Feasibility and acceptability of daily testing at school as an alternative to self-isolation following close contact with a confirmed case of COVID-19: a qualitative analysis

Abstract

Background Daily testing using a rapid Lateral Flow Device (LFD) has been suggested as an alternative to self-isolation. A randomised trial comparing daily contact testing (DCT) in schools with self-isolation found that SARS-CoV-2 transmission within school was comparable and low in both groups. However, if this approach is to be adopted widely, it is critical that we understand the perspective of those who will be delivering and receiving DCT. The aim of this qualitative process study embedded in the randomised controlled trial (RCT) was to improve understanding of a range of behavioural factors that could influence implementation. Methods Interviews were conducted with 63 participants, including staff, students, and parents of students who had been identified as being in close contact with someone with COVID-19. The topic guide explored perceptions of daily testing, understanding of positive and negative test results, and adherence to guidance. Data were analysed using an inductive thematic approach. Results Results were organised under three main headings: (1) factors influencing daily testing (2) interpretation of test results (3) behaviour during testing period. Participants recognized that daily testing may allow students to remain in school, which was viewed as necessary for both education and social needs. Whilst some felt safer as a result of daily testing, others raised concerns about safety. Participants did not always understand how to interpret and respond to test results, and although participants reported high levels of adherence to the guidance, improved communications were desired. Conclusion Daily testing may be a feasible and acceptable alternative to self-isolation among close contacts of people who test positive. However, improved communications are needed to ensure that all students and parents have a good understanding of the rationale for testing, what test results mean, how test results should be acted on, and how likely students are to test positive following close contact. Support is needed for students and parents of students who have to self-isolate and for those who have concerns about the safety of daily testing.

Decision to self-isolate during the COVID-19 pandemic in the UK: a rapid scoping review

“…The consequences of self-isolation for certain groups in society, such as those who were homeless, misusing substances, or involved in the criminal justice system, may have differed from those experienced by the wider population, and circumstances may have made self-isolation more difficult to manage and influenced decisions to isolate for these groups 32. In particular, the financial consequences and considerations were not uniform, with some reporting that they could absorb the loss of income or worked from home already, while others could not ‘afford to isolate’ 18 75 79 83. The financial implications of isolation were described as particularly challenging for those with ethnic minority backgrounds, younger people, women, those on lower or precarious incomes, those unable to work from home while self-isolating, those working in ‘shut-down sectors’, migrant workers and those who were self-employed, impacting adherence to self-isolation recommendations in these groups 19 34 78 83 84…”

“…32 In particular, the financial consequences and considerations were not uniform, with some reporting that they could absorb the loss of income or worked from home already, while others could not ‘afford to isolate’. 18 75 79 83 The financial implications of isolation were described as particularly challenging for those with ethnic minority backgrounds, younger people, women, those on lower or precarious incomes, those unable to work from home while self-isolating, those working in ‘shut-down sectors’, migrant workers and those who were self-employed, impacting adherence to self-isolation recommendations in these groups. 19 34 78 83 84 …”

A qualitative process analysis of daily contact testing as an alternative to self-isolation following close contact with a confirmed carrier of SARS-CoV-2

“…In accordance with survey findings, participants in the current study described how testing had facilitated engagement in low-risk activities [ 15 ]. Behaviour during the testing period appeared to be the result of a carefully considered assessment of the risks and benefits of DCT; including the need to avoid isolation, the perceived likelihood of infection, and the accuracy of LFTs [ 11 , 12 ]. In line with previous studies [ 11 , 12 ], those considering themselves at a higher risk of having caught COVID-19 reported considerable efforts to reduce risk, with many avoiding close contact with others even after receiving negative test results.…”

“…Previous studies have found DCT to be an acceptable alternative to self-isolation during lockdown [ 10 , 11 ] and in school settings [ 12 ]. Interviews conducted as part of the current study occurred during the summer months with relatively few social distancing measures in place; opportunities for social interaction were relatively high, and the number of fully vaccinated people had increased.…”

“…Previous research has suggested that DCT may be a feasible alternative to self-isolation [ 10 – 13 ], and may be as effective as self-isolation for controlling transmission in certain situations [ 14 ]. However, earlier studies were either conducted while stringent society-wide restrictions were in force, and familiarity with testing was low [ 11 , 12 ], or within specific settings, such as schools [ 14 ]. Self-isolation following close contact is no longer a requirement, however, close contacts of SARS-CoV-2 carriers are still at an increased risk of becoming infected, and diagnostic testing may still be beneficial during potential future outbreaks.…”