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Test to Stay Programs Will Keep Schools Open—If States Provide Sufficient Staffing and Support

Research from Duke-Margolis Reiterates Test to Stay’s Effectiveness, but Clarifies Key Technical and Equity Pitfalls Schools Must Avoid

New York | January 19, 2022 — A new issue brief, Testing as an Alternative to Quarantining: Key Considerations and Best Practices for Implementing Test to Stay, from the Duke-Margolis Center for Health Policy, with support from The Rockefeller Foundation, shows that school Test to Stay programs, when implemented correctly, can reduce tens of thousands of unnecessary student quarantines while keeping children safe in schools.

Complementing guidance from the U.S. Centers for Disease Control and Prevention, this issue brief highlights case examples from Illinois, Massachusetts, and North Carolina’s Test to Stay programs, which allow students who are close contacts of positive cases for Covid-19 to stay in school and undergo repeated testing, instead of quarantining at home. The brief shares ways to design and implement Test to Stay programs that are effective in keeping classrooms open and reducing longstanding inequities, especially for working parents. These findings draw on interviews with state and school leaders, along with leaders at ABC Science Collaborative, African American Covid Taskforce (AACT+), and Latinx Advocacy Team & Interdisciplinary Network for Covid-19 (LATIN-19).

“Keeping kids at school and in-person safely is vital to their mental health and educational well-being and, importantly, minimizes disruption to families, especially for parents or caregivers who cannot work remotely” said Dr. Mark McClellan, Director of Duke-Margolis Center for Health Policy. “It is critical that policymakers implement strategies that overcome the potential technical and equity gaps in their Test to Stay programs, if they want to fully harness the benefits of Test to Stay.”

The issue brief details key takeaways from early data on Test to Stay programs. Test to Stay can safely increase in-person school days for students who have been in close contact with someone who has tested positive for Covid-19 by allowing the student to stay in school while being repeatedly tested as an alternative to quarantining at home. For example, the Illinois’ Test to Stay program allowed more students to stay in school as they did not have to quarantine. Researchers found that of the 6,600 students identified as close contacts, only two percent (139 students) tested positive for Covid-19 and had to quarantine. That’s 6,461 students that were able to safely stay learning in-person rather than missing school and thousands of families who didn’t need to scramble to make unexpected childcare arrangements.

“The data is clear: Test to Stay programs mean that more kids are safe and in school, parents face fewer quarantine disruptions, and everyone – including teachers and staff – feels safer with in-person learning,” said Leah Perkinson, Manager of Pandemics at The Rockefeller Foundation. “But the potential for success hinges on the technical and equity considerations outlined in today’s brief, including test supply. If school officials don’t think through all the challenges in advance, they risk overburdening weary staff and alienating concerned parents, especially in school districts that are already underfunded.”

Researchers also recommend Test to Stay be used as part of a layered Covid-19 safety plan and combined with other strategies like physical distancing, improved ventilation, masking, and school-located vaccinations to create a safer school environment.

“Test to Stay implemented alongside other Covid-19 mitigation strategies offers a powerful tool to facilitate safe, in-person instruction,” said Andrea Thoumi, Health Equity Policy Fellow, Duke-Margolis. “Efforts centering just and equitable strategies are needed to ensure all children, educators, and school staff, especially those from marginalized and minoritized communities, can access Test to Stay.”

The brief also identifies four keys to success to help state- and local officials overcome the challenges of Test to Stay programs:

  • Fund and Staff Adequately: successful schools received funding quickly and efficiently hired appropriate staff members to help administer their programs.
  • Give More to Existing Underfunded Schools: states reallocated funds and staff to ensure that traditionally underfunded schools had adequate funding and staffing.
  • Help Parents and Students Understand: successful schools prioritized communicating their Test to Stay program to parents and students, including its benefits, how it would work and why it is safe.
  • Consider Cultural Differences: successful schools developed culturally appropriate responses that account for local contexts and parental views.

Today’s report is the latest in The Rockefeller Foundation’s ongoing efforts to provide America’s educators and policymakers with the tools they need to reopen their schools safely and effectively, including real-world research and operational guidance. Find a compilation of resources here.


About the Duke-Margolis Center for Health Policy
The mission of the Robert J. Margolis, MD, Center for Health Policy at Duke University is to improve health, health equity, and the value of health care through practical, innovative, and evidence-based policy solutions. For more information, visit healthpolicy.duke.edu and follow us on Twitter @DukeMargolis.

About The Rockefeller Foundation
The Rockefeller Foundation is a pioneering philanthropy built on collaborative partnerships at the frontiers of science, technology, and innovation to enable individuals, families, and communities to flourish. We work to promote the well-being of humanity and make opportunity universal. Our focus is on scaling renewable energy for all, stimulating economic mobility, and ensuring equitable access to healthy and nutritious food. For more information, sign up for our newsletter at rockefellerfoundation.org and follow us on Twitter @RockefellerFdn.

Media Contacts

Patricia Green
Duke-Margolis Center for Health Policy
Patricia.S.Green@duke.edu
+1 301 520 6482

Davina Dukuly
The Rockefeller Foundation
DDukuly@rockfound.org
+1 212 852 0000

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