Question: I read an article about Rochester Institute of Technology in NY requiring students to get tested before they showed up at college and to bring their negative test result as proof to get onto campus. Why aren’t all schools doing that? Seems like a best practice to prevent spread in the first place?

Answer: We talked about school reopening in our Q&As of 7/30 (#Teachers), 7/28 (#Private School) and 7/27 (#School Reopening), but haven’t directly talked about universal testing. I’m afraid there’s not a straightforward answer to your question…

On the one hand, contrary to your suggestion that universal testing would be a best practice, CDC’s considerations for testing in K-12 schools states, “CDC does not recommend universal testing of all students and staff.” Figure 1 is a screenshot of the full paragraph. Here, the issue is lack of evidence supporting universal testing coupled with implementation challenges. Because testing limitations abound — including time to receive results and the possibility of false negative results (more on false negatives, see Q&A of 7/3 #False Negative) — universal testing would still be insufficient to curtail the spread. Other key interventions — like mask wearing, classroom cohorting, improved ventilation, expanded cleaning/disinfection, daily health checks — would need to continue to be followed. Indeed, as reported last week in CDC’s Morbidity and Mortality Weekly Report, Rhode Island Child Care Centers were able to curtail secondary transmission without using universal testing. Rather, cohorting in small class groups, universal mask wearing by all adults, daily symptom screening of adults and children, and enhanced cleaning and disinfection according to CDC guidelines kept secondary transmission at bay. The authors concluded,”Possible secondary transmission was identified in four of the 666 programs that had been allowed to reopen, all in the last 2 weeks of July, when community transmission in Rhode Island increased. The apparent absence of secondary transmission within the other 662 child care programs was likely the result of RIDOH response efforts to contain transmission and child care programs’ adherence to RIDHS requirements, in particular maximum class sizes and use of face masks for adults.”

On the other hand, when it comes to keeping kids and young adults safe in residential learning facilities like sleep-away camps and residential colleges, the recent experiences of summer camps in Maine offer some important guidance for the way forward. As reported just a few days ago in CDC’s Morbidity and Mortality Weekly Report, the experiences of four different camps in Maine DO point to the utility of universal testing as part of a multifaceted prevention and mitigation strategy (Figure 2). This multifaceted approach included “precamp quarantine, pre- and post-arrival testing and symptom screening, cohorting, and physical distancing between cohorts. In addition, camps required use of face coverings, enhanced hygiene measures, enhanced cleaning and disinfecting, maximal outdoor programming, and early and rapid identification of infection and isolation.” And thanks to these measures, the camps were “successful in identifying and isolating three asymptomatic COVID-19 cases and preventing secondary transmission.” Here testing before arrival was a key component of the strategy and it did have utility.

Figure 1. CDC Recommends Against Universal Testing in K-12 Schools (from CDC)

Figure 2. Multifaceted COVID Prevention and Mitigation in 4 Maine Sleepaway Camps (from CDC)