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New Guidance for Using Covid-19 Testing Strategies to Reopen America’s Schools Safely

First-of-its-Kind Screening Testing Protocols for K-12 Schools Across the United States

Four Cities and One State to Pilot Protocols with 120,000 Rapid Antigen Tests Provided by HHS

NEW YORK | October 14, 2020 – As schools across the country strive to safely return to in-person classes, a new report by the Duke-Margolis Center for Health Policy and the Johns Hopkins Center for Health Security with support from The Rockefeller Foundation provides the first application of a detailed framework to provide guidance to America’s school administrators on how best to screen for, and stop or reduce the spread of, Covid-19 (SARS-CoV-2) in their schools. The report, Risk Assessment and Testing Considerations for Reducing SARS-CoV-2 Transmission in K-12 Schools, is the first-of-its-kind to offer a risk assessment and testing guidance that can be adapted to reflect the risk of Covid-19 in a school’s community. It also considers the benefits of transmission reduction alongside the costs of testing and of managing “false positive” results. As availability increases for rapid-result Covid-19 tests and supporting confirmatory lab tests, this groundbreaking report, which builds upon the Duke Margolis report released last month with support from The Rockefeller Foundation, can help schools integrate screening tests with other mitigation measures in an effective strategy to protect against the spread of the virus at school and in the wider community.

To test and refine this approach, The Rockefeller Foundation signed a memorandum of understanding with the U.S. Department of Health and Human Services, which will send at least 120,000 Abbott BinaxNOW tests to initially support the 5 pilot areas: Louisville, Ky.; Los Angeles; New Orleans; Tulsa, Okla.; and Rhode Island. In conjunction with the Foundation’s support for state and local governments to share experiences and lessons learned through applicable National Institutes of Health RADx studies, these pilots will provide real-world insights about best practices for schools across the country on how to effectively integrate testing into school settings for K-12 students and teachers.

“Reopening schools should be a national priority – it is essential for the educational, social, and emotional development of our children and it represents an important milestone in our response to Covid-19, both from a public health and economic perspective,” says Dr. Rajiv J. Shah, President of The Rockefeller Foundation. “This is an extraordinary opportunity to take a scientific, data-driven approach to reopen our schools, while protecting our communities and ensuring that parents can get back to work and communities are safe and open for business.”

Creating an Early Warning System

Identifying Covid-19 in children can be challenging. Studies suggest that most children are asymptomatic to Covid-19 or have mild symptoms, making it difficult to use traditional screening methods for temperature or other visible symptoms to identify potential cases. With rapid testing, schools can create an early warning system to stop outbreaks before they spread to others in the school and the wider community.

“School-related outbreaks can have substantial impacts for students, household members, teachers, and the wider community,” said Dr. Mark McClellan, Director of the Duke-Margolis Center for Health Policy. “As the use of rapid testing increases, it’s critical to develop evidence-based guidance to help schools find the most effective ways to incorporate testing into their efforts to reopen safely and avoid contributing to community outbreaks.”.

Building off the testing framework published in September, the report recommends that testing protocols should be customized for individual school districts based on the risk assessment and includes strategies for schools in low, medium, and high-risk areas. The recommendations also consider community priorities, test performance, and communication. To develop a testing strategy to fit local needs, the report proposes a two-part process:

  • First, school administrators should assess the level of risk in the community that considers the likelihood of a case in the school building, the likelihood that a case will become an outbreak, and the consequences of transmission.
  • Once a risk assessment has been conducted, the report provides strategies for using testing to reduce the risk of outbreaks in schools based on community prevalence, test performance, and the school’s goals.

The report recommends that school administrators implement testing protocols as part of a larger Covid-19 mitigation strategy for K-12 schools. “To reduce transmission within schools, testing frequency, and quick turnaround time for test results are more important than a highly accurate test alone,” said Dr. Caitlin Rivers, Senior Scholar, Johns Hopkins Center for Health Security. “Most importantly, testing should not be the only approach to reducing risk in schools. By combining rapid testing with protective measures like wearing masks, physically distancing, and improved ventilation, schools can both protect students, teachers, and administrators from Covid-19 and detect new cases to reduce the risk of further transmission.”

Testing Pilots in Real-Time across America:

  • Los Angeles: The Rapid Antigen Testing for Covid-19 in Los Angeles study is a partnership between Mayor Eric Garcetti’s Office, the USC Schaeffer Center for Health Policy & Economics, the Keck School of Medicine of USC, and the Los Angeles County Department of Public Health. The study will examine the feasibility and acceptability of using rapid antigen tests for population screening. Overall, the study will evaluate the implementation protocols required for different groups in each unique environment. The effort will also look at the ideal ways to communicate with individuals, institutions, and families about the tests.
  • Louisville: The Louisville Department of Public Health and Wellness and the Jefferson County Public Schools (JCPS) plan to pilot a screening testing system to support the re-opening—and sustained opening—of the school system, the 29th largest system in the country.  They plan to pilot a system of screening testing for staff and students according to a phased re-opening plan being developed by JCPS for Board approval:  in sequence, K-5 re-opening, followed by 6th and 9th grades, followed by Middle School and High School.  The “screening” testing pilots will be coordinated with a system to deploy diagnostic tests for symptomatic students and staff, and “surveillance” testing using wastewater monitoring that is part of the City’s overall testing plan in conjunction with the University of Louisville and the Metropolitan Sewer District.  In addition, JCPS and the City are using GIS supported analytics to help preliminarily design the screening test pilots using BinaxNOW tests to account for the fact that many JCPS students travel on buses from their residential area to their school community.
  • New Orleans: New Orleans Public Schools has established partnerships with multiple local health systems to provide responsive testing to symptomatic individuals and close contacts, as well as wide-scale routine staff testing. The addition of 20,000 BINAXNow antigen tests will allow the school district and its health partners to implement a pilot program for students and staff within one to two school settings. Specifically, the district would initially implement screening activities two times a week for students and school staff, aligned to the testing protocols, as well as gold standard PCR testing for positive antigen cases and the pilot school population.
    • “New Orleans has been well ahead of the curve when it comes to keeping our students and teachers as safe as possible during this pandemic. In fact, that diligence has let us return to some in-person learning at every grade level,” Superintendent Henderson Lewis, Jr. said. “We remain committed to safe, innovative ways to better protect our school community, and this pilot program shows promise in these uncertain times.”
    • “We made safely returning our children to schools a priority milestone for the continued gradual reopening of our city,” Mayor LaToya Cantrell said. “That cannot happen without adequate testing. I want to commend NOLA Public Schools and Superintendent Dr. Henderson Lewis for partnering with the Rockefeller Foundation and the U.S. Department of Health and Human Services to create a pilot program that will improve testing in our schools. We will continue to make the health and safety of our children a top priority.”
  • Rhode Island: The state of Rhode Island has implemented a comprehensive and robust approach to addressing Covid-19 that includes symptomatic, outbreak, and surveillance testing. Rhode Island currently has one of these highest rates of testing in the country. The addition of the Abbott BinaxNOW tests, and incorporation of Rockefeller Testing Protocols will be a game-changer in Rhode Island’s approach to testing for K-12 schools, colleges and universities, high-density communities, and congregate care settings. Our approach has always been to test strategically in higher-risk settings and use results to support our work to prevent outbreaks and community transmission. The Abbott BinaxNOW tests will be integrated into the statewide testing system to significantly improve capacity and turn-around-times for both symptomatic individuals and for screening. Rapid testing will ensure that we are able to get people who are positive into isolation in a timely manner, as well as quarantining of their close contacts. The approach of comprehensive testing and timely isolation and quarantine is a key approach to addressing COVID-19 in the state.
  • Tulsa: Tulsa Public Schools and the Tulsa Health Department plans to work with business and nonprofit partners to provide testing strategies guided by the Duke Margolis report that best use resources to help schools to reopen, educators return to the classroom, and parents and caregivers return to work. The 20,000 Abbott BinaxNOW tests will be part of this focused response across the district that will use data analytics as well as mitigation measures, rapid and PCR Covid-19 testing to reduce infection rates and help Tulsa Public Schools remain open for its 35,000 students and 6,000 employees.

The guidance on testing protocols will continue to be updated as the science around Covid-19 evolves. Additionally, the report cautions that most of the tests currently available have not been evaluated specifically for performance in children or people who do not have symptoms. It is possible that some tests are not as accurate at detecting infection in school-age populations and in asymptomatic individuals.  Administrators should work with their local health departments to continue to incorporate the latest guidance and evidence into school testing programs as it becomes available.


Duke-Margolis Center for Health Policy

The Robert J. Margolis, MD, Center for Health Policy at Duke University is directed by Mark McClellan, MD, PhD, and brings together expertise from the Washington, DC, policy community, Duke University, and Duke Health to address the most pressing issues in health policy. The mission of Duke-Margolis is to improve health and the value of health care through practical, innovative, and evidence-based policy solutions. Duke-Margolis catalyzes Duke University’s leading capabilities, including interdisciplinary academic research and capacity for education and engagement, to inform policy making and implementation for better health and health care. Dr. Christina Silcox leads the Center’s initiatives related to Covid-19 diagnostic testing. For more information, visit healthpolicy.duke.edu

Johns Hopkins Center for Health Security

The Johns Hopkins Center for Health Security at the Bloomberg School of Public Health works to protect people’s health from epidemics and disasters and ensure that communities are resilient to major challenges. The Center for Health Security studies the policies, organizations, systems, and tools needed to prevent and respond to outbreaks and public health crises, and advances policies and practice to address a range of challenges, including the global rise in emerging infectious diseases, a continued risk of pandemic flu, , and the potential for intentional biological threats.

The Rockefeller Foundation

The Rockefeller Foundation advances new frontiers of science, data, and innovation to solve global challenges related to health, food, power, and economic mobility. As a science-driven philanthropy focused on building collaborative relationships with partners and grantees, The Rockefeller Foundation seeks to inspire and foster large-scale human impact that promotes the well-being of humanity throughout the world by identifying and accelerating breakthrough solutions, ideas, and conversations. For more information, sign up for our newsletter at rockefellerfoundation.org and follow us on Twitter @RockefellerFdn.

Media contacts:

Ashley Chang
The Rockefeller Foundation
+1 (917) 373-9530
achang@rockfound.org

Patricia Green
Duke-Margolis Center for Health Policy
+1 (301) 520-6482
patricia.s.green@duke.edu

Margaret Miller
Johns Hopkins Center for Health Security
+1 (703) 626-1813
margaret.miller@jhu.edu

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