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Guidance on Test-to-Stay in Schools

I. Summary

Test-to-Stay (TTS) is a COVID-19 strategy that enables school-aged students and staff to continue in-person learning while minimizing the disruption of quarantine on students, families, and schools. While not officially endorsed, TTS has been highlighted as a "promising practice" in recent statements by the CDC. The Pennsylvania Department of Health (DOH) is issuing the following revised guidance for school district leaders who wish to adopt a policy of test-to-stay in their schools.

TTS is a program that, when combined with regular mitigation measures (e.g., masking, social distancing, etc.), allows individuals who are identified as a close contact to a case of COVID-19 in certain school settings to continue in-person learning, so long as they remain asymptomatic and serially test negative for COVID-19. Individuals who are exempt from quarantine under the latest CDC guidance (e.g., due to vaccination status or past confirmed COVID infection) do not need to participate in TTS to remain in school, as long as they remain asymptomatic.

This document outlines guidance from the DOH on how schools can safely participate in TTS; it does not signify a recommendation for schools to participate. Schools within a county or municipal health department (CMHD) jurisdiction should work with their local health department when responding to cases of COVID-19 in school settings, and assess risk to students and staff based on COVID-19 spread in their geographic area to inform any decisions made on whether and how to implement a TTS program. School districts that choose not to adopt a TTS program or individuals who elect not to participate should continue to follow the latest quarantine guidance for close contacts.

The objective of TTS is to enable students and staff who have been exposed at school, but are at low-risk of contracting or transmitting COVID-19, to remain in school. Vaccination continues to be the best strategy to reduce the spread of COVID-19, and these recommendations are intended to help support schools in reducing disruptions to in-person learning as vaccines for younger school-age children are being rolled out.

Please note that these guidelines are subject to change as additional data become available. DOH will be working to understand the efficacy of TTS in preserving in-person learning while minimizing risk of COVID-19 spread. As new data become available, DOH may amend or rescind the guidance, or provide additional direction to schools to assist in the implementation of test-to-stay programs. Please note that schools electing to adopt a TTS program should still follow the current guidance around responding to positive cases, identification and notification of close contacts, and reporting to DOH.

To opt into this new test-to-stay school testing program, school leaders must complete the Statement of Assurances form and submit the completed form to RA-DHK12COVIDTEST@pa.gov.

II. Guidelines on Implementing TTS

A. Testing cadence (number and frequency of tests)

After being identified as a close contact, TTS program participants  can continue in-person learning/teaching if they remain asymptomatic and continue to test negative for COVID-19 according to the following schedule:

  • 1st test: Within 2 – 4 days post-exposure
  • 2nd test: Within 5 – 7 days post-exposure
  • The 1st and 2nd tests must be administered on non-consecutive days (i.e., a test on Day 4 and a second test on Day 5 would not meet this criteria)

In-line with CDC guidelines, even with diagnostic testing, individuals exposed to COVID-19 are considered active in the TTS program for at least 7 days. A student or staff member will have completed TTS and will no longer be considered a close contact or active in the program:

  • After Day 7 if they receive a negative result from at least one test administered between Day 5 and Day 7
  • If an individual is not able to receive a test between Day 5 and Day 7, they will be released from test-to-stay as soon as they receive a negative test result (on or after Day 7), or after Day 10 assuming no symptoms, whichever comes first

Note that Day 0 is considered the day of exposure, and this timeline is irrespective of when the close contact is identified e.g., if the student/staff member is identified on Day 3 post-exposure, they are eligible for testing that day, should it be available. If a student/staff member is notified of exposure on or after Day 5, the student/staff member should receive at least one test, administered within Days 5-7.

If school is not in session on Days 5-7, or testing is not otherwise available, students/staff must receive their final test on the next available testing day, or receive a test through a health care provider in line with the guidance below, to be released from the TTS program.

B. Type of test

It is recommended that TTS programs utilize rapid antigen tests for quick results and to minimize disruption to learning. All tests conducted for TTS must be for individual students & staff members (i.e., negative pooled test results are not sufficient unless results are individually identifiable).  

The following test results will be considered eligible to fulfill the above testing criteria:

  • Rapid antigen tests administered on-site through a school testing program
  • Rapid antigen tests administered through a health care provider

At this time, at-home tests are not considered eligible for participation in TTS.

C. Eligible population

The goal of TTS is to enable student and staff close contacts that are at low-risk of infection and transmission to continue in-person education. It is not recommended for or designed to accommodate high-risk exposures, as the continued presence of high-risk close contacts in school may increase the likelihood of an outbreak.

TTS is only intended for school-based exposures. Individuals who were exposed to COVID-19 in non-school settings (e.g., household exposure) are not eligible for TTS under any circumstances and should continue to follow the latest quarantine protocol.

Participation in TTS is limited to students and staff whose in school exposures to COVID-19 occurred during  periods of masking while at school (which make them close contacts at lower-risk for infection and transmission). For example, close contacts in the following lower-risk scenarios would be eligible for participation:

  • If indoors, the close contact and positive student were both masked at less than 3ft distance for longer than 15 minutes
  • If indoors, the close contact and positive adult (staff member) were both masked at less than 6ft distance for longer than 15 minutes
  • If outdoors, the individuals were masked or unmasked but distanced appropriately

Under this guidance, students and staff who are exposed to COVID-19 on-campus indoors during mask breaks or periods with limited masking adherence (e.g., lunch, high-intensity sports) should be excluded from participation in test-to-stay as the most protective public health measure since they may be at higher-risk of infection and transmission. These close contacts should continue to follow the latest quarantine protocol.

DOH acknowledges that determining the TTS eligibility of students or staff that have been exposed to COVID-19 in school may require additional tracking and contact tracing. Individual schools and school districts should assess the applicable risk levels based on COVID-19 spread in their local geographic area, other COVID-19 safety infrastructure on-campus, and risk-mitigating or increasing factors when applying the eligibility requirements of their TTS program.

TTS is designed for individuals who would otherwise be required to quarantine (while they remain asymptomatic). Please refer to the latest guidance on quarantine requirements based on vaccination status.

If an individual tests positive or becomes symptomatic at any point, they should immediately be isolated and sent home. Symptomatic individuals will no longer be able to participate in TTS, should isolate in accordance with DOH and CDC guidelines, and should seek diagnostic testing.

TTS may not be an appropriate strategy for all schools or individuals. Parents/guardians of students and individual staff members may elect not to participate in TTS, and instead follow the normal CDC-recommended protocol for exposure. School leaders should take into consideration relevant characteristics of the student body and staff (e.g., adherence to masking and other mitigation measures) and resource capabilities when considering whether to adopt a TTS program.

Please note that this guidance is not intended for schools experiencing an outbreak or a rapid rise in cases; test-to-stay should not be used or should be rescinded in these situations. Please refer to current PDE guidance for the definition of school setting outbreaks and additional detail on responding to COVID-19 outbreaks in schools.

Parents/guardians of students and individual staff members who choose to enroll in a TTS program offered by their school must actively consent to testing conducted for the program. A record of written consent should be maintained by the school.

D. Other mitigation measures

The success of a test-to-stay program relies on the risk of school-based transmission remaining low. As such, it is important for schools implementing TTS programs to continue rigorous adherence to routine COVID-19 mitigation measures, including but not limited to masking and social distancing. In order to safely participate in test-to-stay, schools are recommended to have a universal masking policy in place to effectively implement TTS, which means that all students, staff, or visitors should wear a face covering when indoors on school grounds.

Individuals who are not able to fulfill masking requirements in line with the school/school district's masking policies (e.g., individuals with mask exemptions, individuals utilizing face shields, etc.) should not be eligible for TTS and should instead complete standard COVID-19 quarantine.

E. Policy for close contacts in TTS program prior to receiving first test result

Under the above TTS guidance, students/staff that are identified as close contacts may remain in school while awaiting their first test result. Based on the results, they:

  • May continue in-person learning if negative
  • Must isolate as they are no longer eligible for TTS if positive

F. Recommendations for TTS participants outside of classroom learning (e.g., extracurriculars, sports)

While there is risk associated with any exposure to COVID-19, TTS is intended to enable low-risk close contacts to continue in-person learning. However, schools may decide to allow individuals enrolled in a TTS program to continue participating in extracurricular activities (i.e., outside of the classroom setting) and sports while they are actively undergoing testing and/or awaiting results under the TTS program. This period is defined as the period in which students/staff have not yet received a negative test result following a test on/after Day 5 post-exposure, which would enable them to be fully released from the TTS program and no longer be subject to any additional restrictions beyond the routine mitigation strategies employed against COVID-19 spread (masking, social distancing, etc.)

In light of the different risk profiles of exposure to COVID-19, schools can employ additional mitigation protocols for students/staff who are identified as close contacts and are enrolled in the TTS program. These protocols should be considered as additional to the standard risk mitigation strategies (e.g., indoor masking, social distancing, etc.) that help reduce the spread of COVID-19 in school settings and are strongly recommended by the CDC. It is recommended that schools have a universal masking policy in place to effectively implement TTS. The following additional mitigation strategies may be employed until the student/staff member participating in TTS has completed their testing cadence and is released from TTS, while they continue in-person learning.

Note: the following additional mitigation protocols are illustrative examples for schools planning for implementation of a TTS program. Schools may choose to follow these example strategies if appropriate in light of physical, space, and student constraints. Individual schools and school districts should assess the applicable risk levels based on COVID-19 spread in their specific area to inform the adoption of any of the below mitigation strategies or additional strategies as appropriate.

Potential additional mitigation protocols for active TTS participants:

  • Consider creating separate lunch or recess areas for TTS participants when masking is not possible
  • Ensure staff members active in TTS have a separate lunch area
  • Reduce overall maximum occupancy of shared transportation or school areas
  • Encourage active TTS participants to take alternative transportation (vs regular shared school transportation)
  • If alternative transportation for active TTS participants cannot be arranged, schools/districts can consider applying the following additional considerations:
    • Close every other row of seats or otherwise reduce maximum occupancy of buses
    • Teach students to maintain physical distancing and/or provide physical guides to help with this (e.g., floor decals, colored tape, or signs)
    • Assign seating on the bus following physical distancing guidelines; allow students from the same household or living unit to sit together
    • Maintain physical distancing at bus stops by students and their families/caregivers.
  • Disallow exceptions to mask-wearing periods for active TTS participants (e.g., during sports)
  • Encourage a negative rapid antigen test 24 hours or less before large in-person events (e.g., fairs, spirit nights) from active TTS participants

G. Routine surveillance testing

Schools and school districts are strongly encouraged to continue routine screening testing or enroll in routine screening testing if they have not already done so. Routine testing is the best practice for identifying and isolating all asymptomatic cases and DOH will continue to provide financial and operational support for any school choosing to use the Commonwealth's K-12 School COVID-10 Testing Program.

Note that TTS is not designed to replace routine testing – the two types of testing complement each other. Routine pooled screening testing will help to identify potentially asymptomatic cases and TTS to enable close contacts to continue in-person learning.

Additional Resources:

DOH has partnered with Ginkgo Bioworks to provide support for schools interested in participating in testing. Please refer to the DOH website for more information on the Commonwealth's K-12 School COVID-19 Testing Program.

Please note that additional testing support programs are in place across Pennsylvania, including but not limited to:

For more information about COVID-19 safety in schools and for definitions of key terms, please refer to the Pennsylvania Department of Education's guidance on responding to COVID-19 cases in schools.