wearing masks, physically distancing, and improved ventilation, schools can both protect students, teachers, and administrators from Covid-19 and detect new cases to reduce the risk of further transmission.”

Read the full press release from The Rockefeller Foundation.

Read the report.