Reopening Schools Safely in the COVID-19 Pandemic Through the Use of Low-Cost Pooled Surveillance Testing

Abstract

Background: The negative impact of continued school closures during the height of the COVID-19 pandemic warrants the establishment of cost-effective strategies for surveillance and screening to safely reopen and monitor for potential in-school transmission. Here, we present a novel approach to increase the availability of repetitive and routine Covid-19 testing that may ultimately reduce the overall viral burden in the community. Methods: We implemented a testing program that included students, faculty and staff from K-12 schools and universities participating in the SalivaClear™ pooled surveillance method (Mirimus Clinical Labs, Brooklyn, NY). Findings: Over 250,000 saliva specimens were self-collected from students, faculty and staff from 93 K-12 schools and 18 universities. Pool sizes of up to 24 samples were tested over a 20-week period. Pooled testing did not significantly alter the sensitivity of the molecular assay in terms of both qualitative (100% detection rate on both pooled and individual samples) and quantitative (comparable cycle threshold (CT) values between pooled and individual samples) measures. Pooling samples substantially reduced the costs associated with PCR testing and allowed schools to rapidly assess transmission and adjust prevention protocols as necessary. In one instance, in-school transmission of the virus was determined within the main office and led to review and revision of heating, ventilating and air-conditioning systems. Interpretation: By establishing low-cost, weekly testing of students and faculty, pooled saliva analysis enabled schools to determine whether transmission had occurred, make data-driven decisions, and adjust safety protocols. Pooled testing is a fundamental component to the reopening of schools, minimizing transmission among students and faculty.Funding: Skoll Foundation generously provided funding to Mobilizing Foundation and Mirimus for these studies.Declaration of Interests: None.Ethics Approval Statement: The SUNY Downstate Health Sciences University Institutional Review Board (IRB) reviewed and approved the study protocol (IRB #1232938-3).