BACKGROUND AND OBJECTIVES Mandatory quarantine upon exposure to Covid-19 results in a substantial number of lost days of school. We hypothesized that implementation of a state-wide test-to-stay (TTS) program would allow more students to participate in in-person learning, and not cause additional clusters of Covid-19 cases due to in-school transmission. METHODS For the 2020/2021 academic year, Massachusetts implemented an opt-in TTS program, in which students exposed to Covid-19 in school are tested each school day with a rapid antigen test. If negative, students may participate in school-related activities that day. Testing occurs daily for a duration of 7 calendar days after exposure. Here, we report the results from the first thirteen weeks of the program. RESULTS 2,298 schools signed up for TTS, and 504,167 individuals out of a total population of 860,457 consented. During the first thirteen weeks with complete data, 1,959 schools activated the program at least once for 102,373 individual, exposed students. Out of 328,271 tests performed, 2,943 positive cases were identified (per person positivity rate, 2.9%, 95% CI 2.8%, 3.0%). A minimum of 325,328 and a maximum of 497,150 days of in-person school were saved through participation in the program. CONCLUSIONS Daily, rapid on-site antigen testing is a safe and feasible alternative to mandatory quarantine and can be used to maximize safe in-person learning time during the pandemic.

Healthcare workers are a trusted health information source and are uniquely positioned to reduce the burden of the COVID-19 pandemic. The purpose of this sequential exploratory mixed methods study was to understand attitudes of healthcare workers working in Massachusetts during the COVID-19 pandemic regarding strategies to improve COVID-19 vaccine utilization, including vaccine mandates and incentives. Fifty-two individuals completed one-on-one interviews between April 22 nd and September 7th, 2021. The survey was developed based on findings from the interviews; 209 individuals completed the online survey between February 17 th and March 23 rd , 2022. Both the interview and survey asked about attitudes toward COVID-19 vaccine and booster mandates, incentives, and strategies to improve vaccination rates. Most participants were female (79%-interview, 81%-survey), Caucasian (56%, 73%), and worked as physicians (37%, 34%) or nurses (10%, 18%). Overall, nuanced attitudes regarding vaccine and booster mandates were expressed; many supported mandates to protect their patients’ health, others emphasized personal autonomy, while some were against mandates if job termination was the consequence of declining vaccines. Similarly, views regarding vaccine incentives differed; some considered incentives helpful, yet many viewed them as coercive. Strategies believed to be most effective to encourage vaccination included improving accessibility to vaccination sites, addressing misinformation, discussing vaccine safety, tailored community outreach via trusted messengers, and one-on-one conversations between patients and healthcare workers. Healthcare workers’ experiences with strategies to improve utilization of COVID-19 vaccines and boosters have implications for public health policies. Generally, efforts to improve access and education were viewed more favorably than incentives and mandates.