COVID-19 testing in schools

Testing and Vaccinations > COVID-19 testing in schools

In order to facilitate the safe reopening of schools, effective measures to prevent COVID-19 transmission must be at the forefront (e.g. universal mask wearing, physical distancing, cleaning and disinfection, hand hygiene, respiratory etiquette, adequate ventilation). Implementation of prevention strategies in concert with viral testing strategies in schools helps schools create a comprehensive prevention approach. Adding viral testing strategies can help to detect new cases of COVID-19 to prevent outbreaks, reduce the risk of significant transmission, and help to protect students and school staff from COVID-19. Additionally, there are benefits to implementing COVID-19 testing in schools including proactively identifying asymptomatic individuals, helping to ensure equitable access to testing, and increasing confidence in schools’ reopening plans. In March 2021, the Biden Administration announced $10 billion from the American Rescue Plan to increase COVID-19 testing, with a focus on K-8 schools.

The role of the school nurse is to serve as the frontline healthcare provider leading the public health response to the COVID-19 pandemic schools. In addition to providing care and addressing ongoing health needs of students, school nurses may also participate in performing COVID-19 testing.

Key Considerations:

  • Design testing protocols for your school based on community risk for transmission (the likelihood of an introduction of SARS-CoV-2 into the school building, the likelihood that a single case spreads in the building and becomes an outbreak, and the consequences of an outbreak for students, staff, and families), test availability, budget, resources, staffing, and ability to provide training to staff.
  • Design and implement screening programs (diagnostic testing, screening testing, surveillance testing) that allow schools to fluctuate between testing strategies based on the level of community risk for transmission of COVID-19.
    • As risk decreases but the likelihood of multiple infected individuals at the school remains high, frequent routine screening tests can be deployed to help identify and contain outbreaks. And as the risk decreases further, a transition to less frequent testing, for example through a surveillance program, may be appropriate.
    • Diagnostic testing for SARS-CoV-2 is intended to identify occurrence of SARS-CoV-2 infection at the individual level and is performed when there is a reason to suspect that an individual may be infected, such as having symptoms or suspected recent exposure.
    • Screening testing involves using SARS-CoV-2 viral tests (diagnostic tests used for screening purposes) intended to identify occurrence at the individual level even if there is no reason to suspect infection—i.e., there is no known exposure and no symptoms.
    • Pooled testing involves mixing several samples from different individuals together in a “batch” or pooled sample, then testing the pooled sample with a diagnostic test.
  • Develop protocols to communicate when individuals should isolate from others and the timeframe.
    • Individuals with symptoms should be isolated away from others as soon as symptoms appear.
    • Individuals who test positive should remain in isolation until they have met the criteria for release.
    • The current CDC criteria are: 10 days have passed since symptom onset; at least 24 hours have passed since resolution of fever without medication; and other symptoms have improved.
      • Regardless of the test result, individuals with a known exposure should be quarantined away from others for 14 days. (School nurses should follow state or local guidelines for quarantine if additional recommendations exist).
  • Develop a multi-faceted approach to reducing risk in school buildings to include mitigation measures like limiting contacts, masks, physical distancing, improved ventilation. Consider implementing testing to augment the effectiveness of these mitigation measures.
  • Collaborate with the local health department to develop clear procedures for how to handle positive test results from diagnostic, screening, and surveillance tests, as well as negative test results for people who are symptomatic.
    • These plans should clearly describe expectations around testing and isolation for both the individual who tested positive, their close contacts, and other contacts in the school’s community and clearly identify the plans for allowing the teacher, staff, or student to return to school.
  • Define who will be included as a “close contact”.
    • CDC defines a close contact as being within 6 feet of an infected individual for at least 15 minutes. Schools may also want to consider quarantining of other contacts, such as members of “cohorts or pods” who are spending long periods of time in the same indoor classroom, particularly if masks are removed for eating and drinking.
  • For schools using rapid tests as part of their screening program, confirmatory testing may be recommended for positive results, due to the possibility of a false positive.
  • If an individual with symptoms tests negative, they should still stay home until their symptoms resolve to avoid spreading any infection - coronavirus or otherwise
  • For students, teachers, and staff who had previously received positive test results and do not have symptoms of COVID-19, retesting is not recommended for up to 3 months from their last positive test result and quarantine is not recommended.
  • For students, teachers, and staff who have been fully vaccinated and do not have symptoms of COVID, testing and quarantine is not recommended.
  • For schools using pooled testing, a positive result for the pool should result in all individuals in the pool being quarantined until individual test results can be determined. Because of the complexities of acting on a positive result, pooled testing is best used in situations where the number of positives is expected to be very low, for example in areas with low community prevalence.
  • Develop a communication plan, including templates for communication to families, that will be disseminated if there is an exposure, case, or outbreak.
  • Develop plans for continuing learning, for example through remote instruction, should also be prepared in advance and shared in case a closure or quarantining of cohorts/pods is needed.
  • Determine if your school has the capacity to conduct COVID-19 testing. If not, consider selecting a vendor that allows for easy implementation and provides or supports the school’s testing needs.

NASN Resources

Interim Guidance: Role of the School Nurse in COVID-19 Testing in Schools

CDC Resources

Operational Strategy for K-12 Schools through Phased Prevention | Testing

US Department of Health and Human Services: Biden Administration to Invest More Than $12 Billion to Expand COVID-19 Testing

Other Resources

How to Get Certification for In-school COVID-19 Testing | The Centers for Medicare & Medicaid Services

Quick Start Guide to CLIA Certification for COVID-19 Testing in Schools | The Centers for Medicare & Medicaid Services

White House Announces $10 Billion For COVID-19 Testing In Schools | NPR

COVID Relief for K-12: Use of Funds Advisory Memo | COVID Collaborative

The Science is Clear: Layered Infection Prevention and Control Measures Allow Return to Safe In-Person Learning | COVID Collaborative

Roadmap for Healthy Schools: Building Organizational Capacity for Infection Prevention and Control (IPC) | COVID Collaborative

State and Local Testing Strategies for Responding to Covid-19 Outbreaks in Communities: Considerations for Equitable Distribution | The Rockefeller Foundation

Risk Assessment and Testing for Reducing SARS-CoV-2 Transmission in K-12 Schools | The Rockefeller Foundation

The K-12 National Testing Action Program: Connecting Schools with the Nation’s Leading Testing Companies to Safely Reopen | The Rockefeller Foundation

Covid-19 Testing in K-12 Settings: A Playbook for Educators and Leaders | The Rockefeller Foundation

Early Insights and Recommendations for Implementing a COVID-19 Antigen Testing Program in K-12 Schools: Lessons Learned from Six Pilot Sites | Mathematica

Intentions and Views around COVID-19 Vaccination Among K-12 Populations Findings from Parents, Teachers and School Leadership: February - April 2021 | CDC Foundation

Intentions and Views around COVID-19 Vaccination Among K-12 Populations: Findings from Parents, Teachers, and Principals May 2021 | CDC Foundation