Scott, ZeniUthappa, Diya MMann, Tara KKim, HwasoonBrookhart, MAEdwards, LauraRak, ZsoltBenjamin, Daniel KZimmerman, Kanecia OABC Science Collaborative2024-06-102024-06-102023-050022-43911746-1561https://hdl.handle.net/10161/31152<h4>Background</h4>Test-to-stay (TTS) is a strategy to limit school exclusion following an exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We evaluated the use of TTS within universally masked kindergarten through 12th grade (K-12) school settings following household SARS-CoV-2 exposure.<h4>Methods</h4>Three hundred twenty-two participants were enrolled. Serial rapid antigen testing was performed up to 15 days post-exposure. Analysis-eligible participants completed the 15-day testing protocol, tested positive any time during the testing window, or received a negative test on or after day 9. Primary outcomes included within-school tertiary attack rate (TAR) (test positivity among close contacts of positive TTS participants), and school days saved among TTS participants.<h4>Results</h4>Seventy-three of 265 analysis-eligible participants tested positive for SARS-CoV-2 (secondary attack rate of 28% [95% CI: 16-63%]). Among 77 within-school close contacts, 2 were positive (TAR = 3% [95% CI: 1-5%]). Participant absences were limited to 338 days, resulting in 82% of 1849 school days saved.<h4>Implications for school health policy, practice, and equity</h4>TTS facilitates continued in-person learning and can greatly reduce the number of missed school days.<h4>Conclusions</h4>Within universally masked K-12 schools, TTS is a safe alternative to school exclusion following household SARS-CoV-2 exposure.https://creativecommons.org/licenses/by-nc/4.0ABC Science CollaborativeHumansFamily CharacteristicsSchoolsEducational StatusCOVID-19SARS-CoV-2Journal article