SARS-CoV-2 Test-to-Stay in Daycare

• Published in: Pediatrics (Evanston) Vol. 153; no. 5
• Main Authors: Dewald, Felix, Steger, Gertrud, Fish, Irina, Torre-Lage, Ivonne, Hellriegel, Christina, Milz, Esther, Kolb-Bastigkeit, Anja, Heger, Eva, Fries, Mira, Buess, Michael, Marizy, Niklas, Michaelis, Barbara, Suárez, Isabelle, Rubio Quintanares, Gibran Horemheb, Pirkl, Martin, Aigner, Annette, Oberste, Max, Hellmich, Martin, Wong, Anabelle, Orduz, Juan Camilo, Fätkenheuer, Gerd, Dötsch, Jörg, Kossow, Annelene, Moench, Eva-Maria, Quade, Gustav, Neumann, Udo, Kaiser, Rolf, Schranz, Madlen, Klein, Florian
• Format: Journal Article
• Language: English
• Published: United States 01.05.2024
• Subjects: Child; Child Day Care Centers; Child, Preschool; COVID-19 - diagnosis; COVID-19 - epidemiology; COVID-19 - prevention & control; COVID-19 Nucleic Acid Testing; Female; Germany - epidemiology; Humans; Infant; Male; Mass Screening - methods; Quarantine; SARS-CoV-2; Germany
• ISSN: 1098-4275
• DOI: 10.1542/peds.2023-064668

Test-to-stay concepts apply serial testing of children in daycare after exposure to SARS-CoV-2 without use of quarantine. This study aims to assess the safety of a test-to-stay screening in daycare facilities. 714 daycare facilities and approximately 50 000 children ≤6 years in Cologne, Germany participated in a SARS-CoV-2 Pool-polymerase chain reaction (PCR) screening from March 2021 to April 2022. The screening initially comprised post-exposure quarantine and was adapted to a test-to-stay approach during its course. To assess safety of the test-to-stay approach, we explored potential changes in frequencies of infections among children after the adaptation to the test-to-stay approach by applying regression discontinuity in time (RDiT) analyses. To this end, PCR-test data were linked with routinely collected data on reported infections in children and analyzed using ordinary least squares regressions. 219 885 Pool-PCRs and 352 305 Single-PCRs were performed. 6440 (2.93%) Pool-PCRs tested positive, and 17 208 infections in children were reported. We estimated that during a period of 30 weeks, the test-to-stay concept avoided between 7 and 20 days of quarantine per eligible daycare child. RDiT revealed a 26% reduction (Exp. Coef: 0.74, confidence interval 0.52-1.06) in infection frequency among children and indicated no significant increase attributable to the test-to-stay approach. This result was not sensitive to adjustments for 7-day incidence, season, SARS-CoV-2 variant, and socioeconomic status. Our analyses provide evidence that suggest safety of the test-to-stay approach compared with quarantine measures. This approach offers a promising option to avoid use of quarantine after exposure to respiratory pathogens in daycare settings.