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Thompson AL, Davis BS, Rohrbach A, Davis JM, Sebastiani P, Tang AM. Communication Disparities and Trusted Sources of COVID-19 Information in Massachusetts School Districts. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024:00124784-990000000-00344. [PMID: 39249147 DOI: 10.1097/phh.0000000000002052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
CONTEXT The COVID-19 pandemic led to the closure of prekindergarten to grade 12 schools and an inequitable return to full-time in-person learning. OBJECTIVE To explore how ethnic and racial differences across school districts in Massachusetts correlate with parents' attitudes, beliefs, and trusted sources of information about COVID-19 and mitigation strategies. DESIGN An electronic survey was distributed by school administrators to parents and guardians in November and December 2021 using existing school district contact lists and established methods of communication (email in 2 school districts; email and text message in 1 district). SETTING Three school districts in Massachusetts (Chelsea, Medford, and Somerville). PARTICIPANTS Parents of prekindergarten to grade 12 school students attending public schools. MAIN OUTCOME MEASURES Parental attitudes and beliefs regarding mitigation strategies for COVID-19 (surveillance testing, masking, and vaccination); trusted information sources about COVID-19; preferred methods of communication from schools. RESULTS A total of 1496 survey responses were analyzed. Chelsea respondents were predominantly Hispanic/LatinX (88%); Medford and Somerville were predominantly White/non-Hispanic (80% and 68%, respectively). Testing, masks, and vaccination were supported by >80% of parents/guardians across districts. However, there were statistically significant differences between school districts regarding participation in testing programs, implications of a child testing positive, vaccination of young children, communication preferences, and trusted sources of information. CONCLUSIONS Although primarily focused on COVID-19, these results highlight opportunities for public health personnel and school administrators to work directly with parents and guardians in their school districts to improve communication strategies and be a trusted source of information for a variety of public health issues.
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Affiliation(s)
- Anna L Thompson
- Author Affiliations: Strategic Initiatives, Office of the Vice Provost for Research, Tufts University, Boston, MA (Ms Anna Thompson, Mr Bradley Davis, Dr Augusta Rohrbach); Tufts Clinical and Translational Science Institute (CTSI), Tufts University, Tufts Medical Center, Boston, MA (Dr Jonathan Davis); Biostatistics, Epidemiology, and Research Design (BERD) Center, Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA (Dr Paola Sebastiani); and Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA (Dr Alice Tang)
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Chmelík F, Frömel K, Groffik D, Mitáš J. Physical activity and life satisfaction among adolescents before and during the COVID-19 pandemic. Acta Psychol (Amst) 2023; 241:104081. [PMID: 37976920 DOI: 10.1016/j.actpsy.2023.104081] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023] Open
Abstract
The negative impact of the COVID-19 pandemic and distance education has significantly affected adolescents' lives. The restrictive policies negatively affected their physical and mental health and life satisfaction. It is therefore desirable to look for ways to eliminate similar negative impacts on adolescents in the future. This study aimed to identify the differences in the association between physical activity and life satisfaction in Polish adolescents before and during the pandemic. The study included 1541 participants (891 before the pandemic and 650 during the pandemic) aged 15-19 years. The International Physical Activity Questionnaire-Long Form questionnaire was used to assess physical activity, and the Bern Subjective Well-Being Questionnaire was used to evaluate life satisfaction. The objectivity of data collection and analysis before and during the pandemic was ensured by the web application the International Database for Research and Educational Support. During the pandemic, we found lower physical activity and life satisfaction in both boys and girls compared to before the pandemic. Girls with low and high physical activity levels showed significantly lower life satisfaction during the pandemic than they did before. Low life satisfaction was associated with lower physical activity, and high life satisfaction was associated with greater total physical activity. Both boys and girls with low and high life satisfaction achieved significantly fewer physical activity recommendations during the pandemic. High life satisfaction increased the likelihood of meeting the recommendations for physical activity before and during the pandemic. This study provides new insights into the differences and associations between life satisfaction and physical activity in adolescent boys and girls before and during the pandemic. It provides suggestions for the prevention of possible future restrictions in the school settings. Support for post-pandemic life satisfaction in adolescents should focus mainly on increasing vigorous physical activity and improving adolescent participation in organized physical activity settings.
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Affiliation(s)
- František Chmelík
- Institute of Active Lifestyle, Faculty of Physical Culture, Palacký University Olomouc, Tř. Míru 117, 771 11 Olomouc, Czech Republic.
| | - Karel Frömel
- Institute of Active Lifestyle, Faculty of Physical Culture, Palacký University Olomouc, Tř. Míru 117, 771 11 Olomouc, Czech Republic; Institute of Sport Science, The Jerzy Kukuczka Academy of Physical Education in Katowice, Mikołowska 72a, 40-065 Katowice, Poland.
| | - Dorota Groffik
- Institute of Sport Science, The Jerzy Kukuczka Academy of Physical Education in Katowice, Mikołowska 72a, 40-065 Katowice, Poland.
| | - Josef Mitáš
- Institute of Active Lifestyle, Faculty of Physical Culture, Palacký University Olomouc, Tř. Míru 117, 771 11 Olomouc, Czech Republic.
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Lyu S, Adegboye O, Adhinugraha K, Emeto TI, Taniar D. COVID-19 Prevention Strategies for Victoria Students within Educational Facilities: An AI-Based Modelling Study. Healthcare (Basel) 2023; 11:healthcare11060860. [PMID: 36981517 PMCID: PMC10048279 DOI: 10.3390/healthcare11060860] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/11/2023] [Accepted: 03/12/2023] [Indexed: 03/17/2023] Open
Abstract
Educational institutions play a significant role in the community spread of SARS-CoV-2 in Victoria. Despite a series of social restrictions and preventive measures in educational institutions implemented by the Victorian Government, confirmed cases among people under 20 years of age accounted for more than a quarter of the total infections in the state. In this study, we investigated the risk factors associated with COVID-19 infection within Victoria educational institutions using an incremental deep learning recurrent neural network-gated recurrent unit (RNN-GRU) model. The RNN-GRU model simulation was built based on three risk dimensions: (1) school-related risk factors, (2) student-related community risk factors, and (3) general population risk factors. Our data analysis showed that COVID-19 infection cases among people aged 10–19 years were higher than those aged 0–9 years in the Victorian region in 2020–2022. Within the three dimensions, a significant association was identified between school-initiated contact tracing (0.6110), vaccination policy for students and teachers (0.6100), testing policy (0.6109), and face covering (0.6071) and prevention of COVID-19 infection in educational settings. Furthermore, the study showed that different risk factors have varying degrees of effectiveness in preventing COVID-19 infection for the 0–9 and 10–19 age groups, such as state travel control (0.2743 vs. 0.3390), international travel control (0.2757 vs. 0.3357) and school closure (0.2738 vs. 0.3323), etc. More preventive support is suggested for the younger generation, especially for the 10–19 age group.
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Affiliation(s)
- Shiyang Lyu
- Faculty of Information Technology, Monash University, Melbourne, VIC 3800, Australia
| | - Oyelola Adegboye
- Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia
| | - Kiki Adhinugraha
- Department of Computer Science and Information Technology, La Trobe University, Melbourne, VIC 3086, Australia
| | - Theophilus I. Emeto
- Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia
| | - David Taniar
- Faculty of Information Technology, Monash University, Melbourne, VIC 3800, Australia
- Correspondence:
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Cooper CM, Przeworski A, Smith AC, Obeid R, Short EJ. Perceptions of Social-Emotional Learning Among K-12 Teachers in the USA During the COVID-19 Pandemic. SCHOOL MENTAL HEALTH 2023; 15:1-14. [PMID: 36686286 PMCID: PMC9838265 DOI: 10.1007/s12310-022-09563-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 01/12/2023]
Abstract
Social-emotional learning (SEL) is the process of acquiring and applying knowledge, skills, and attitudes to achieve long-term relational and emotional goals. Teachers often implement SEL strategies in the classroom; however, shifting to online schooling during the COVID-19 pandemic may have impacted teachers' perceptions of their abilities to implement SEL. This study was designed to identify whether and how teachers' perceptions of SEL changed since the onset of the COVID-19 pandemic. Teachers (N = 637) in the USA completed a demographic questionnaire, the Depression, Anxiety, and Stress Scale (DASS-21), and rated their beliefs about SEL during the pandemic on a modified version of the Comfort and Culture subscales of the Teacher SEL Beliefs Scale. Data were collected between September 2020 and March 2021. Teachers indicated that they felt neutral to comfortable with SEL and that they felt neutral to supported by their school culture for SEL during the pandemic. Lower depression symptoms, greater school poverty, and perceived general support (not specific to SEL) from the administration were associated with higher teacher comfort with SEL. Further, greater general support from the district and colleagues was associated with greater school culture supporting SEL during COVID-19. Results suggest that addressing teachers' internalizing symptoms and fostering a supportive work environment is important in aiding teachers in SEL implementation.
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Affiliation(s)
- Chelsea M. Cooper
- Department of Psychological Sciences, Case Western Reserve University, 11220 Bellflower Road, Cleveland, OH 44106 USA
| | - Amy Przeworski
- Department of Psychological Sciences, Case Western Reserve University, 11220 Bellflower Road, Cleveland, OH 44106 USA
| | - Alexandra C. Smith
- Department of Psychological Sciences, Case Western Reserve University, 11220 Bellflower Road, Cleveland, OH 44106 USA
| | - Rita Obeid
- Department of Psychological Sciences, Case Western Reserve University, 11220 Bellflower Road, Cleveland, OH 44106 USA
| | - Elizabeth J. Short
- Department of Psychological Sciences, Case Western Reserve University, 11220 Bellflower Road, Cleveland, OH 44106 USA
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Rotevatn TA, Nygård K, Espenhain L, Legarth R, Møller KL, Sarvikivi E, Helve O, Aspelund G, Ersson A, Nordahl M, Greve-Isdahl M, Astrup E, Johansen TB. When schools were open for in-person teaching during the COVID-19 pandemic - the nordic experience on control measures and transmission in schools during the delta wave. BMC Public Health 2023; 23:62. [PMID: 36624496 PMCID: PMC9828373 DOI: 10.1186/s12889-022-14906-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Extensive measures to control spread of SARS-CoV-2 have led to limited access to education for millions of children and adolescents during the COVID-19 pandemic. Education and access to schools is vital for children and adolescents' learning, health, and wellbeing. Based on high vaccine uptake and low incidence levels, the Nordic countries (Denmark, Finland, Iceland, Norway and Sweden) decided to start the academic year 2021/22 with schools open for in-person teaching and moderate mitigation measures. We describe trends in SARS-CoV-2 infections and vaccination coverage among students during the first 12 weeks of the fall semester. METHODS In this multinational, retrospective, observational study, we have used surveillance and registry data from each of the Nordic countries to describe vaccine uptake (≥12 years), infection incidence (whole population) and transmission of SARS-CoV-2 among students. The study period, week 30 to 41 (Jul 26th - Oct 17th), represents the autumn semester from immediately before school started until fall break. In addition, we collected information on mitigation measures applied by the respective countries. RESULTS There were slight variations between the countries regarding existing infection prevention and control (IPC) measures, testing strategies and vaccination start-up among adolescents. All countries had high vaccine uptake in the adult population, while uptake varied more in the younger age groups. Incidence in the school-aged population differed between countries and seemed to be influenced by both vaccine uptake and test activity. Infection clusters among school-aged children were described for Denmark and Norway, and the number of clusters per week reflected the incidence trend of the country. Most events consisted of only 1-2 cases. Larger clusters appeared more frequently in the higher grades in Norway and in lower grades in Denmark. CONCLUSION Data from the Nordic countries indicate that vaccination of adults and adolescents, in addition to mitigation measures, enabled full in-person learning. As SARS-CoV-2 infection does not represent a severe medical risk for most children as previously thought, measures targeting this group should be carefully adjusted and kept at a minimum. Our data add to the evidence on incidence and transmission of SARS-CoV-2 among students in schools open for in-person teaching, and may be valuable for decision makers worldwide.
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Affiliation(s)
| | - Karin Nygård
- Norwegian Institute of Public Health, Oslo, Norway
| | | | | | | | - Emmi Sarvikivi
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Otto Helve
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Annika Ersson
- The Public Health Agency of Sweden, Stockholm, Sweden
| | - Marie Nordahl
- The Public Health Agency of Sweden, Stockholm, Sweden
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Lotfy NM, Shafik HM, Nassief M. Risk factor assessment of digital eye strain during the COVID-19 pandemic: a cross-sectional survey. MEDICAL HYPOTHESIS, DISCOVERY & INNOVATION OPHTHALMOLOGY JOURNAL 2022; 11:119-128. [PMID: 37641641 PMCID: PMC10445314 DOI: 10.51329/mehdiophthal1455] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/30/2022] [Indexed: 08/31/2023]
Abstract
Background Shifting to online learning during the coronavirus pandemic has increased the number of individuals symptomatic of digital eye strain (DES). This study aimed to determine the frequency and potential risk factors of DES among university staff members and students in this pandemic era. Methods A cross-sectional online survey was conducted during the pandemic, in May and June 2020. The online questionnaire was designed to collect data on DES-related ocular and extraocular manifestations. The survey was sent via social media to the previous year's students and staff within the Faculty of Medicine, Tanta University, Tanta, Egypt. The responses were downloaded and analyzed. Results Of the 412 participants completing the questionnaire, 34 (8.3%) were university staff members with a mean (standard deviation [SD]) age of 36.7 (6.6) years, and 378 (91.7%) were university students with a mean (SD) age of 20.8 (1.8) years. Participants with DES symptoms numbered 294 (71.4%) before the lockdown, increasing to 366 (88.8%) during the last month, with 84 developing new-onset DES. Most participants reported ocular symptoms associated with DES. After the lockdown, both students and staff had a significant prolongation of nighttime digital screen use and TV watching, an increase in the 4-item Patient Health Questionnaire (PHQ-4) severity scale scores, and anxiety and depression, with a reduced duration of daytime reading (all P < 0.05). Students had a significant prolongation of daytime digital screen use and TV watching and an increase in the frequency of eye lubricant use and mean Perceived Stress Scale (PSS)-4 scores (all P < 0.05). Multiple logistic regression analysis revealed that studenthood and increased nighttime screen use were independent risk factors for DES by odds ratios (95% confidence intervals) of 10.60 (2.12 - 53.00) and 3.99 (1.71 - 9.34), respectively (both P < 0.05). Conclusions Lockdown and closure of the university, with a shift to online learning, increased the exposure of staff and students to digital screens and the number of individuals with DES. Studenthood and prolonged nighttime digital screen use were independent risk factors for DES. Further studies investigating the prevalence and risk factors of DES, comparing similar data during and after the pandemic, may reveal other aspects of DES caused by virtual reality-based training.
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Affiliation(s)
- Nancy M. Lotfy
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Heba M. Shafik
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mona Nassief
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
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Campbell MM, Benjamin DK, Mann TK, Fist A, Blakemore A, Diaz KS, Kim H, Edwards LJ, Rak Z, Brookhart MA, Moore Z, Tilson EC, Kalu I, Boutzoukas AE, Moorthy GS, Uthappa D, Scott Z, Weber DJ, Shane AL, Bryant KA, Zimmerman KO. Test-to-Stay After SARS-CoV-2 Exposure: A Mitigation Strategy for Optionally Masked K-12 Schools. Pediatrics 2022; 150:e2022058200. [PMID: 35971240 PMCID: PMC9647593 DOI: 10.1542/peds.2022-058200] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES We evaluated the impact of a test-to-stay (TTS) program on within-school transmission and missed school days in optionally masked kindergarten through 12th grade schools during a period of high community severe acute respiratory syndrome coronavirus 2 transmission. METHODS Close contacts of those with confirmed severe acute respiratory syndrome coronavirus 2 infection were eligible for enrollment in the TTS program if exposure to a nonhousehold contact occurred between November 11, 2021 and January 28, 2022. Consented participants avoided school exclusion if they remained asymptomatic and rapid antigen testing at prespecified intervals remained negative. Primary outcomes included within-school tertiary attack rate (test positivity among close contacts of positive TTS participants) and school days saved among TTS participants. We estimated the number of additional school-acquired cases resulting from TTS and eliminating school exclusion. RESULTS A total of 1675 participants tested positive or received at least 1 negative test between days 5 and 7 and completed follow-up; 92% were students and 91% were exposed to an unmasked primary case. We identified 201 positive cases. We observed a tertiary attack rate of 10% (95% confidence interval: 6%-19%), and 7272 (89%) of potentially missed days were saved through TTS implementation. We estimated 1 additional school-acquired case for every 21 TTS participants remaining in school buildings during the entire study period. CONCLUSIONS Even in the setting of high community transmission, a TTS strategy resulted in substantial reduction in missed school days in optionally masked schools.
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Affiliation(s)
| | - Daniel K Benjamin
- Duke Clinical Research Institute
- Department of Pediatrics
- Co-Chair, The ABC Science Collaborative, Durham, North Carolina
| | | | | | | | | | | | | | | | | | - Zack Moore
- North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | | | - Ibukun Kalu
- Duke Clinical Research Institute
- Department of Pediatrics
| | | | | | - Diya Uthappa
- Doctor of Medicine Program, Duke University School of Medicine, Durham, North Carolina
| | | | - David J Weber
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Andi L Shane
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Kristina A Bryant
- University of Louisville and Norton Children's Hospital, Louisville, Kentucky
| | - Kanecia O Zimmerman
- Duke Clinical Research Institute
- Department of Pediatrics
- Co-Chair, The ABC Science Collaborative, Durham, North Carolina
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Schulze Heuling D, Helm C. [School Closures - an Ethical Challenge]. ZEITSCHRIFT FUR BILDUNGSFORSCHUNG 2022; 12:631-645. [PMID: 36713970 PMCID: PMC9549434 DOI: 10.1007/s35834-022-00364-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 11/23/2022]
Abstract
The COVID-19 pandemic has led many countries around the world to take drastic measures. Regardless of the epidemiological impact, it is undisputed that these measures have had significant negative effects on scholastic attainment, psychosocial and physical health of children and adolescents. Given their consequences, such interventions evoke the question of their ethical justifiability. This article introduces the most common ethical theories and, building on them, discusses the ethical evaluation of the COVID-19-related school closures.
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Affiliation(s)
- Dagmar Schulze Heuling
- Staatswissenschaftliche Fakultät, Universität Erfurt, Nordhäuser Str. 63, 99089 Erfurt, Deutschland
| | - Christoph Helm
- Linz School of Education, Johannes Kepler Universität Linz, Altenberger Straße 69, 4040 Linz, Österreich
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Schechter-Perkins EM, Doron S, Johnston R, Hay J, Berlin D, Ciaranello A, Nelson SB, Gormley JM, Smole SC, Brown CM, Madoff LC, Branch-Elliman W. A Test-to-Stay Modified Quarantine Program for COVID-19 in Schools. Pediatrics 2022; 149:184750. [PMID: 35132435 DOI: 10.1542/peds.2021-055727] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Mandatory quarantine upon exposure to coronavirus disease 2019 (COVID-19) results in a substantial number of lost days of school. We hypothesized that implementation of a state-wide test-to-stay (TTS) program would allow more students to participate in in-person learning, and not cause additional clusters of COVID-19 cases due to in-school transmission. METHODS For the 2020-2021 academic year, Massachusetts implemented an opt-in TTS program, in which students exposed to COVID-19 in school are tested each school day with a rapid antigen test. If negative, students may participate in school-related activities that day. Testing occurs daily for a duration of 7 calendar days after exposure. Here, we report the results from the first 13 weeks of the program. RESULTS A total of 2298 schools signed up for TTS, and 504 167 individuals out of a total population of 860 457 consented. During the first 13 weeks with complete data, 1959 schools activated the program at least once for 102 373 individual, exposed students. Out of 328 271 tests performed, 2943 positive cases were identified (per person positivity rate, 2.9%, 95% confidence interval, 2.8-3.0). A minimum of 325 328 and a maximum of 497 150 days of in-person school were saved through participation in the program. CONCLUSIONS Daily, rapid on-site antigen testing is a safe and feasible alternative to mandatory quarantine and can be used to maximize safe in-person learning time during the pandemic.
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Affiliation(s)
- Elissa M Schechter-Perkins
- Department of Emergency Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
| | | | - Russell Johnston
- Massachusetts Department of Elementary and Secondary Education, Malden, Massachusetts
| | - Jeremiah Hay
- Massachusetts Executive Office of Health and Human Services, Boston, Massachusetts
| | | | - Andrea Ciaranello
- Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts
| | - Sandra B Nelson
- Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts
| | - Jenny M Gormley
- Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Sandra C Smole
- Massachusetts Department of Public Health, Boston, Massachusetts
| | | | | | - Westyn Branch-Elliman
- Department of Medicine, Section of Infectious Disease, VA Boston Healthcare System and Harvard Medical School, Boston
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