Testing as an Alternative to Quarantining: Key Considerations and Best Practices for Implementing Test to Stay

Introduction

As schools reopened for in-person instruction for the 2021-2022 academic year, students, families, and teachers expressed concerns about the effectiveness of Covid-19 safety protocols and the burden of quarantines. In 2021, states reported lower in-person student attendance compared to previous years, with students missing in-person days due to quarantine after being identified as close contacts of classmates who tested positive for Covid-19. For example, in Illinois, student attendance dropped 1.5 percentage points (from 94 percent in 2019 to 92.5 percent in 2021) since the start of the pandemic, which amounts to over 25,000 fewer students attending school, either in-person or virtually. The rapid spread of the Omicron variant has exacerbated staff and student absences. Factors underlying these absences include increased community transmission, hospitalizations, and quarantines, continued concerns regarding spread in schools, and difficulty in accessing rapid antigen or PCR tests. In addition to vaccinations, use of higher-quality masks, and ventilation upgrades, it is critical to include a testing infrastructure as part of a layered mitigation approach to make schools safer for students, teachers, and other school staff.

State policymakers and school administrators across the U.S. began piloting programs in 2021 to safely increase in-person instruction time that otherwise would be lost to quarantining students who did not ultimately test positive for Covid-19. Under a Test to Stay program (also called a “close contact testing program”), certain close contacts of a person who tests positive for Covid-19 undergo repeated testing after an exposure and can stay in school as long as they continue to test negative. Recently, the Centers for Disease Control and Prevention (CDC) published a statement on Test to Stay and released results from pilot programs, noting that it can be a valuable additional mitigation strategy for increasing Covid-19 related safety for in-person instruction.

In this issue brief, we provide states considering Test to Stay programs in K-12 schools practical guidance on key technical and health equity strategies to inform planning, design, and implementation efforts. Preliminary evidence collected during the Delta wave shows Test to Stay can increase in-person attendance, minimize school-related disruption, increase access to testing, and address concerns regarding safety with in-person instruction. However, Test to Stay programs may produce unintended consequences unless programs address technical and equity considerations in the planning and design phases of program development. Potential unintended consequences include overburdening staff and exacerbating existing disparities among underfunded schools that lack sufficient staff, space, or tests to launch a Test to Stay program due to existing systemic inequities. Furthermore, similar to other mitigation strategies, ongoing monitoring of community transmission, Covid-19 case counts, and other social impacts is needed to reassess safety and respond to variants as they emerge.