Assessment of a Program for SARS-CoV-2 Screening and Environmental Monitoring in an Urban Public School District

• Published in: JAMA network open 2021-09, Vol.4 (9), p.e2126447
• Main Authors: Crowe, John, Schnaubelt, Andy T, SchmidtBonne, Scott, Angell, Kathleen, Bai, Julia, Eske, Teresa, Nicklin, Molly, Pratt, Catherine, White, Bailey, Crotts-Hannibal, Brodie, Staffend, Nicholas, Herrera, Vicki, Cobb, Jeramie, Conner, Jennifer, Carstens, Julie, Tempero, Jonell, Bouda, Lori, Ray, Matthew, Lawler, James V, Campbell, W Scott, Lowe, John-Martin, Santarpia, Joshua, Bartelt-Hunt, Shannon, Wiley, Michael, Brett-Major, David, Logan, Cheryl, Broadhurst, M Jana
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Air Microbiology; Asymptomatic; COVID-19 - epidemiology; COVID-19 - virology; COVID-19 Testing - methods; Environmental Monitoring; Female; Humans; Infectious Diseases; Kindergarten; Learning; Male; Mass Screening; Middle Aged; Nebraska; Online Only; Original Investigation; Pandemics; Pilot Projects; Polymerase Chain Reaction; Program Evaluation; Risk Assessment; Saliva; SARS-CoV-2; School Teachers; Schools; Severe acute respiratory syndrome coronavirus 2; Students; Surveillance; Urban Population; Wastewater - virology
• ISSN: 2574-3805; 2574-3805
• DOI: 10.1001/jamanetworkopen.2021.26447

Scalable programs for school-based SARS-CoV-2 testing and surveillance are needed to guide in-person learning practices and inform risk assessments in kindergarten through 12th grade settings. To characterize SARS-CoV-2 infections in staff and students in an urban public school setting and evaluate test-based strategies to support ongoing risk assessment and mitigation for kindergarten through 12th grade in-person learning. This pilot quality improvement program engaged 3 schools in Omaha, Nebraska, for weekly saliva polymerase chain reaction testing of staff and students participating in in-person learning over a 5-week period from November 9 to December 11, 2020. Wastewater, air, and surface samples were collected weekly and tested for SARS-CoV-2 RNA to evaluate surrogacy for case detection and interrogate transmission risk of in-building activities. SARS-CoV-2 detection in saliva and environmental samples and risk factors for SARS-CoV-2 infection. A total of 2885 supervised, self-collected saliva samples were tested from 458 asymptomatic staff members (mean [SD] age, 42.9 [12.4] years; 303 women [66.2%]; 25 Black or African American [5.5%], 83 Hispanic [18.1%], 312 White [68.1%], and 35 other or not provided [7.6%]) and 315 students (mean age, 14.2 [0.7] years; 151 female students [48%]; 20 Black or African American [6.3%], 201 Hispanic [63.8%], 75 White [23.8%], and 19 other race or not provided [6.0%]). A total of 46 cases of SARS-CoV-2 (22 students and 24 staff members) were detected, representing an increase in cumulative case detection rates from 1.2% (12 of 1000) to 7.0% (70 of 1000) among students and from 2.1% (21 of 1000) to 5.3% (53 of 1000) among staff compared with conventional reporting mechanisms during the pilot period. SARS-CoV-2 RNA was detected in wastewater samples from all pilot schools as well as in air samples collected from 2 choir rooms. Sequencing of 21 viral genomes in saliva specimens demonstrated minimal clustering associated with 1 school. Geographical analysis of SARS-CoV-2 cases reported district-wide demonstrated higher community risk in zip codes proximal to the pilot schools. In this study of staff and students in 3 urban public schools in Omaha, Nebraska, weekly screening of asymptomatic staff and students by saliva polymerase chain reaction testing was associated with increased SARS-CoV-2 case detection, exceeding infection rates reported at the county level. Experiences differed among schools, and virus sequencing an