This fall, a school district in Georgia asked students who had contact with someone with COVID-19 to come to school early to take a rapid test every day for seven days. If the tests came back negative, they were allowed to go to class. If a test came back positive, they had to quarantine. The goal of this approach was to minimize time missed from school due to quarantine and keep as many students as possible learning in-person at school.

School leaders across the country are actively seeking a less disruptive way to minimize risk beyond sending students home to quarantine. Massachusetts was reportedly one of the early states that adopted the new COVID-19 testing model ― “Test and Stay.” Schools from California to Illinois were also reported to have adopted such testing models.

The approach is essentially a modified quarantine that allows students to stay in school as long as they’re tested regularly and adhere to precautions such as wearing masks and social distancing. “These tests allow us to know who is positive and who is not on a daily basis, and so everyone can sit there with much better peace of mind,” said Dr. Michael Mina, an assistant professor of epidemiology and immunology at Harvard School of Public Health.

To provide more understanding of school practices in COVID-19 testing and quarantine, the Center for Public Education (CPE) of the National School Boards Association (NSBA) conducted research on the following questions:

• What is the current trend of COVID-19 cases among K-12 students?
• How do states support and implement policies of COVID-19 testing and quarantine in K-12 schools?
• How do school districts implement COVID-19 testing and quarantine?

COVID-19 Cases among Children and Adolescents

Nearly 252,000 children in United States tested positive for COVID-19 in the midst of back-to-school season, according to a news report on September 7, 2021. “There is no federal effort to monitor coronavirus cases in schools, and reporting by school districts is uneven,” according to the New York Times. While it is unclear the exact number of students that have and have had COVID-19 in the United States, the Centers for Disease Control and Prevention (CDC) has tracked COVID-19 weekly case rate by age groups (Figure 1).

The data show that compared with the summer months, the COVID-19 weekly case rate for teenagers peaked at the beginning of the 2021-22 school year. By the end of August, the weekly case rate was higher for children ages 5-11 than that for adults ages 40 above and higher, and the case rate for children ages 12-17 was the highest compared with other age groups.

Figure 1. COVID-19 Weekly Case Rate in August and September

Source: CDC COVID Data Tracker

In a CDC Science Brief, researchers suggest that in the U.S. through March 2021, the lower COVID-19 incidence rates of children may have been due in part to children having fewer opportunities for exposure (i.e., the closures of school, daycare, and extracurricular activities), and a lower probability of being tested, when compared to adults. This fall, nearly all schools started in-person instruction. Therefore, the increased opportunities for exposure and being tested are likely to contribute to the reporting of higher COVID-19 case rates among K-12 students.

• In Michigan, it was reported that COVID-19 cases in K-12 schools accounted for 56% of all recorded new outbreaks in the state the week of October 8, 2021. (10/8/2021)
• In Utah, it was reported that so far this school year, 9,285 students have tested positive for COVID-19. (10/11/2021)
• In Ohio, 7,405 new cases were reported in schools for the week ending October 3, 2021, and new data from the Ohio Department of Health show that 1,384 of the 2,767 K-12 schools (50%), from the smallest private preschools to the largest public school districts, have reported at least one coronavirus case among students and staff since opening in August or September. (10/7/2021)

In brief, the CDC data show a sharp increase in August’s COVID-19 case rates among children and adolescents. In September, some states’ data show an increasing trend of students with COVID-19 infections. Since October data are not yet completed, it is unclear whether the number of COVID-19 cases in K-12 schools will keep increasing or will decline substantially.

State COVID-19 Testing Resources for School Districts

“As schools go back to in-person learning, some may offer regular COVID-19 testing for students and staff,” the CDC recommended on August 25, 2021. COVID-19 testing in K-12 schools means testing is offered regularly, even for people who don’t have symptoms of COVID-19. According to a study of the Rand Corporation, testing programs varied on whether testing was voluntary or required; whether testing was for staff only or also for students; whether testing was to be conducted for diagnostic, screening, or surveillance purposes; whether tests used saliva samples or nasal swabs; where tests were collected; and where and how tests were analyzed.

The Center on Reinventing Public Education (CRPE), a nonpartisan research center, provides current information about state policies of COVID-19 mitigation in K-12 schools. The state data for September 2021 show that in 36 states and the District of Columbia (73%), the state governments have provided guidance for school districts to build a COVID-19 testing process in the new school year. As of September 2021, however, 14 states (Alabama, Arkansas, Florida, Iowa, Louisiana, Michigan, Missouri, North Carolina, Nebraska, New Jersey, Ohio, Oklahoma, Tennessee, and West Virginia) have not provided such guidance for school districts (Figure 2).

Figure 2. State Testing Resources for Schools in the 2021-22 School Year

 

Data source: State Responses to COVID-19 School Closures | Center on Reinventing Public Education (crpe.org)

Figure 2 also shows that 36 states and the District of Columbia provide financial or other resources for COVID-19 testing at the district level. It should be noted that not all states with COVID-19 testing guidance for school districts have provided financial or other resources for COVID-19 testing at the district level.

• Hawaii, Nevada, New Hampshire, , New York, and Virginia have provided COVID-19 testing guidance for school districts, but not financial or other resources for COVID-19 testing at the district level.
• Alabama, Iowa, Ohio, Tennessee, and West Virginia have provided financial or other resources for COVID-19 testing at the district level, but not guidance for school districts to build a COVID-19 testing process.
• As of September 2021, in nine states (i.e., Arkansas, Florida, Louisiana, Michigan, Missouri, , Nebraska, New Jersey, North Carolina, and Oklahoma), the state governments have not provided COVID-19 testing guidance or testing-related financial/other resources for the new school year.

Last school year, many K–12 schools across the U.S. implemented COVID-19 testing. The study conducted by Rand researchers reported that the largest group of schools to implement COVID-19 testing in the fall of 2020 were those located in states that had begun distributing BinaxNOW rapid antigen tests from the federal government to K–12 schools through state-specific allocation processes (e.g., Missouri,Texas, and Utah). During the 2020-21 school year,

• The New York State Department of Health implemented a mandatory statewide surveillance program that sampled staff and students in all schools in zones at higher risk for COVID-19 transmission.
• COVIDCheck Colorado, an innovative vendor for the state of Colorado, provided a “soup to nuts” testing service that made COVID-19 testing scalable for districts. It also provided hands-on and on-demand technical assistance for school and district leaders.
• The Illinois Department of Public Health, in collaboration with the Illinois State Board of Education, provided the BinaxNOW tests, as well as guidance and support for districts that participated in the COVID-19 testing program.

Recently, it was reported that Minnesota would distribute $55 million to help districts test students for COVID-19. As of September 10, 2021, 54% of schools in Maine had enrolled in the pooled testing program. With pooled testing, students take nose swabs (PCR tests) once a week and submit those swabs in a batch for testing. If that batch comes back positive, each person is retested using a BiNaxNow rapid antigen test. The people who test positive are identified and isolated to stop the spread of the virus.

In brief, compared with 2020-21, more states in this new school year (i.e., 31 states and the District of Columbia) have provided school districts with both COVID-19 testing guidance and financial/other resources specifically for COVID-19 testing.

COVID-19 Testing in Large School Districts

The CRPE database tracks 100 large and urban districts that range in size and geography and serve nearly 10 million students. While it is not a nationally representative sample, the information gives us some idea about how school districts are using COVID testing as a mitigation strategy. In the data, the Test-to-Stay program refers to districts that allow students who have been exposed to COVID-19 to stay in school from the date of exposure if they test negative for COVID over a sequence of days.

Table 1 shows that among the 100 school districts, only eight (8%) offer Test-to-Stay programs. Five of the districts are in California (i.e., Long Beach Unified School District, Oakland Unified School District, Sacramento City Unified School District, San Diego Unified School District, and Stockton Unified School District). Boston Public Schools (Massachusetts) allow students who have been exposed to COVID-19 to continue to attend school each day if their COVID-19 tests are negative for the first five days following exposure. In Wichita Public Schools (Kansas), free COVID-19 testing is provided to help aid contact tracing from positive cases. In Maine, Portland Public Schools allow K-6 students and staff to opt into the district's voluntary pooled testing program to get tested for COVID-19 weekly; while exposed students must quarantine for up to 10 days, vaccinated students, recently recovered students, and asymptomatic students who participate in the weekly pooled testing are exempt from quarantining.

Table 1. Number of Large School Districts with Test-to-Stay Programs/ Requirements for COVID-19 Testing, by State (N=100)

 

Source: Center on Reinventing Public Education (crpe.org), data retrieved by 10/14/2021

The same dataset shows that more than one third of the districts require COVID-19 testing for school staff. In most of the districts, this requirement is particularly for staff without the COVID-19 vaccination. For instance, in Fairfax County Public Schools (Virginia), the staff must be vaccinated or subject themselves to regular COVID-19 testing. Likewise, in Jefferson County Public Schools (Kentucky), the staff must either be vaccinated or participate in weekly COVID-19 testing, but weekly testing is optional for students and vaccinated staff.

Several large districts detailed the requirement that school staff need to have regular COVID-19 tests.

• In Atlanta Public Schools (GA), twice-weekly testing is required for staff, but testing is optional for students.
• In Detroit Public Schools Community District (MI), weekly COVID-19 testing is required for all school staff.
• In the School District of Philadelphia (PA), all staff must undergo COVID-19 surveillance testing, and unvaccinated staff must be tested twice a week, while vaccinated staff only needs to be tested once a week.
• In Saint Louis Public Schools (MO), the district required teachers to be tested for COVID-19 prior to the first day of school. Staff were required to be vaccinated by mid-October, and those exempt for medical or religious reasons are subject to testing semi-weekly.

Only 15% of the districts require COVID-19 testing for students. Likewise, most districts implement the testing requirement with certain specifications. For example, in the Boulder Valley School District (Colorado), student-athletes are required to either show proof of vaccination or be subject to regular testing to participate in athletic activities; in the El Paso Independent School District (Texas), testing is required for student athletes who are not fully vaccinated.

Several large school districts have implemented strict COVID-19 testing requirements for all students, including strict sampling measures.

• The Los Angeles Unified School District (CA) requires all students and staff to be vaccinated and be subject to regular testing.
• In the Santa Ana Unified School District (CA), weekly COVID-19 testing is required for all staff and students.
• According to the New York City Department of Education, every school randomly tests weekly unvaccinated students who have submitted consent for testing, at a threshold of 10% of unvaccinated students per school population (Pre-K and Kindergarten are excluded).
• In Buffalo Public Schools (NY), 30% of staff and students are randomly tested each week for COVID-19.

COVID-19 Testing in Rural Low-Income School Districts

To have a comprehensive national picture of COVID-19 testing in K-12 schools, we gathered additional, relevant information of 338 rural low-income school districts (RLIS). According to the U.S. Department of Education, a rural low-income school district (RLIS) should be geographically in an area of the state defined as rural by a governmental agency of the state, and serve 20% or more of the children ages five to 17 from families with incomes below the poverty line defined by the U.S. Census Bureau. The RLIS districts we investigated meet these criteria of both federal and state agencies; nearly 60% of the districts have fewer than 1,000 students, and more than 52% have at least a quarter of the student population living in poverty.

The data we studied show that less than 1% of the RLIS districts have implemented some strategies like Test-to-Stay programs (Table 2). One district in Ohio worked with local health departments using a modified quarantine approach to keep students in school provided they remain symptom free and adhere to the required masking guidelines. Two districts in Maine have participated in the state’s pooled testing program as a modified quarantine method. 

Table 2. Number of Rural Low-income School Districts with Test-to-Stay Programs/Requirements for COVID-19 Testing, by State (N=338)

 

Source: The list of rural low-income school districts was retrieved from RLIS Eligibility - Office of Elementary and Secondary Education, and the data were collected by CPE between October 10-20, 2021.

The RLIS data also show that for the new school year, 17% of the rural districts have required COVID-19 testing for school staff, and 15% required COVID-19 testing for students.

• Alaska: The Annette Island School District implements screening testing for students and staff involved in extra-curricular activities on a weekly basis, and will consider expanding the screening testing program in the future. According to the Craig City School District (CCSD), all students and staff members traveling off island for district sponsored extra-curricular events or district sponsored business shall receive a COVID-19 test and negative results prior to travel to ensure all CCSD students and staff are symptom free of COVID-19.
• Arizona: The Whiteriver Unified School District in Navajo County reported that 853 people were tested through COVID-19 pooled testing during the week of 9/6/21 – 9/10/21, and the estimated percent of those tested through pooled testing that have COVID-19 was 0.012%.
• New York: The Addison Central School District requires weekly pool testing for all unvaccinated staff and optional weekly pool testing for students (with parent permission). The Cattaraugus-Little Valley Central School District announced that the district would follow an emergency regulation passed by the local health department to require all teachers, administrators and other school employees to submit to weekly COVID-19 testing unless they show proof of vaccination, with either a CDC vaccine card or the Excelsior Pass.
• Texas: The Ricardo Independent School District emphasizes using screening and rapid testing as a mitigation strategy to identify COVID-19 cases as early as possible.

As we screened the websites and social media of the RLIS districts, we found that many school districts recommend, educate, and encourage their community to use COVID-19 testing as a preventive measure against the spread of coronavirus. School leaders show their thoughtfulness and caring for their community members (students, parents, and staff) when making decisions regarding COVID-19 testing. For instance, the school leaders of the Monticello Central School District (New York) wrote in its path forward plan for 2021-22 ―

“Individuals may elect to have screening testing. Screening testing identifies infected people, including those with or without symptoms (or before development of symptoms) who may be contagious, so that measures can be taken to prevent further transmission. In K-12 schools, screening testing can help promptly identify and isolate cases, quarantine those who may have been exposed to COVID-19 and are not fully vaccinated, and identify clusters to reduce the risk to in-person education. CDC guidance provides that people who are fully vaccinated do not need to participate in screening testing and do not need to quarantine if they do not have any symptoms. If conducted by the district, screening testing will be done in a way that ensures the ability to maintain confidentiality of results and protect student, teacher, and staff privacy.”

Quarantine and Isolation

According to the CDC, quarantining aims to help break the chain of COVID-19 transmission by separating someone exposed to COVID-19 away from others during the time in which the person could become ill after exposure. By contrast, isolation is a measure used to separate people infected with COVID-19 from those who are not infected.

As shown in Figure 3, states have different policies in terms of the number of days for quarantine and isolation. There are 14 states that require or recommend that students who had direct contact with positive COVID-19 cases quarantine for one to two weeks, and another 10 states for one to one and half weeks. Three states ― Minnesota, Oregon, and Wyoming ― require/recommend exactly 14 days for COVID-19 quarantines, while another three states ― Hawaii, Maine, and Nebraska ― require or recommend exactly 10 days. As for isolation, 20 states require/recommend 10 days.

Figure 3. Quarantine and Isolation Days for Students Who Had Direct Contact with Positive COVID-19 Case (September 2021)

 

Data source: State Responses to COVID-19 School Closures | Center on Reinventing Public Education (crpe.org)

Figure 4 shows that most states have provided school districts with guidance or recommendations about how to implement COVID-19 quarantine.

• Forty-four states (86%) have shared their updated 2021 quarantine protocols with school districts.
• Twenty-nine states (57%) recommend school districts follow their quarantine guidance in the 2021-22 school year.
• Twenty-six states (51%) recommend school districts follow their COVID-19 contact tracing guidance in the 2021-22 school year.

Seventeen states (33%) require school districts to ensure that students have access to instruction during quarantine or isolation.

Figure 4. State Quarantine Policies for School Districts in the 2021-22 School Year (September 2021)

Source: State Responses to COVID-19 School Closures | Center on Reinventing Public Education (crpe.org)

As most school districts implement quarantine policies set by state and local governments, we decided to only report the relevant state data in this article.

Conclusions

Many factors influence district leaders when they make policies on COVID-19 testing among school staff and students. According to the Rand report, schoolwide screening testing programs (i.e., testing asymptomatic individuals) were mostly implemented in public and independent schools that had access to more resources. The report suggests that the following three types of schools and districts are more likely to adopt COVID-19 testing:

• Public schools and districts that received tests through statewide programs, as well as guidance and training in how to use them.
• Public schools and districts with access to local resources and strong partners that helped them implement COVID-19 testing independent of statewide test distribution.
• Independent schools with sufficient financial and other resources, peer networks, smaller student bodies, and the ability to require testing for in-person instruction.

In terms of how school districts implement COVID-19 testing and quarantine, diversity can be used to describe the national picture. We visited hundreds of school districts’ websites and found that many districts have made great efforts to be as transparent as possible when considering any COVID-related mitigation strategy. They survey parents and students, communicate, and connect parents through writing letters, phone messages, and engaging their community on social media. School leaders strive to protect students and teachers from this virus while improving students’ school experience.

• Let students enjoy sports again. For the 2021-22 school year, the Oppenheim-Ephratah-St. Johnsville Central School District (New York) not only provides a full in-person academic program, but also a wide range of extracurricular and athletic offerings for all students. The district policy is that regular or random COVID-19 testing is instituted for high-risk sports, based on the local pandemic situation. Student-athletes will be tested by qualified medical personnel. If a student presents proof of vaccination, they do not need to partake in the random testing.
• Work with local health department and respect parents’ decisions. The Globe Unified School District (Arizona) informed parents that the district would work with the county health department to expedite students return to school using the testing protocols recommended by the local health department. In Indiana, district leaders of South Adams Schools shared with parents the concerns from the local health department, and delivered a clear message ― “we are doing our best to balance the rights of parents and families to decide what is best for their child with what is best for all students who attend South Adams.”
• Collaborate with all stakeholders and build a shared decision-making team. The Pine Valley Central School (New York) developed a visionary team to make decisions on how to return to school safely in the 2021-22 school year. The team ― comprised of parents, students, members of the Board of Education, district leaders, school counselors, and district faculty and staff ― periodically reviews and updates schools’ mitigation plans to meet student needs in a timely manner.

While the data we present in this article have limitations, timely information often provides insight into the current situation. In summary, COVID-19 testing and quarantine are measures that the CDC recommends for schools to use in order to minimize the spread of the virus and keep as many students as possible in school for in-person learning. As a superintendent wrote to parents, “We all know how important it is for students to learn in the presence of teachers, staff, and peers. Our COVID-related goal for this quarter is to increase attendance to help improve the student experience.”