Weekly SARS-CoV-2 screening of asymptomatic kindergarten to grade 12 students and staff helps inform strategies for safer in-person learning

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission in K–12 schools was rare during in 2020–2021; few studies included Centers for Disease Control and Prevention (CDC)-recommended screening of asymptomatic individuals. We conduct a prospective observational study of SARS-CoV-2 screening in a mid-sized suburban public school district to evaluate the incidence of asymptomatic coronavirus disease 2019 (COVID-19), document frequency of in-school transmission, and characterize barriers and facilitators to asymptomatic screening in schools. Staff and students undergo weekly pooled testing using home-collected saliva samples. Identification of >1 case in a school prompts investigation for in-school transmission and enhancement of safety strategies. With layered mitigation measures, in-school transmission even before student or staff vaccination is rare. Screening identifies a single cluster with in-school staff-to-staff transmission, informing decisions about in-person learning. The proportion of survey respondents self-reporting comfort with in-person learning before versus after implementation of screening increases. Costs exceed $260,000 for assays alone; staff and volunteers spend 135–145 h per week implementing screening. [Display omitted] •In-school SARS-CoV-2 transmissions are rare with screening and safety measures•Comfort with in-person learning increases after screening program implementation•Educator workplace safety beyond in-classroom mitigation is a key priority•Benefits must be balanced against high financial and human resource requirements Reports of rare SARS-CoV-2 transmission in K–12 schools are limited by lack of asymptomatic screening. Doron, Ingalls, et al. report that public-school screening for asymptomatic SARS-CoV-2 in 2020–2021 provides valuable data about in-school transmission risk and informs decisions about in-person learning, but human and financial resource requirements are high.