As the school year has just started in many states, yet has been in full swing for close to two months in others, one thing is true: there are no two schools or school districts with exactly the same protocols when it comes to Covid-19 safety for children and staff. Some schools require masking indoors and out, some only indoors, and some not at all. Some do weekly or bi-weekly Covid-19 testing. Some test only for symptomatic individuals. Some do pooled testing. Some continue to require three or six feet of distancing; most are unable to do so due to space issues. Some schools require all people ages 12 years and older to be vaccinated. Most do not. The algorithms and decision trees are endless. Most parents and students are just thrilled to be back to in- person learning, but many schools have already sent thousands of students home to quarantine, due to either their testing positive for Covid-19, or for a recent exposure to an infected individual. Quarantine periods can last for up to 14 days, even if the exposed individual is not symptomatic, and many schools have needed to close entire classrooms or even the entire school for weeks at a time.
A new testing protocol, called “test-to-stay” has been instituted in some schools as a means of keeping exposed, albeit uninfected, children(and teachers) in the classroom, regardless of their vaccination status. The concept is that if a student or staff is masked and exposed to another student or staff who tests positive, if this exposure occurred when both parties were masked and in the school setting, a “modified” quarantine could take place. This modified quarantine includes daily or every-other-day testing on those exposed, strict masking protocols in the classroom, increased distancing from others while eating, and no participation in extracurricular activities, such as sports, for seven days. In addition, close symptom monitoring would occur. The individual who tested positive would quarantine as per prior protocols, with symptom monitoring and testing prior to return.
This new modified quarantine protocol for students is similar to that which had been recommended back in the summer 2021 for vaccinated individuals who were exposed to a positive case, masked or unmasked. This latter protocol was initiated prior to the delta variant surge that continues to ravage much of the United States, where now even thousands of vaccinated individuals have become infected and/or ill with Covid-19.
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The notion of a modified quarantine protocol in schools is based on a study published in this week’s The Lancet. The study took place in the United Kingdom between March and June 2021, just prior to the delta surge in the U.K. The researchers enrolled over 200 secondary schools over a ten-week period, with the option of either quarantining students who’ve had a known Covid-19 exposure or offering daily Covid-19 antigen testing to students who would continue to come to school in person. The two groups were randomly assigned, meaning that schools could not choose one option over the other. All schools had similar protocols of twice weekly Covid-19 PCR testing for all students and staff as surveillance. If a student or staff tested positive, some schools followed the ten-day quarantine protocol for close contacts, while others offered daily antigen testing for seven days to close contacts while the close contacts remained on school grounds. While the study did not find substantial superiority in the outcomes of the ‘test-to-stay’ groups, they also found no significant increase in new cases of Covid-19, even in those with close contact to a positive case. Vaccination status of study participants was not included.
Today, Pfizer/BioNTech released study data from Covid-19 vaccine trials in 5- to 11-year-old children, reporting safety data as well as evidence of development of a robust immune response to vaccines. While implications on how this will reduce Covid-19 outbreaks and transmission among children, especially in the school setting, remains to be determined, it will be another thick layer of prevention against infection and illness in children. It has yet to be presented to the Food and Drug Administration (FDA) for Emergency Use Authorization (EUA) in this age group. Currently, the Pfizer/BioNTech Covid-19 vaccine is FDA approved in individuals ages 16 years and up.
As for modifications in quarantining when exposed to an infected classmate, it is likely that schools and school systems will each go their own way. The absence of standardization when it comes to masking, testing, vaccinations, and exposure protocols will only continue to expand as more options become available.