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COVID-19 Testing in Schools: FAQs

Overview

Viral testing strategies are an increasingly important part of a comprehensive mitigation approach. Testing is most helpful in identifying new cases to prevent outbreaks, reducing risk of further transmission, and protecting students and staff from COVID-1

All Illinois districts that have high school enrollment now have access to SHIELD Illinois — the University of Illinois’ innovative polymerase chain reaction (PCR) saliva test. The test has a U.S. Food and Drug Administration (FDA) emergency use authorization (EUA) for both asymptomatic and symptomatic individuals and, therefore, can be used for surveillance, screening, and diagnostic purposes. The Illinois Department of Public Health is providing the test — along with a trained third party to collect the test — at no cost to high schools in Evidence-Based Funding Tiers 1 and 2 and at a subsidized rate to high schools in Tiers 3 and 4.

In a recent clinical trial, SHIELD’s sensitivity rate was 96.8% and specificity rate was 98.9%. This level of accuracy means that staff or students who test positive don't need to seek a second test result to confirm the result. Consistent use of this test has kept the COVID-19 positivity rate below 1 percent at the University of Illinois Urbana-Champaign and is already being used at several districts across Illinois. 

School districts also have free access to Abbott’s BinaxNOW rapid test through the State and/or local public health departments. This EUA-authorized test is performed on-site with results in 15 minutes. Many school districts have found success using these tests for testing of symptomatic students and for surveilling the overall health of the school community. 

Districts may also purchase COVID-19 tests using federal pandemic relief dollars. If you are interested in COVID-19 testing at your school through IDPH supported testing programs, please reach out to DPH.COVIDSchool@Illinois.gov

For additional guidance on testing, refer to:

ISBE and IDPH Revised Public Health Guidance for Schools

IDPH Interim Guidance on Rapid Point-Of-Care Testing for COVID-19 in Community Settings and Schools

COVID-19 Interim Exclusion Guidance: Decision Tree for Symptomatic Individuals in Pre-K, K-12 Schools and Day Care Programs

FAQs

What are the benefits of COVID-19 testing?

• Helps schools reopen and stay open safely, while minimizing in-person learning time lost.

• Works to prevent in-school transmission of SARS-CoV-2, the virus that causes COVID-19. School testing programs identify asymptomatic and pre-symptomatic cases that would not have been excluded due to symptoms or quarantine.

• Builds confidence among families and staff that returning to school is safe. Screening programs that regularly test students and staff can help reassure families, staff, students, and the community that schools are in fact safe places to learn, and their children can feel a sense of normalcy.

• Protects the broader community by increasing testing resources.

• Confirms or eliminates COVID-19 in symptomatic students. Those testing negative in most situations can safely return to school quickly. Those testing positive can quickly be isolated from others, monitor their health for severe symptoms and quickly seek care, protect members of their households, especially those at increased risk for severe disease, and identify close contacts in need of quarantine to stop further transmission.

How does testing help prevent in-school transmission of SARS-CoV-2?

The goal of regular COVID-19 testing in schools is to quickly identify cases before they become outbreaks. When used alongside other prevention strategies, like social distancing and wearing face masks, testing creates an additional level of reassurance for students and educators. School screening testing programs identify asymptomatic and pre-symptomatic cases that would not have been excluded due to symptoms or quarantine. Further, testing in schools can also help reduce spread outside the school walls, and play an important role to mitigate community transmission.

How does testing contribute to in-person learning and smoother school operations?

• Testing is one strategy to safely operate schools, along with masking, social distancing, vaccinations, hand hygiene, contact tracing, and healthy environments. Identifying cases more quickly limits transmission, which also limits the need for quarantine of close contacts and isolation of those testing positive. Ultimately, testing helps to reduce disruptions to in-person learning.

• Proper diagnostic testing can also allow those excluded due to COVID-19-like symptoms to return to school quickly with a negative test result, as long as they are not a known close contact to a confirmed case or part of an outbreak.

Should you get tested even if you are vaccinated?

In general, individuals who are fully vaccinated can be excluded from screening programs. If fully vaccinated persons develop symptoms of COVID-19, they should seek medical evaluation and testing. All persons, including fully vaccinated persons, should continue to wear a properly fitting mask and social distance when in large crowds or around unvaccinated persons, and avoid medium and large gatherings. 

What is the recommended testing program for schools?

• Everyone in schools can benefit from testing: teachers, staff, and students. Screening programs that test 1-2 times per week, depending on community transmission levels, benefits teachers, staff, and students by quickly identifying new positive cases and placing them in isolation, which limits further spread of the virus and the number of teachers, staff, and students requiring quarantine.

• When community transmission is low – fewer than 10 new cases of COVID-19 per 100,000 people – schools should prioritize testing teachers and staff and students involved in extracurricular activities, including sports at least once per week. When community transmission is moderate or higher – 10 or more new cases of COVID-19 per 100,000 – schools should test teachers, staff, and all students at least once per week. IDPH recommends testing students participating in higher-risk sports and other extracurricular activities twice per week.

• At all levels of community transmission, schools should also offer referrals to diagnostic testing to any student, teacher, or staff member who exhibits symptoms of COVID-19 at school. Diagnostic testing includes antigen and NAATs, e.g. RT-PCR.

• Schools should contact their local health department for the most recent information on community transmission levels.

What kind of tests are available for use in the school setting?

• There are two types of viral tests for SARS-CoV-2 – Nucleic Acid Amplification Tests (NAATs), and antigen tests. NAATs, such as real-time reverse transcription-polymerase chain reaction (RT-PCR), are the gold-standard test for diagnosing SARS-CoV-2 infection. The SHIELD Illinois test is one example of an RT-PCR test. Most NAATs need to be processed in a laboratory and time to results can vary (roughly 1–3 days), but some are rapid point-of-care tests with results available in about 15–45 minutes.

• Antigen tests, like BinaxNOW, generally have similar specificity but are less sensitive than most NAATs. Most antigen tests can be processed at the point of care with results available in minutes and thus can be used in screening programs to quickly identify those who are likely to be contagious. Because of the performance characteristics of antigen tests, it may be necessary to confirm some antigen test results (e.g., a negative test in persons with symptoms with known close contact or a positive test in persons without symptoms) with a laboratory-based test.

When is a CLIA certificate needed?

• If your school is using SHIELD or another testing provider to conduct end-to-end diagnostic or screening testing, you do not need to obtain a CLIA waiver directly; the testing provider will instead be responsible for obtaining a CLIA waiver.

• Schools administering diagnostic or screening testing on their own for SARS-CoV-2 with antigen or NAATs must comply with federal CLIA regulations.

• Schools that intend to conduct antigen testing using BinaxNOW tests must first obtain a CLIA waiver. The process simply involves completing and submitting a form to DPH.CLIA@illinois.gov. For more information on the process to obtain a CLIA waiver, schools should contact IDPH at DPH.COVIDSchool@Illinois.gov or the Illinois State Board of Education (ISBE) at COVID19@isbe.net.

How does testing support safer extracurricular programs?

• Testing students who participate in extracurricular activities can identify asymptomatic or pre-symptomatic cases. Isolating those cases will prevent further spread of the virus and reduce the number of exposed individuals requiring quarantine, which can disrupt in-person learning and continuing participation in extracurricular activities. Students participating in extracurricular activities (e.g., sports, band, or other performing arts) are at higher risk for COVID-19 due to the nature of the activity. This is due to the fact that they spend an extended amount of time with the same group of people performing an activity that brings them into close contact (e.g., competitive play) with the same people. Social activities are generally a part of extracurricular activities as well, increasing the time and level of close contact. Unfortunately, mask adherence may not be optimal during many of these interactions. This increases the risk of SARS-CoV-2 being introduced into the school by a cohort of students.

• Due to this higher risk, more frequent testing of twice per week screening testing is recommended to identify asymptomatic persons and mitigate spread.

• For more information related to high-risk sports activities, visit: https://www.dph.illinois.gov/covid19/community-guidance/sports-safety-guidance.

What happens if a student or staff member tests positive?

If a person tests positive by an antigen or NAAT and they are symptomatic, they should be considered infectious and isolated immediately. Persons with whom the person has been in close contact during the 48 hours before their onset to the time before they go into isolation will be identified and quarantine with the exception of those who are fully vaccinated or with evidence of recent infection. If an asymptomatic person tests positive by an antigen or rapid NAAT test (this does not include SHIELD Illinois test which is a lab-based NAAT), confirmatory testing should be performed. The person should isolate until the results of the confirmatory test are received. If confirmatory testing is negative, the person will be released from isolation. For additional details, see the IDPH COVID-19 Interim Exclusion Guidance. 

What happens if a student or staff member tests negative?

If a person has symptoms of COVID-19 and tests negative by NAAT, they should be considered non-infectious. If a symptomatic person tests negative by an antigen test or rapid NAAT, a confirmatory test should be performed. If asymptomatic, in general, a negative test means the person was not infected at the time the sample was collected, however if the person was a known close contact to a confirmed case, that person should remain in quarantine.

The school year is nearly over. Why should my school begin testing now?

• COVID-19 transmission fluctuates and can increase rapidly at any given time. Testing creates a layer of protection, preventing outbreaks, and helping schools and communities avoid shutdowns.

• Establishing a testing program this year immediately supports safe in-person learning for the remainder of this school year, while establishing a testing infrastructure to prepare schools to open safely in the fall. Testing at the start of the school year will be especially important as students will have traveled and participated in group activities. Having a testing program in place ensures that cases can be quickly identified and handled before disrupting the school year. Testing enables schools to support full-scale in-person learning.

• Due to the tremendous impact the pandemic and remote learning has had on students’ academic growth and social-emotional wellness, even a limited amount of time back in-person this school year can benefit students and support their reconnection to their teachers, peers, and school community.

The test positivity rate in my community is low. Why should we test?

Test positivity rate is the number of positive tests over the number of total persons tested. It is one of several metrics tracked by IDPH. It means that coronavirus transmission, relative to testing, is low in your area at the moment. While tracking of community transmission levels can be impacted by the number of people seeking testing, a low test positivity rate usually means that the risk of getting COVID-19 in your area is lower at this time. However, it’s important to remember that coronavirus transmission can increase again at any time. If persons with mild illness or those with exposures are not continuing to test, unidentified cases will continue to expose others and increase cases. Schools need to continue to employ all layers of mitigation to keep transmission levels low, which is necessary to get back to normal school activities.

How do we address teachers, staff, students or parents not wanting to test for fear of being identified as positive and requiring quarantining of their peers, missing out on school, work, or other activities?

• Allowing persons who are infected or exposed to continue to attend school and participate in extracurricular activities will fuel transmission of the virus and possible variants, potentially leading to longer-term restrictions, such as school closures and pauses in sports. Everyone needs to do their part in order for us to return to normal and put the pandemic behind us. Early identification of positive cases through robust testing programs, isolation, and quarantine are vital steps to containing the spread of COVID-19 and preventing the need to move back to a more stringent phase of mitigations community-wide.

• To ease concerns about missing out on activities, consider providing virtual options for participation in events, ensuring students and parents are aware that remote learning will be provided for students who are quaran-tining, and ensuring staff are aware of any paid leave availability if they have to quarantine and cannot work.

My school is already using BinaxNOW rapid antigen testing for symptomatic individuals. Does it make sense to implement a weekly screening program?

Yes! The tests complement each other and provide an enhanced layer of protection. Antigen testing can be valuable for rapid identification and isolation of positive cases, while a weekly screening program identifies asymptomatic spreaders.

How can I implement a free or reduced-rate testing option in my school or district?

• There are two free or low-cost options available to schools through state support. BinaxNOW is a rapid antigen test with the benefit of very fast results. A CLIA waiver and standing physician order are required for schools to utilize BinaxNOW. SHIELD Illinois is a saliva-based NAAT that can be used for screening testing programs. Results typically are available within 24 hours. Schools are not responsible for obtaining a CLIA waiver or physician order to implement the SHIELD Illinois test.

• If schools are interested in using the BinaxNOW antigen test, contact your local health department or email IDPH at DPH.AntigenTesting@Illinois.gov.

• If schools are interested in partnering with SHIELD Illinois, contact Beth Heller, director of external engagement, at bheller@uillinois.edu.

What is the risk of false positives?

Viral testing for any pathogen has the risk of both false negative and false positive results. Since the onset of the pandemic, medical experts in Illinois have advised IDPH on how best to conduct testing in schools to address this. Public health officials and school nurses will work with providers to order confirmatory testing when needed to minimize the risk of a false positive or false negative result. In simplest terms, if the results are not what would be expected (e.g., positive in an asymptomatic person or negative in a person with COVID-like illness with a known exposure), confirmatory testing is recommended. For example, in an area where transmission is low and screening testing is being performed, any persons testing positive by an antigen or rapid NAAT will be confirmed by a laboratory-based NAAT.