COVID‐19 Rapid Antigen Testing Implementation in California K‐12 Schools

• DOI: 10.1111/josh.13219
• Publication Date: 2022-08-03T11:13:51Z
• Authors: John D. Malone; Sayone Thihalolip...; Omid Bakhtar; Donnie Salamanca; Sherri Lynn Polanco; Howard Taras
• Keywords: 2019-20 coronavirus outbreak; Pandemic

Scientific evidence is highly supportive that SARS-CoV-2 (COVID-19 virus) transferred to humans from animals sold at a Wuhan China market in the November–December 2019 time.1 The World Health Organization (WHO) declared public health emergency January 2020 and on March 13, 2020, President of United States outbreak national retroactive 1 2020.2, 3 At time with no vaccination or therapeutic capabilities against virus, multiple nonpharmaceutical interventions were implemented. Over 10-day period all 50 states closed kindergarten—grade 12 schools childcare centers along nearly colleges universities.4 Online web-based home instruction was rapidly Only essential service workers (ie, grocery stores, care) allowed engage on-site employment, specifically bars, indoor dining, entertainment venues closed. School opening guidance American Academy Pediatrics June stated, “all policy considerations for coming school year should start goal having students physically present school.”5 In this without vaccine, testing asymptomatic COVID-19-infected children K-12 classroom environment subsequent isolation infected student quarantine exposed students/staff significant intervention. first COVID-19 vaccine 16 years older became available December when Pfizer-BioNTech received FDA Emergency Use Authorization.6 This practice description shares experience two San Diego County socio-economically diverse districts pilot-testing rapid antigen test (BinaxNOW™ card system) amongst staff May 2021. process shared as an example implementation onsite testing. Multiple publications exist support efficacy mitigation strategy.7-11 While remains cornerstone intervention now possible less institutional expense, routine (especially close contact athletic teams) can be effective reducing within-school transmission. Ongoing community leaders parents well coordinated resources state local authorities success. challenges systems implementing weekly screening testing, especially those are chronically underfunded, and/or serve lower socioeconomic students. Laboratory costs, inclusive kits, reagents, laboratory expenses compounded personnel costs obtaining parental permission, training, conduction, isolation, policies who positive, results reporting Public Departments. Pilot development Schools focus project. Unvaccinated pre-symptomatic persons infection capable transmitting including elementary level. Many have minimal symptoms common childhood illness overlap infection. A challenge exists nurses returning child mild headache, nausea) may related non-COVID-19 viral infections calling parent/caretaker likely required leave employment return home. Parents/caretakers then obtain medical clearance care provider negative confirm detectable virus class than effect time. Even turnaround times, often several days absence in-class locating at-home supervision employed parents/caregivers. 2021.10 As advocacy, these partnered Services (PHS) departments, Diego, Human Agency, California State Department (CDPH). pilot different (population 3.38 million). One suburban located high-socio economic area (median price $1.7 M). other rural remote setting, approximately 2-hour drive urban center, median $245 K. Later process, CDPH provided ordering physician, addressed administrative obligations, contracted third party (Primary Health, Inc.) recording results. cards supplied by PHS cost. Test accountability document utilization initial decision point determine specific population test. Those fully vaccinated recovered COVID last 90 become transmit others, if Testing “low prevalence” (likelihood infection) lead “false positive” tests resulting periods individual unvaccinated contacts. major frequency Frequency level acceptable risk prevalence disease population. Once-weekly most appropriate many settings; twice times high transmission beneficial extracurricular activities athletics, cheer, band trumpet players), performing arts song dance.12 Twice while reduce between whom during transmission, disruptive taxes resources; every-other-week more easily allows expose others over course but still better Significant predictive mathematical analytics nationally recognized University indicating would capture largest number based sensitivity detect early Once balanced cost, disruption. compared sensitive once PCR molecular teleconference held Office Education, interested officials recent science advances issues. Initially, distribution schools, training educational County, Agency (County personnel). Of interest, district included Hispanic families routinely crossing US/Mexico border; decreased concerns exposure cross border travel. second type platform. complex nuanced, purposes commentary, will reduced choice “Point care” which utilizes similar pregnancy option polymerase chain reaction (PCR) sent clinical laboratory, returned ideally within 24–48 hours. method through commercial laboratories cost $50/test. settings, hours, settings courier mailing prolonged. Both Authorization (EUA) U.S. Food Drug Administration (FDA). usually involve insertion flocculated swab anterior nares inch nose. Children ages reported tickling sensation not painful. Earlier produced (eg, Quidel Sophia II™, BD Veritor™) distributed federal government small machine read immunofluorescent card-based BinaxNOW™ system here does require reader accurate hands trained earlier tests.13 platforms been EUA approved expected system. Point care, theoretically effectively implemented any situation determining feasibility purpose districts. Initial hurdles finding physician credentialed provider, such nurse practitioner assistant, Clinical Improvement Amendments (CLIA) waiver necessary ensure standards requires clinically provider. also CLIA certifying official California. site (not tests) positive might reporting, tracking desirable.14 cases highest priority handled jurisdictions “probable” per Council Territorial Epidemiologists (CSTE) definition, departments request provide complete picture significance population.15 Since 2021, has invaluable resource schools. Reporting vary jurisdictions. Currently, test, there requirement involvement. Credentialed involvement regulated imply must site, responsible results, notification, is, technician working under RN. On 27 knowledge Omicron variant majority occurs illness, CDC shortened recommended 5 mask wearing 10 after exposure.16 our area, guidelines (CDPH) longer tracing, unidentified group notification case their school. Exposed individuals encouraged tested, symptomatic prior entry (antigen acceptable). Quarantine members, masks strongly MERV 13 air filtration. both BinaxNow™ card-based, found ably performed staff. team comprised 5–6 individuals. Staff primarily accomplished online videos coupled external nursing/physician Onsite ensures control prevention measures place personal protective equipment (PPE) utilized. Moreover, accuracy result operator's expertise. Specifically, detection “positive” colored line, matter how faint, essential. Photos obtained outside experts evaluation questionable cases. Positive suspect generated same-day additional PCR/molecular nasal member truly positive. low setting higher probability involves following roles: (1) “Greeter” enroller. socio-economic educated English-speaking population, preregistration, consent via cell phone feasible portion (2) Self-administered supervisor. 2 showed that, young grade self-swab supervision. Kindergarten initially direct swabbing assistance able Short instructional age-appropriate made one site. swab, optional prize rewarding obtained, supervisor follows kit adding 6 drops reagent, followed insertion, turning card. kept (3) Timer/preliminary reader. minimum 15 exceed 30 minutes. performs preliminary visually confirmed registered (RN) licensed vocational (LVN). simultaneously processed. (4) senior administrator efficient process. (5) interpreter. (RN LVN) interprets reading single-colored line indicates valid result; two-colored lines result. (6) Recorder. documents into data base utilized existing nonmedical events. Attention detail ability follow procedures interpersonal teamwork skills important qualifications. Executive assistants supply proven excellent members. Processing 20–30 hour, repeat teachers procedures. Some educators combined event curriculum. PPE face shield/goggles, double fit-tested N95 respirator, gowns, gloves members—the timer/preliminary handle potentially infectious swabs. No PPE. Infectious waste requirements vary. Southern only material designated “infectious waste” requiring “red bag” specialized environmental handling swabs tests. Notification confidentiality sensitivity, teacher tested student, During frame, back same day confirmatory These analysis. current paradigm, confirmation necessary. upon 20K Binax™ showing specificity 98%, meaning 100 false-positive Close interactions maintained suggestions “from field” eagerly accepted authority team. program, managed “presumptive case, removal until 24 48 If negative, student/staff returned; continued isolation. School-based conjunction identified contacts 14 days. had antigen-positive out 1800 2021 positives occurring February prevalent community. month later, location conducted 400 positives, coinciding fallen. All samples districts' leadership nursing valuable broader providing technical information encouragement program throughout State. quick response (QR) codes, therefore, digitalized Two merged—Color.Com Primary. Health—both products assisting management systems. services free charge. Fees monthly stipend cost—with varying volume states, noncommercial sourced spread sheets potential substitutes, onerous situations. “rapid” RNA “loop” amplification (Cue™), genetic technology evaluated systems.17 FDA/EUA approval sample placed cartridge very platform 20 synchronized application reports An coverage, required. time, could required.18 great benefit delineate sudden onset setting. shown feasible, partnership departments. geographically successfully procedure. then, functioned mentors quickly advanced offers efforts address students, parents, teachers, staff, administrators, leaders. identify mitigate opinions assertions expressed herein authors do necessarily reflect position Coronado Borrego Springs, Agency. conflicts interest authors.