Test-to-Stay After SARS-CoV-2 Exposure: A Mitigation Strategy for Optionally Masked K-12 Schools.

OBJECTIVES: We evaluated the impact of a test-to-stay (TTS) program on within-school transmission and missed school days in optionally masked kindergarten through 12th grade schools during a period of high community severe acute respiratory syndrome coronavirus 2 transmission. METHODS: Close contacts of those with confirmed severe acute respiratory syndrome coronavirus 2 infection were eligible for enrollment in the TTS program if exposure to a nonhousehold contact occurred between November 11, 2021 and January 28, 2022. Consented participants avoided school exclusion if they remained asymptomatic and rapid antigen testing at prespecified intervals remained negative. Primary outcomes included within-school tertiary attack rate (test positivity among close contacts of positive TTS participants) and school days saved among TTS participants. We estimated the number of additional school-acquired cases resulting from TTS and eliminating school exclusion. RESULTS: A total of 1675 participants tested positive or received at least 1 negative test between days 5 and 7 and completed follow-up; 92% were students and 91% were exposed to an unmasked primary case. We identified 201 positive cases. We observed a tertiary attack rate of 10% (95% confidence interval: 6%-19%), and 7272 (89%) of potentially missed days were saved through TTS implementation. We estimated 1 additional school-acquired case for every 21 TTS participants remaining in school buildings during the entire study period. CONCLUSIONS: Even in the setting of high community transmission, a TTS strategy resulted in substantial reduction in missed school days in optionally masked schools.

Test-to-Stay After Exposure to SARS-CoV-2 in K-12 Schools.

OBJECTIVES: We evaluated the safety and efficacy of a test-to-stay program for unvaccinated students and staff who experienced an unmasked, in-school exposure to someone with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Serial testing instead of quarantine was offered to asymptomatic contacts. We measured secondary and tertiary transmission rates within participating schools and in-school days preserved for participants. METHODS: Participating staff or students from universally masked districts in North Carolina underwent rapid antigen testing at set intervals up to 7 days after known exposure. Collected data included location or setting of exposure, participant symptoms, and school absences up to 14 days after enrollment. Outcomes included tertiary transmission, secondary transmission, and school days saved among test-to-stay participants. A prespecified interim safety analysis occurred after 1 month of enrollment. RESULTS: We enrolled 367 participants and completed 14-day follow-up on all participants for this analysis. Nearly all (215 of 238, 90%) exposure encounters involved an unmasked index case and an unmasked close contact, with most (353 of 366, 96%) occurring indoors, during lunch (137 of 357, 39%) or athletics (45 of 357, 13%). Secondary attack rate was 1.7% (95% confidence interval: 0.6%-4.7%) based on 883 SARS-CoV-2 serial rapid antigen tests with results from 357 participants; no tertiary cases were identified, and 1628 (92%) school days were saved through test-to-stay program implementation out of 1764 days potentially missed. CONCLUSION: After unmasked in-school exposure to SARS-CoV-2, even in a mostly unvaccinated population, a test-to-stay strategy is a safe alternative to quarantine.

Investing in Whole Person Health: Working Toward an Integration of Physical, Behavioral, and Social Health.

North Carolina is developing a unique and innovative infrastructure to support integrated physical, behavioral, and social health care. Efforts by the North Carolina Department of Health and Human Services, the Foundation for Health Leadership & Innovation, Cone Health, Atrium Health, and the One Charlotte Health Alliance advance our understanding of how to best operationalize the design and payment of integrated services. Best practices such as the collaborative care and primary care behavioral health models reduce inefficiencies and disparities by bringing together teams of primary care and behavioral health care providers.

Buying Health For North Carolinians: Addressing Nonmedical Drivers Of Health At Scale.

Since 2017 the North Carolina Department of Health and Human Services has asked how its resources could be optimized to buy health, not only health care. This has led the department to incorporate whole-person care into all of its priorities, including building a statewide infrastructure and implementing incentives to address nonmedical drivers of health-focusing on food, housing, transportation, employment, and interpersonal safety/toxic stress. This article describes four interconnected initiatives that the department has implemented or is implementing to begin integrating medical and nonmedical drivers of health. This multifaceted effort involves many partners and includes financial incentives for commercial payers, Medicare, and Medicaid that are aligned with whole-person care; a standardized screening process to identify people with unmet social resource needs across all populations; NCCARE360, the first statewide network linking health care and human services providers to one another with a shared technology platform; and a large-scale Medicaid pilot to evaluate the impact of nonmedical health interventions on health outcomes and health care costs. North Carolina's interconnected initiatives can help inform efforts around the US and generate needed evidence on how to implement systems through public-private partnerships to address nonmedical drivers of health at scale.

Adverse Childhood Experiences (ACEs): An Important Element of a Comprehensive Approach to the Opioid Crisis.

Adverse childhood experiences (ACEs) are traumatic life events that are linked to more than 40 poor adult health outcomes. Up to two-thirds of drug use problems may be traced back to ACEs [1]. Investing in the resiliency of our children is an important component of a comprehensive approach to the opioid epidemic.

Dissemination and Adoption of Guidelines: The Experience of Community Care of North Carolina.

Dissemination and adoption of practice guidelines has the potential to improve the health of a population. However, these processes are complex and take place in the context of a myriad of factors that impact patient and provider behaviors. Therefore, successful strategies-like the ones utilized by Community Care of North Carolina-need to be multifaceted.

Community Care of North Carolina's approach to asthma management.

Community Care of North Carolina (CCNC) takes a comprehensive approach to asthma management. Support from CCNC helps providers follow evidence-based practice guidelines; data guide continuous quality improvement initiatives and inform the care of individual patients and populations; and care managers work with high-risk patients.