Implementation of SARS-CoV2 Screening in K-12 Schools using In-School Pooled Molecular Testing and Deconvolution by Rapid Antigen Test

Pollock, Nira R.; Berlin, David; Smole, Sandra; Madoff, Lawrence C.; Henderson, Kelsey; Larsen, Elizabeth; Hay, Justin L.; Gabriel, Stacey; Gawande, Atul A.; Lennon, Niall J.

doi:10.1101/2021.05.03.21256560

Cited by 7 publications

(13 citation statements)

References 6 publications

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“…Other screening testing methods such as molecular-based pool testing, which involves RT-PCR testing of pooled samples and so-called deconvolution testing of individuals belonging to pools tested positive, are currently under investigation71–73 and may complement mere antigen testing, in particular in low prevalence settings. Additionally, novel tests, for example, lateral flow tests based on clustered regularly interspaced short palindromic repeat (CRISPR), hold great promise for a highly sensitive direct detection of SARS-CoV-274 but have yet to gain market access and demonstrate their value.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of rapid point-of-care tests for diagnosis of current SARS-CoV-2 infections in children: a systematic review and meta-analysis

Fujita-Rohwerder

Beckmann

Zens

et al. 2022

BMJ EBM

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ObjectiveTo systematically assess the diagnostic accuracy of rapid point-of-care tests for diagnosis of current SARS-CoV-2 infections in children under real-life conditions.DesignSystematic review and meta-analysis.Data sourcesMEDLINE, Embase, Cochrane Database for Systematic Reviews, INAHTA HTA database, preprint servers (via Europe PMC), ClinicalTrials.gov, WHO ICTRP from 1 January 2020 to 7 May 2021; NICE Evidence Search, NICE Guidance, FIND Website from 1 January 2020 to 24 May 2021.Review methodsDiagnostic cross-sectional or cohort studies were eligible for inclusion if they had paediatric study participants and compared rapid point-of care tests for diagnosing current SARS-CoV-2 infections with reverse transcription polymerase chain reaction (RT-PCR) as the reference standard. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool was used to assess the risk of bias and the applicability of the included studies. Bivariate meta-analyses with random effects were performed. Variability was assessed by subgroup analyses.Results17 studies with a total of 6355 paediatric study participants were included. All studies compared antigen tests against RT-PCR. Overall, studies evaluated eight antigen tests from six different brands. Only one study was at low risk of bias. The pooled overall diagnostic sensitivity and specificity in paediatric populations was 64.2% (95% CI 57.4% to 70.5%) and 99.1% (95% CI 98.2% to 99.5%), respectively. In symptomatic children, the pooled diagnostic sensitivity was 71.8% (95% CI 63.6% to 78.8%) and the pooled diagnostic specificity was 98.7% (95% CI 96.6% to 99.5%). The pooled diagnostic sensitivity in asymptomatic children was 56.2% (95% CI 47.6% to 64.4%) and the pooled diagnostic specificity was 98.6% (95% CI 97.3% to 99.3%).ConclusionsThe performance of current antigen tests in paediatric populations under real-life conditions varies broadly. Relevant data were only identified for very few antigen tests on the market, and the risk of bias was mostly unclear due to poor reporting. Additionally, the most common uses of these tests in children (eg, self-testing in schools or parents testing their toddlers before kindergarten) have not been addressed in clinical performance studies yet. The observed low diagnostic sensitivity may impact the planned purpose of the broad implementation of testing programmes.PROSPERO registration numberCRD42021236313.

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Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of rapid point-of-care tests for diagnosis of current SARS-CoV-2 infections in children: a systematic review and meta-analysis

Fujita-Rohwerder

Beckmann

Zens

et al. 2022

BMJ EBM

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“…In August 2020, a consortium of 6 Massachusetts public K-12 schools, Safer Teachers Safer Students (STSS), was developed to implement and evaluate SARS-CoV-2 screening programs, negotiate lower assay costs, advocate for access to screening for all public school districts, and develop online resources. 14,[22][23][24][25] screening to all Massachusetts K-12 public schools providing in-person learning. 26 The state provided test kits, support from testing service providers, and testing software.…”

Section: Participating Public School Districts: Stss and Dese Programmentioning

confidence: 99%

“…With at-school pooling, any pool reported as positive then required a second sample collection for "deconvolution" to identify the individual(s) from the original pool with SARS-CoV-2 infection. Most schools requested that members of a positive pool return to school for rapid antigen testing with a moderate-sensitivity and high-specificity assay provided by the state, 23 or seek individual PCR testing at an outside facility (including free PCR testing offered at many state-sponsored testing sites). Some STSS districts had previously contracted independently with vendors outside the state-supported program and continued to work with those vendors, while other STSS districts transitioned to the state-supported screening program.…”

Section: Participating Public School Districts: Stss and Dese Programmentioning

confidence: 99%

“…At all COVID-19 incidence levels, screening provides local, real-time information about SARS-CoV-2 prevalence in schools and may be reassuring to students, educators/staff, and their families. 5,[10][11][12][13][14][15] For the 2021-22 school year, CDC recommends screening of unvaccinated students and staff in communities where COVID-19 incidence is at least 10/100,000 people/week. 5 Many K-12 schools are using substantially fewer mitigation measures than in 2020-21, including cohorting, universal masking, and physical distancing; at the same time, vaccination of al K-12 students is now available.…”

Section: Introductionmentioning

confidence: 99%

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Resources Required for Implementation of SARS-CoV-2 Screening in Massachusetts K-12 Public Schools in Winter/Spring 2021

Lee

Weitz

Ardlie

et al. 2021

Preprint

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ImportanceCDC guidance emphasizes the importance of in-person education for students in grades kindergarten to 12 (K-12) during the COVID-19 pandemic. CDC encourage weekly SARS-CoV-2 testing of asymptomatic, unvaccinated students and staff (“screening”) to reduce infection risk and provide data about in-school SARS-CoV-2 prevalence where community incidence is high. The financial costs of screening assays have been described, but the human resource requirements at the school and district level to implement a SARS-CoV-2 screening program are not well known.ObjectiveTo quantify the resources required to implement a screening program in K-12 schools.Design, Setting, and ParticipantsA consortium of Massachusetts public K-12 schools was formed to implement and evaluate a range of SARS-CoV-2 screening approaches. Participating districts were surveyed weekly about their programs, including: type of assay used, individual vs. pooled screening, approaches to return of results and deconvolution (identification of positive individual specimens) of positive pools, number and type of personnel implementing the screening program, and hours spent on program implementation.Main Outcomes and MeasuresCosts, resource utilizationResultsIn 21 participating districts, over 21 weeks from January to June 2021, the positivity rate was 0.0%-0.21% among students and 0.0%-0.13% among educators/staff, and 4 out of 21 (19%) districts had at least one classroom transition to remote learning at any point due to a positive case. The average weekly cost to implement a screening program, including assay and personnel costs, was $17.00 per person tested; this was $46.68 for individual screenings and $15.61 for pooled screenings. The total weekly costs by district ranged from $1,644-$93,486, and districts screened between 58 and 3,675 people per week. The reported number of personnel working per week ranged from 1-5 to >50, and the total number of hours worked by all personnel ranged from 5-10 to >50.Conclusion and RelevanceThe human resources required to implement SARS-CoV-2 screening in Massachusetts public K-12 schools were substantial. Where screening is recommended for the 2021-22 school year due to high COVID-19 incidence (e.g., where vaccination uptake is low and/or more infectious variants predominate), understanding the human resources required to implement screening will assist districts policymakers in planning.

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“…Where COVID‐19 incidence is high, screening serves as an additional mitigation measure by identifying people with SARS‐CoV‐2 infection and isolating them before in‐school transmission can occur. At all COVID‐19 incidence levels, screening provides local, real‐time information about SARS‐CoV‐2 prevalence in schools and may be reassuring to students, educators/staff, and their families 5,10‐15 …”

mentioning

confidence: 99%

Resources Required for Implementation of SARS‐CoV‐2 Screening in Massachusetts K‐12 Public Schools in Winter/Spring 2021

Lee

Weitz

Ardlie

et al. 2022

Journal of School Health

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BACKGROUND:The financial costs and human resource requirements at the school and district level to implement a SARS-CoV-2 screening program are not well known. METHODS:A consortium of Massachusetts public K-12 schools was formed to implement and evaluate a range of SARS-CoV-2 screening approaches. Participating districts were surveyed weekly about their programs, including: type of assay used, individual vs. pooled screening, approaches to return of results and deconvolution of positive pools, number and type of personnel, and hours spent implementing the screening program, and hours spent on program implementation. RESULTS:In 21 participating districts, over 21 weeks from January to June 2021, the positivity rate was 0.0% to 0.21% among students and 0.0% to 0.13% among educators/staff. The average weekly cost to implement a screening program, including assay

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Implementation of SARS-CoV2 Screening in K-12 Schools using In-School Pooled Molecular Testing and Deconvolution by Rapid Antigen Test

Cited by 7 publications

References 6 publications

Diagnostic accuracy of rapid point-of-care tests for diagnosis of current SARS-CoV-2 infections in children: a systematic review and meta-analysis

Diagnostic accuracy of rapid point-of-care tests for diagnosis of current SARS-CoV-2 infections in children: a systematic review and meta-analysis

Resources Required for Implementation of SARS-CoV-2 Screening in Massachusetts K-12 Public Schools in Winter/Spring 2021

Resources Required for Implementation of SARS‐CoV‐2 Screening in Massachusetts K‐12 Public Schools in Winter/Spring 2021

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