Self-testing and vaccination against COVID-19 to minimize school closure

ABSTRACT

Schools were closed extensively in 2020-2021 to counter COVID-19 spread, impacting students education and well-being. With highly contagious variants expanding in Europe, safe options to maintain schools open are urgently needed. We developed an agent-based model of SARS-CoV-2 transmission in school. We used empirical contact data in a primary and a secondary school, and data from pilot screenings in 683 schools during the 2021 spring Alpha wave in France. We fitted the model to observed school prevalence to estimate the school-specific reproductive number and performed a cost-benefit analysis examining different intervention protocols. We estimated RAlpha=1.40 (95%CI 1.35-1.45) in the primary and RAlpha=1.46 (1.41-1.51) in the secondary school during the wave, higher than Rt estimated from community surveillance. Considering the Delta variant and vaccination coverage in Europe, we estimated RDelta=1.66 (1.60-1.71) and RDelta=1.10 (1.06-1.14) in the two settings, respectively. Under these conditions, weekly screening with 75% adherence would reduce cases by 34% (95%CI 32-36%) in the primary and 36% (35-39%) in the secondary school compared to symptom-based testing. Insufficient adherence was recorded in pilot screening (median [≤]53%). Regular screening would also reduce student-days lost up to 80% compared to reactive closure. Moderate vaccination coverage in students would still benefit from regular screening for additional control (23% case reduction with 50% vaccinated children). COVID-19 pandemic will likely continue to pose a risk for school opening. Extending vaccination coverage in students, complemented by regular testing largely incentivizing adherence, are essential steps to keep schools open, especially under the threat of more contagious variants.