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- Title
Estimated Transmission Outcomes and Costs of SARS-CoV-2 Diagnostic Testing, Screening, and Surveillance Strategies Among a Simulated Population of Primary School Students.
- Authors
Bilinski, Alyssa; Ciaranello, Andrea; Fitzpatrick, Meagan C.; Giardina, John; Shah, Maunank; Salomon, Joshua A.; Kendall, Emily A.
- Abstract
This decision analytic model explores strategies for COVID-19 testing in primary schools and estimates costs and infection rates in relation to the preservation of in-person school attendance. Key Points: Question: What are the costs and benefits of COVID-19 testing in primary schools (students in kindergarten through eighth grade)? Findings: In this decision analytic model of COVID-19 transmission in simulated US elementary and middle schools, test-to-stay strategies were associated with reduced quarantine time but minimal increases in transmission across all levels of community incidence. Compared with no testing, weekly screening was associated with substantial reductions to in-school transmission when community incidence was high and had lower societal cost than remote instruction, while an adaptive surveillance strategy offered a more efficient option to detect outbreaks when local incidence was lower or poorly characterized. Meaning: With federal funding available, schools should use COVID-19 testing to facilitate in-person education, adapting their testing strategy to changes in local COVID-19 risk. Importance: In addition to illness, the COVID-19 pandemic has led to historic educational disruptions. In March 2021, the federal government allocated $10 billion for COVID-19 testing in US schools. Objective: Costs and benefits of COVID-19 testing strategies were evaluated in the context of full-time, in-person kindergarten through eighth grade (K-8) education at different community incidence levels. Design, Setting, and Participants: An updated version of a previously published agent-based network model was used to simulate transmission in elementary and middle school communities in the United States. Assuming dominance of the delta SARS-CoV-2 variant, the model simulated an elementary school (638 students in grades K-5, 60 staff) and middle school (460 students grades 6-8, 51 staff). Exposures: Multiple strategies for testing students and faculty/staff, including expanded diagnostic testing (test to stay) designed to avoid symptom-based isolation and contact quarantine, screening (routinely testing asymptomatic individuals to identify infections and contain transmission), and surveillance (testing a random sample of students to identify undetected transmission and trigger additional investigation or interventions). Main Outcomes and Measures: Projections included 30-day cumulative incidence of SARS-CoV-2 infection, proportion of cases detected, proportion of planned and unplanned days out of school, cost of testing programs, and childcare costs associated with different strategies. For screening policies, the cost per SARS-CoV-2 infection averted in students and staff was estimated, and for surveillance, the probability of correctly or falsely triggering an outbreak response was estimated at different incidence and attack rates. Results: Compared with quarantine policies, test-to-stay policies are associated with similar model-projected transmission, with a mean of less than 0.25 student days per month of quarantine or isolation. Weekly universal screening is associated with approximately 50% less in-school transmission at one-seventh to one-half the societal cost of hybrid or remote schooling. The cost per infection averted in students and staff by weekly screening is lowest for schools with less vaccination, fewer other mitigation measures, and higher levels of community transmission. In settings where local student incidence is unknown or rapidly changing, surveillance testing may detect moderate to large in-school outbreaks with fewer resources compared with schoolwide screening. Conclusions and Relevance: In this modeling study of a simulated population of primary school students and simulated transmission of COVID-19, test-to-stay policies and/or screening tests facilitated consistent in-person school attendance with low transmission risk across a range of community incidence. Surveillance was a useful reduced-cost option for detecting outbreaks and identifying school environments that would benefit from increased mitigation.
- Subjects
UNITED States; PUBLIC health surveillance; SCHOOL environment; ELEMENTARY schools; COVID-19 testing; STATISTICAL sampling; COST benefit analysis; DESCRIPTIVE statistics; QUARANTINE; SCHOOL children; MEDICAL screening; HEALTH outcome assessment; MIDDLE schools; COVID-19; COVID-19 pandemic; DISEASE incidence
- Publication
JAMA Pediatrics, 2022, Vol 176, Issue 7, p679
- ISSN
2168-6203
- Publication type
Article
- DOI
10.1001/jamapediatrics.2022.1326