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Volume 29, Number 3—March 2023
Research

COVID-19 Test Allocation Strategy to Mitigate SARS-CoV-2 Infections across School Districts

Remy Pasco, Kaitlyn Johnson, Spencer J. Fox, Kelly A. Pierce, Maureen Johnson-León, Michael Lachmann, David P. Morton, and Lauren Ancel MeyersComments to Author 
Author affiliations: The University of Texas at Austin, Austin, Texas, USA (R. Pasco, K. Johnson, S.J. Fox, K.A. Pierce, M. Johnson-León, L.A. Meyers); Santa Fe Institute, Santa Fe, New Mexico, USA (M. Lachmann, L.A. Meyers); Northwestern University, Evanston, Illinois, USA (D.P. Morton)

Main Article

Table

Estimated heterogeneity in COVID-19 incidence and total disease burden across 11 high schools in the Austin Independent School District, Austin, Texas, USA, under 3 testing scenarios in a modeled COVID-19 test allocation strategy to mitigate SARS-CoV-2 infections across school districts*

Infections
 Testing allocation
No testing
 Pro rata testing
 Optimal testing
Total infections†
Risk gap 5.8 4.8 3.6
Gini coefficient (SE)‡ 0.23 (0.053) 0.26 (0.057) 0.19 (0.037)
No. infections (95% CI)§ 115 (79–158) 70 (50–94) 69 (49–93)
Infection rate (95% CI)§
 9.4 (6.5–12.9)
 5.7 (4.1–7.7)
 5.6 (4–7.6)
On-campus infections#
Risk gap 6.5 5.6 1.8
Gini coefficient (SE)‡ 0.27 (0.098) 0.23 (0.075) 0.13 (0.041)
No. infections (95% CI)§ 70 (38–119) 27 (13–49) 26 (12–48)
Infection rate (95% CI)§ 5.8 (3.1–9.7) 2.2 (1.1–4.1) 2.1 (1.0–3.9)

*The risk gap is the ratio of the median cumulative incidence across 300 simulations of the school with the highest expected incidence to that of the school with the lowest expected incidence. †Total student infections, occurring both on and off campus, over the 10-week projection period. ‡Gini coefficients indicate overall disparities in expected burden, where values of 0 correspond to maximum equality and values of 1 correspond to maximum inequality (43). Gini coefficients were calculated using the median proportion of students infected across 300 simulations. §The total median infections in the district over the horizon simulated, expressed as absolute and per capita. #Infections occurring on campus, over the 10-week projection period.

Main Article

References
  1. Johns Hopkins Coronavirus Resource Center. COVID-19 map [cited 2023 Jan 13]. https://coronavirus.jhu.edu/map.html
  2. United Nations Conference on Trade and Development. COVID-19’s economic fallout will long outlive the health crisis, report warns [cited 2021 Apr 13]. https://unctad.org/news/covid-19s-economic-fallout-will-long-outlive-health-crisis-report-warns
  3. Czeisler  MÉ, Lane  RI, Petrosky  E, Wiley  JF, Christensen  A, Njai  R, et al. Mental health, substance use, and suicidal ideation during the COVID-19 pandemic—United States, June 24–30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:1049–57. DOIPubMedGoogle Scholar
  4. Vahratian  A, Blumberg  SJ, Terlizzi  EP, Schiller  JS. Symptoms of anxiety or depressive disorder and use of mental health care among adults during the COVID-19 pandemic—United States, August 2020–February 2021. MMWR Morb Mortal Wkly Rep. 2021;70:490–4. DOIPubMedGoogle Scholar
  5. Center on Budget and Policy Priorities. Tracking the COVID-19 recession’s effects on food, housing, and employment hardships [cited 2021 Apr 13]. https://www.cbpp.org/research/poverty-and-inequality/tracking-the-covid-19-recessions-effects-on-food-housing-and
  6. Parker  K, Minkin  R, Bennett  J. Economic fallout from COVID-19 continues to hit lower-income Americans the hardest. Pew Research Foundation; 2020 Sep 24 [cited 2021 Apr 13]. https://www.pewresearch.org/social-trends/2020/09/24/economic-fallout-from-covid-19-continues-to-hit-lower-income-americans-the-hardest
  7. Azevedo  JP, Hasan  A, Goldemberg  D, Geven  K, Iqbal  SA. Simulating the potential impacts of COVID-19 school closures on schooling and learning outcomes: a set of global estimates [cited 2021 Apr 13]. World Bank Res Obs. 2021;36:1–40 https://academic.oup.com/wbro/article-pdf/36/1/1/36757308/lkab003.pdf.
  8. Engzell  P, Frey  A, Verhagen  MD. Learning loss due to school closures during the COVID-19 pandemic. Proc Natl Acad Sci U S A. 2021;118:e2022376118. DOIPubMedGoogle Scholar
  9. Dorn  E, Hancock  B, Sarakatsannis  J, Viruleg  E. COVID-19 and learning loss—disparities grow and students need help. McKinsey & Company. 2020 [cited 2021 Apr 13]. https://www.mckinsey.com/industries/public-and-social-sector/our-insights/covid-19-and-learning-loss-disparities-grow-and-students-need-help
  10. Baron  EJ, Goldstein  EG, Wallace  CT. Suffering in silence: How COVID-19 school closures inhibit the reporting of child maltreatment. J Public Econ. 2020;190:104258. DOIPubMedGoogle Scholar
  11. Kinsey  EW, Hecht  AA, Dunn  CG, Levi  R, Read  MA, Smith  C, et al. School closures during COVID-19: opportunities for innovation in meal service. Am J Public Health. 2020;110:1635–43. DOIPubMedGoogle Scholar
  12. Orgilés  M, Morales  A, Delvecchio  E, Mazzeschi  C, Espada  JP. Immediate psychological effects of the COVID-19 quarantine in youth from Italy and Spain. Front Psychol. 2020;11:579038. DOIPubMedGoogle Scholar
  13. Honein  MA, Barrios  LC, Brooks  JT. Data and policy to guide opening schools safely to limit the spread of SARS-CoV-2 infection. JAMA. 2021;325:823–4. DOIPubMedGoogle Scholar
  14. Education Week Staff. A year of COVID-19: what it looked like for schools. Education Week. 2021 Mar 4 [cited 2021 Nov 2]. https://www.edweek.org/leadership/a-year-of-covid-19-what-it-looked-like-for-schools/2021/03
  15. Center for American Progress. Remote learning and school reopenings: what worked and what didn’t [cited 2021 Nov 2]. https://www.americanprogress.org/issues/education-k-12/reports/2021/07/06/501221/remote-learning-school-reopenings-worked-didnt
  16. US Centers for Disease Control and Prevention. COVID data tracker [cited 2021 Aug 12]. https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-total-admin-rate-total
  17. Busser  C. NEA survey finds educators back in classrooms and ready for fall. National Education Association. 2021 Jun 17 [cited 2021 Nov 2]. https://www.nea.org/about-nea/media-center/press-releases/nea-survey-finds-educators-back-classrooms-and-ready-fall
  18. Gutman-Wei  R. Why is it taking so long to get vaccines for kids? The Atlantic. 2021 Aug 11 [cited 2021 Aug 12]. https://www.theatlantic.com/health/archive/2021/08/covid-vaccination-timeline-children/619729/
  19. US Food and Drug Administration. FDA Authorizes Pfizer-BioNTech COVID-19 vaccine for emergency use in children 5 through 11 years of age [cited 2021 Dec 6]. https://www.fda.gov/news-events/press-announcements/fda-authorizes-pfizer-biontech-covid-19-vaccine-emergency-use-children-5-through-11-years-age
  20. Goldstein  D. Omicron upends return to school in U.S. The New York Times. 2022 Jan 3 [cited 2022 Jan 5]. https://www.nytimes.com/live/2022/01/03/us/school-closings-covid
  21. Parks  SE, Zviedrite  N, Budzyn  SE, Panaggio  MJ, Raible  E, Papazian  M, et al. COVID-19–related school closures and learning modality changes—United States, August 1–September 17, 2021. MMWR Morb Mortal Wkly Rep. 2021;70:1374–6. DOIPubMedGoogle Scholar
  22. US Department of Health and Human Services. Biden administration to invest more than $12 billion to expand COVID-19 testing [cited 2021 Jul 7]. https://www.hhs.gov/about/news/2021/03/17/biden-administration-invest-more-than-12-billion-expand-covid-19-testing.html
  23. US Department of Education. Department of Education announces American Rescue Plan funds for all 50 States, Puerto Rico, and the District of Columbia to help schools reopen [cited 2021 Jul 5]. https://www.ed.gov/news/press-releases/department-education-announces-american-rescue-plan-funds-all-50-states-puerto-rico-and-district-columbia-help-schools-reopen
  24. Larremore  DB, Wilder  B, Lester  E, Shehata  S, Burke  JM, Hay  JA, et al. Test sensitivity is secondary to frequency and turnaround time for COVID-19 screening. Sci Adv. 2021;7:eabd5393. DOIPubMedGoogle Scholar
  25. Du  Z, Pandey  A, Bai  Y, Fitzpatrick  MC, Chinazzi  M, Pastore Y Piontti  A, et al. Comparative cost-effectiveness of SARS-CoV-2 testing strategies in the USA: a modelling study. Lancet Public Health. 2021;6:e184–91. DOIPubMedGoogle Scholar
  26. Paltiel  AD, Zheng  A, Walensky  RP. Assessment of SARS-CoV-2 screening strategies to permit the safe reopening of college campuses in the United States. JAMA Netw Open. 2020;3:e2016818. DOIPubMedGoogle Scholar
  27. Lanier  WA, Babitz  KD, Collingwood  A, Graul  MF, Dickson  S, Cunningham  L, et al. COVID-19 testing to sustain in-person instruction and extracurricular activities in high schools—Utah, November 2020–March 2021. MMWR Morb Mortal Wkly Rep. 2021;70:785–91. DOIPubMedGoogle Scholar
  28. Frazier  PI, Cashore  JM, Duan  N, Henderson  SG, Janmohamed  A, Liu  B, et al. Modeling for COVID-19 college reopening decisions: Cornell, a case study. Proc Natl Acad Sci U S A. 2022;119:e2112532119. DOIPubMedGoogle Scholar
  29. Vohra  D, Rowan  P, Goyal  R, Hotchkiss  J, O’Neil  S. Early insights and recommendations for implementing a covid-19 antigen testing program in K-12 schools: lessons learned from six pilot sites. New York: The Rockefeller Foundation; 2021 [cited 2021 Apr 13]. https://www.rockefellerfoundation.org/wp-content/uploads/2021/02/Early-Insights-and-Recommendations-for-K-12-Schools-Covid-19-Testing-Lessons-Learned-from-Six-Pilot-Sites.pdf
  30. Faherty  LJ, Master  BK, Steiner  ED, Kaufman  JH, Predmore  Z, Stelitano  L, et al. COVID-19 testing in K-12 schools–insights from early adopters. Santa Monica (CA): RAND Corporation; 2021 [cited 2021 Jul 5]. https://www.rockefellerfoundation.org/wp-content/uploads/2021/02/RAND_Covid-19-Testing-in-K-12-Schools_Insights-from-Early-Adopters.pdf
  31. Howard J. Debate emerges around Covid-19 testing strategies in schools as districts plan to reopen. CNN. 2021 Jul 19 [cited 2021 Nov 2]. https://www.cnn.com/videos/tv/2021/07/19/lead-erica-hill-live-jake-tapper.cnn
  32. Austin Independent School District. About our schools [cited 2021 May 19]. https://www.austinisd.org/schools
  33. Austin Independent School District. COVID-19 dashboard [cited 2021 Apr 14]. https://www.austinisd.org/openforlearning/dashboard
  34. Abbott. Taking COVID-19 testing to a new level [cited 2021 Apr 14]. https://www.abbott.com/BinaxNOW-Test-NAVICA-App.html
  35. Davies  NG, Klepac  P, Liu  Y, Prem  K, Jit  M, Eggo  RM; CMMID COVID-19 working group. Age-dependent effects in the transmission and control of COVID-19 epidemics. Nat Med. 2020;26:1205–11. DOIPubMedGoogle Scholar
  36. Gudbjartsson  DF, Helgason  A, Jonsson  H, Magnusson  OT, Melsted  P, Norddahl  GL, et al. Spread of SARS-CoV-2 in the Icelandic population. N Engl J Med. 2020;382:2302–15. DOIPubMedGoogle Scholar
  37. Pollock  NR, Jacobs  JR, Tran  K, Cranston  AE, Smith  S, O’Kane  CY, et al. Performance and implementation evaluation of the Abbott BinaxNOW Rapid Antigen Test in a high-throughput drive-through community testing site in Massachusetts. J Clin Microbiol. 2021;59:e00083–21. DOIPubMedGoogle Scholar
  38. US Food and Drug Administration. Abbott BinaxNOW COVID-19 Ag CARD instructions for use and characteristics [cited 2021 Apr 19]. https://www.fda.gov/media/141570/download
  39. He  X, Lau  EHY, Wu  P, Deng  X, Wang  J, Hao  X, et al. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med. 2020;26:672–5. DOIPubMedGoogle Scholar
  40. He  D, Zhao  S, Lin  Q, Zhuang  Z, Cao  P, Wang  MH, et al. The relative transmissibility of asymptomatic COVID-19 infections among close contacts. Int J Infect Dis. 2020;94:145–7. DOIPubMedGoogle Scholar
  41. University of Texas at Austin COVID-19 Modeling Consortium. Heterogeneous burden of the COVID-19 pandemic in central Texas [cited 2021 Apr 25]. https://sites.cns.utexas.edu/sites/default/files/cid/files/austin_covid-19_spatial_burden_report.pdf
  42. University of Texas at Austin COVID-19 Modeling Consortium. Austin dashboard [cited 2021 Nov 5]. https://covid-19.tacc.utexas.edu/dashboards/austin
  43. Atkinson  AB. On the measurement of inequality. J Econ Theory. 1970;2:244–63. DOIGoogle Scholar
  44. Liu  Q-H, Zhang  J, Peng  C, Litvinova  M, Huang  S, Poletti  P, et al. Model-based evaluation of alternative reactive class closure strategies against COVID-19. Nat Commun. 2022;13:322. DOIPubMedGoogle Scholar
  45. Rubin-Miller  L, Alban  C, Artiga  S, Sullivan  S. COVID-19 Racial Disparities in Testing, Infection, Hospitalization, and Death: Analysis of Epic Patient Data. Kaiser Family Foundation; 2020 Sep 15 [cited 2021 Jul 5]. https://www.kff.org/coronavirus-covid-19/issue-brief/covid-19-racial-disparities-testing-infection-hospitalization-death-analysis-epic-patient-data
  46. Mena  GE, Martinez  PP, Mahmud  AS, Marquet  PA, Buckee  CO, Santillana  M. Socioeconomic status determines COVID-19 incidence and related mortality in Santiago, Chile. Science. 2021;372:eabg5298. DOIPubMedGoogle Scholar
  47. Martin  CA, Jenkins  DR, Minhas  JS, Gray  LJ, Tang  J, Williams  C, et al.; Leicester COVID-19 consortium. Socio-demographic heterogeneity in the prevalence of COVID-19 during lockdown is associated with ethnicity and household size: Results from an observational cohort study. EClinicalMedicine. 2020;25:100466. DOIPubMedGoogle Scholar
  48. Endo  A, Abbott  S, Kucharski  AJ, Funk  S; Centre for the Mathematical Modelling of Infectious Diseases COVID-19 Working Group. Estimating the overdispersion in COVID-19 transmission using outbreak sizes outside China. Wellcome Open Res. 2020;5:67. DOIPubMedGoogle Scholar
  49. Leng  T, Hill  EM, Holmes  A, Southall  E, Thompson  RN, Tildesley  MJ, et al. Quantifying pupil-to-pupil SARS-CoV-2 transmission and the impact of lateral flow testing in English secondary schools. Nat Commun. 2022;13:1106. DOIPubMedGoogle Scholar
  50. Woody  S, Javan  E, Johnson  K, Pasco  R, Johnson-León  M, Lachmann  M, et al. Spatial distribution of COVID-19 infections and vaccinations in Austin, Texas. University of Texas at Austin. 2021 [cited 2021 Jul 5]. https://covid-19.tacc.utexas.edu/media/filer_public/fe/f2/fef289f8-800c-4390-ab27-6eff3b229f59/covid_infections_and_vaccinations_-_austin_zip_codes_-_ut_-_041221.pdf

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