How to Implement Safe, Efficient and Cost-Effective SARS-CoV-2 Testing in Urban and Rural Schools within One Month

Abstract

(1) Background: With vaccination and new variants of SARS-CoV-2 on the horizon, efficient testing in schools may enable prevention of mass infection outbreaks, keeping schools safe places and buying time until decisions on feasibility and the necessity of vaccination in children and youth are made. We established, in the course of the WICOVIR (Where Is the COrona VIRus) study, that gargle-based pool-PCR testing offers a feasible, efficient, and safe testing system for schools in Germany when applied by central university laboratories. (2) Objectives: We evaluated whether this approach can be implemented in different rural and urban settings. (3) Methods: We assessed the arrangements required for successful implementation of the WICOVIR approach in a variety of settings in terms of transport logistics, data transfer and pre-existing laboratory set-up, as well as the time required to establish the set-up. (4) Results: We found that once regulatory issues have been overcome, all challenges pertaining to logistics, data transfer, and laboratory testing on different platforms can be solved within one month. Pooling and depooling of samples down to the individual test result were achievable within one working day in all settings. Local involvement of the community and decentralized set-ups were keys for success. (5) Conclusion: The WICOVIR gargle-based pool-PCR system is so robust and simple that it can be implemented within one month in all settings now or in future pandemics.

Gargle pool PCR testing in a hospital during medium and high SARS-CoV-2 incidence

“…Thus, if a pool was tested positive, no single department, unit or ward had to shut down completely. This was a fundamental change in strategy from school testing, where school classes are recommended to be tested together due to logistics ( 4 ).…”

“…We used two setups to process gargle pool samples for rRT-PCR: (a) the Point of care (POC) GX-VI-4 module of the GeneXpert instrument (Cepheid, Sunnyvale, CA, USA) as previously described( 7 ) and (b) a combination of RNA isolation by the Auto-Pure96 Nucleic Acid Purification System (Hangzhou Allsheng Instruments, Shanghai, China) and subsequent PCR on a Bio-Rad real time PCR system (CFX96; Bio-Rad, Hercules, California, USA) as previously described ( 1 ) ( 4 ). Briefly, the GX-VI-4 module of the GeneXpert instrument allows to use 4 cartridges of predefined mastermix concomitantly detecting SARS-CoV-2 E and N2 genes.…”

“…In the WICOVIR (Where Is the Corona VIRus?) project we showed previously, that a gargle pool rRT-PCR test system is a safe, efficient, and cost-effective and accurate way to test large numbers of students and teachers in a school setting ( 1 ), which can be implemented quickly and easily ( 4 ). We now report on application of this system to test the staff of a large university paediatric and maternity hospital.…”

From disgusting and complicated to simple and brilliant: Implementation perspectives and lessons learned from users and rejectors of mail-in SARS-CoV-2 gargle tests

“…While gargling has been promoted as the least invasive sampling method, it has hardly been implemented at large scale. Projects that we know of are for instance: “Alles gurgelt” in Vienna, Austria, that uses a screening testing strategy aiming at testing many individuals with gargle test kits available for free at supermarkets, sample drop-off at collection points and PCR results available within 24 h; and the study “WICOVIR” that uses at-home gargle testing and pool PCR testing in German schools ( 30 , 54 ). While we are not aware of any published research on the implementation and user experience of “Alles gurgelt,” Kheiroddin et al ( 30 ) have evaluated and published how to efficiently implement SARS-CoV-2 gargle-based pool PCR testing, but focus on schools and not the general population.…”

“…While studies have outlined provider perspectives of testing sites, gaps exist about how users experience testing interventions, how test rejectors perceive testing methods and how individuals respond to mail in SARS-CoV-2 tests ( 29 ). Studies examined how to improve the implementation of SARS-CoV-2 tests in Germany among specific settings such as homeless shelters and schools ( 22 , 30 , 31 ). This study aims to gain a deeper understanding of how test users and test rejectors perceived SARS-CoV-2 gargle tests and their implementation as mail-in tests with self-sampling and laboratory-based sample analysis.…”