Study reveals the importance of COVID-19 testing in reopening of schools

The emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is the virus responsible for the coronavirus disease 2019 (COVID-19), led to the closure of schools throughout the world.

Study: COVID-19 testing in schools: Perspectives of school administrators, teachers, parents, and students in Southern California. Image Credit: Photoroyalty / Shutterstock.com

Background

Although widespread school closures were meant to reduce the spread of SARS-CoV-2, the effect of these closures on the viral transmission of and its associated risk was found to be quite modest in families with school-aged children. Furthermore, the closing of schools was found to have detrimental societal, economic, and psychosocial effects on the children. Therefore, reopening schools with safety precautions has been an important priority.

Although school-based transmission was found to be rare, clusters of transmission have been reported. Therefore, periodic COVID-19 testing in schools, along with mask mandates, maintenance of physical distancing, and improved cleaning procedures, could help to identify and isolate infected individuals easily. More specifically, COVID-19 testing in school would lead to the identification of positive cases quickly and provide a quarantine strategy to mitigate the outbreaks.

Several national organizations have recommended the opening of schools; however, most of these entities have recommended that the reopening of schools is accompanied by mask requirements, social distancing, and thorough cleaning. Many states in the United States have also provided free test kits to schools and obtained state-wide Clinical Laboratory Improvement Amendment (CLIA) waivers that allowed COVID-19 tests to be performed at schools.

Online tool kits have also been made available to assist schools in selecting an appropriate testing strategy. However, many schools in Southern California did not include COVID-19 testing in their opening strategies, as it was too expensive and difficult to implement.

A new study published in the preprint server medRxiv*, which was guided by the Protection Motivation Theory, involved a qualitative study to examine attitudes of school administrators, teachers, parents, and students towards the implementation of COVID-19 testing as a part of the reopening strategy. The study also examined the threat of returning to school during the pandemic and how COVID-19 testing could respond to this threat.

About the study

The current study took place in Los Angeles, California, and included interviews of school administrators, focus teacher groups, students, and parents. The recruited participants belonged to nine school districts across Los Angeles that did not include COVID-19 testing as part of their reopening strategy. All districts included in the study were urban and mostly included the Hispanic/Latinx population.

Nine school administrators agreed to participate in the study. These individuals sent out emails to teachers, parents, and students to inquire whether they were interested in participating in the focus group.

If interested in participating, teachers and parents were to sign an online consent form, while the students could become a part of the study when their parents signed the consent form. Taken together, the current study included nine interviews from administrators, four focus groups of teachers involving 23 teachers, five focus groups of parents involving 39 parents, and two focus groups consisting of 13 students.

The data for the study was collected between December 2020 and January 2021 online using the Zoom platform. Several interview questions specific for each group were asked for a duration of 45 to 60 minutes.

Based on the Zoom interviews, transcripts were generated. These transcripts were then reviewed and identified for recurring themes by trained coders.

Study findings

School administrators

Four main themes were identified concerning administrators, including willingness to open, the financial impact of testing, concerns regarding students, and staffing and logistical barriers. The school administrators were willing to open schools by following safety precautions that did not involve COVID-19 testing. Since they had already planned their reopening strategies, the administrators considered the testing to be too expensive and inconvenient.

The administrators were also concerned that they did not have enough staff who were willing to carry out the testing. Additionally, the space required for testing and subsequent quarantining of positive cases was not available. School administrators were also concerned about the stigma of students around testing positive and the trauma of being quarantined in a room alone.

Teachers

For teachers, three main themes were identified, including comfort returning to the classroom, support of frequent testing, and prevention of sending sick children to school. The teachers, unlike the administrators, were in favor of frequent testing, as it would provide a healthier school environment.

Many teachers claimed they did not feel safe returning to the classrooms, as the COVID-19 rate was still high. In addition, few of the teachers believed that frequent testing would prevent parents from sending their sick children to the school that would, in turn, prevent further outbreaks in school.

Parents

For parents, four themes were identified: support of frequent testing, prevention of sending sick children to school, stigma regarding testing positive, and concerns regarding the children’s mental health. Most of the parents favored frequent testing, as it would allow them to send their children to school without any concerns. Notably, parents were concerned about the physical discomfort of testing and the stigma if a student tests positive.

Similar to the teachers' opinions, parents also believed that frequent testing would prevent them from sending sick children to school. In addition, this would prevent other children and staff members from falling sick.

Parents were also concerned about the mental health of their children. The parents reported that children felt depressed, anxious, and lonely due to lockdown and the closure of schools. Therefore, some stated that returning to school would improve the mental health of children.

Students

For students, three themes were identified: concern regarding physical discomfort of testing, support for frequent testing, and opinions regarding in-person compared to online school.

Students, like the parent and teacher groups, were in support of frequent testing in school. However, some students were concerned about the physical discomfort of testing and expressed a preference for tests that were not painful.

The students expressed mixed feelings regarding the continuation of online classes or returning to in-person learning. Some students preferred online learning, as it helped them in having more control over their schedules, while some were frustrated with the monotony and difficulty of concentration during online classes. Students were also concerned that returning to school could pose a threat to their families.

Implications

If schools choose to implement COVID-19 testing, several factors must be considered. For example, schools would need to decide which type of tests to implement, the feasibility of the tests, and the appropriate protocols that would reduce physical and emotional trauma.

Schools also need to devise non-threatening ways to inform parents and teachers of positive results and provide guidance on when infected students could return to school if they test positive for COVID-19. Schools also need to consider how to handle families who do not agree to testing, whether they should implement testing weekly or monthly, and how vaccination would affect testing.

The study had certain limitations. It involved a small population who responded to an email invitation. The study results pertained to high school and might not generalize to middle and elementary schools, and attitudes towards implementation of COVID-19 testing might have changed since the data was collected almost a year ago.

*Important notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:
Suchandrima Bhowmik

Written by

Suchandrima Bhowmik

Suchandrima has a Bachelor of Science (B.Sc.) degree in Microbiology and a Master of Science (M.Sc.) degree in Microbiology from the University of Calcutta, India. The study of health and diseases was always very important to her. In addition to Microbiology, she also gained extensive knowledge in Biochemistry, Immunology, Medical Microbiology, Metabolism, and Biotechnology as part of her master's degree.

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