Research Questions

  1. What was the landscape of COVID-19 testing in U.S. K–12 schools during the 2020 fall semester in terms of the testing programs that early adopters put in place?
  2. What implementation insights can be gained from the efforts of schools that implemented COVID-19 testing in the fall semester of 2020?
  3. How can widespread COVID-19 testing in schools be made more feasible, acceptable, and effective?

To help schools safely return to in-person instruction and expand coronavirus disease 2019 (COVID-19) testing of teachers, other staff, and students, it will be imperative to successfully scale up and spread promising practices from K–12 schools and districts that were early adopters of COVID-19 testing in the fall semester of 2020. This report describes approaches that early adopters of COVID-19 testing in U.S. K–12 schools were using as of December 2020, highlighting key facilitators that made testing feasible, acceptable, and effective in these schools.

In the first half of the report, the authors describe the landscape of testing as of December 2020, summarize the benefits and costs of early adopters' testing programs, and offer recommendations to school leaders, district officials, and policymakers for implementing feasible, acceptable, and effective COVID-19 testing in K–12 schools. They then profile COVID-19 testing programs in selected schools, districts, and states, with a focus on describing the practical details of their testing approaches, challenges they had to overcome, and key factors that facilitated their efforts.

Key Findings

COVID-19 testing programs in K–12 schools and districts in fall 2020 varied across several key dimensions

  • Testing programs varied on whether testing was voluntary or required; whether testing was for staff only or also for students; whether testing was to be conducted for diagnostic, screening, or surveillance purposes; whether tests used saliva samples or nasal swabs; where tests were collected; and where and how tests were analyzed.

Feasible, acceptable, and effective COVID-19 testing among early adopters was marked by several key facilitators

  • Several federal policies and actions, as well as state policies, supported COVID-19 testing adoption.
  • Early-adopter schools developed a variety of creative solutions to address the complex logistical challenges of testing.
  • Early adopters found it critical to partner with local public health departments, local health systems, academia, their peers, and vendors to launch their COVID-19 testing programs.
  • Early adopters encountered varying degrees of resistance to testing and used a variety of strategies to engage their communities.
  • Nearly all of the district and school leaders examined stressed the importance of using testing as one of several tools to facilitate safer in-person instruction.

Early adopters of COVID-19 testing in schools cited three main benefits

  • District and school leaders said that their screening testing programs made staff and families at their schools feel safer.
  • Schools implemented screening testing to identify and isolate individuals with asymptomatic COVID-19 infections and break the chain of transmission.
  • Many school leaders said that their screening testing programs were a prerequisite for offering the option of in-person instruction.

Recommendations

To support feasible COVID-19 testing in schools:

  • Expand federal and state funding for screening testing in schools to pay for tests and associated materials, to hire needed staff, and to contract with vendors for logistical support.
  • Continue to streamline requirements (e.g., CLIA certification waivers) to reduce barriers for schools to implement testing.
  • Convene learning networks of state, district, and school leaders to share promising practices.
  • Continue to invest in research and development of testing solutions that are convenient to administer.

To support schools in making COVID-19 testing acceptable to their communities:

  • Convey clear, consistent, and science-based messages around the risk of COVID-19 transmission in schools and how testing can help to mitigate that risk.
  • Provide incentives, such as paid leave, for teachers and families to be tested and to isolate if infected.
  • Expand guidance around the range of potential testing program designs to help school and district leaders identify an approach that makes the most sense for their context.

To support schools to implement COVID-19 testing programs that achieve their intended goals:

  • Expand laboratory capacity and access to tests that can provide rapid turnaround of test results.
  • Establish state and regional technical assistance networks for schools and districts.
  • Promote the use of standardized metrics and of robust data and reporting platforms to support decisionmaking.
  • Provide resources to strengthen state and local public health departments to help schools and districts respond appropriately to positive tests.

Table of Contents

  • Part 1

    Overview and Key Findings

  • Part 2

    Profiles of Early Adopters

  • Appendix

    Additional Detail on Study Methods

This research was funded by The Rockefeller Foundation and conduced by the Access and Delivery Program within RAND Health Care and RAND Education and Labor.

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