Test-to-Stay After SARS-CoV-2 Exposure: A Mitigation Strategy for Optionally Masked K-12 Schools.



We evaluated the impact of a test-to-stay (TTS) program on within-school transmission and missed school days in optionally masked kindergarten through 12th grade schools during a period of high community severe acute respiratory syndrome coronavirus 2 transmission.


Close contacts of those with confirmed severe acute respiratory syndrome coronavirus 2 infection were eligible for enrollment in the TTS program if exposure to a nonhousehold contact occurred between November 11, 2021 and January 28, 2022. Consented participants avoided school exclusion if they remained asymptomatic and rapid antigen testing at prespecified intervals remained negative. Primary outcomes included within-school tertiary attack rate (test positivity among close contacts of positive TTS participants) and school days saved among TTS participants. We estimated the number of additional school-acquired cases resulting from TTS and eliminating school exclusion.


A total of 1675 participants tested positive or received at least 1 negative test between days 5 and 7 and completed follow-up; 92% were students and 91% were exposed to an unmasked primary case. We identified 201 positive cases. We observed a tertiary attack rate of 10% (95% confidence interval: 6%-19%), and 7272 (89%) of potentially missed days were saved through TTS implementation. We estimated 1 additional school-acquired case for every 21 TTS participants remaining in school buildings during the entire study period.


Even in the setting of high community transmission, a TTS strategy resulted in substantial reduction in missed school days in optionally masked schools.





Published Version (Please cite this version)


Publication Info

Campbell, Melissa M, Daniel K Benjamin, Tara K Mann, Alex Fist, Ashley Blakemore, Kylee S Diaz, Hwasoon Kim, Laura J Edwards, et al. (2022). Test-to-Stay After SARS-CoV-2 Exposure: A Mitigation Strategy for Optionally Masked K-12 Schools. Pediatrics, 150(5). p. e2022058200. 10.1542/peds.2022-058200 Retrieved from https://hdl.handle.net/10161/31153.

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Angelique Boutzoukas

Assistant Professor of Pediatrics

I am a pediatric infectious disease specialist and pediatric clinical researcher. My research interests are centered around finding the optimal ways to manage infections and minimize harms to patients. Recognizing the growing global threat of antibiotic resistance, I am particularly interested in finding the right dose and duration of antibiotics that children should receive to treat their infections, and studying the epidemiology and prevention of antibiotic resistant infections.   


Ganga Moorthy

Assistant Professor of Pediatrics

Kanecia Obie Zimmerman

Wilburt C. Davison Distinguished Professor

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