Daily testing for contacts of individuals with SARS-CoV-2 infection and attendance and SARS-CoV-2 transmission in English secondary schools and colleges: an open-label, cluster-randomised trial
Open accessPublished version of a preprint
Abstract
Background School-based COVID-19 contacts in England have been asked to self-isolate at home, missing key educational opportunities. We trialled daily testing of contacts as an alternative to assess whether this resulted in similar control of transmission, while allowing more school attendance.Methods We did an open-label, cluster-randomised, controlled trial in secondary schools and further education colleges in England. Schools were randomly assigned (1:1) to self-isolation of school-based COVID-19 contacts for 10 days (control) or to voluntary daily lateral flow device (LFD) testing for 7 days with LFD-negative contacts remaining at school (intervention). Randomisation was stratified according to school type and size, presence of a sixth form, presence of residential students, and proportion of students eligible for free school meals. Group assignment was not masked during procedures or analysis. Coprimary outcomes in all students and staff were COVID-19-related school absence and symptomatic PCR-confirmed COVID-19, adjusted for community case rates, to estimate within-school transmission (non-inferiority margin <50% relative increase). Analyses were done on an intention-to-treat basis using quasi-Poisson regression, also estimating complier average causal effects (CACE). This trial is registered with the ISRCTN registry, ISRCTN18100261.Findings Between March 18 and May 4, 2021, 204 schools were taken through the consent process, during which three decided not to participate further. 201 schools were randomly assigned (control group n=99, intervention group n=102) in the 10-week study (April 19-May 10, 2021), which continued until the pre-appointed stop date (June 27, 2021). 76 control group schools and 86 intervention group schools actively participated; additional national data allowed most non-participating schools to be included in analysis of coprimary outcomes. 2432 (42·4%) of 5763 intervention group contacts participated in daily contact testing. There were 657 symptomatic PCR-confirmed infections during 7 782 537 days-at-risk (59·1 per 100 000 per week) in the control group and 740 during 8 379 749 days-at-risk (61·8 per 100 000 per week) in the intervention group (intention-to-treat adjusted incidence rate ratio [aIRR] 0·96 [95% CI 0·75-1·22]; p=0·72; CACE aIRR 0·86 [0·55-1·34]). Among students and staff, there were 59 422 (1·62%) COVID-19-related absences during 3 659 017 person-school-days in the control group and 51 541 (1·34%) during 3 845 208 person-school-days in the intervention group (intention-to-treat aIRR 0·80 [95% CI 0·54-1·19]; p=0·27; CACE aIRR 0·61 [0·30-1·23]).Interpretation Daily contact testing of school-based contacts was non-inferior to self-isolation for control of COVID-19 transmission, with similar rates of symptomatic infections among students and staff with both approaches. Infection rates in school-based contacts were low, with very few school contacts testing positive. Daily contact testing should be considered for implementation as a safe alternative to home isolation following school-based exposures.Funding UK Government Department of Health and Social Care.
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Young 2021 suggested no difference between the two treatment arms for SARS-CoV-2 infection (RR 0.96, 95% CI 0.75 to 1.22).
“Results from Young 2021 suggested no difference between the two treatment arms for SARS‐CoV‐2 infection (RR 0.96, 95% CI 0.75 to 1.22)”
From Physical interventions to interrupt or reduce the spread of respiratory viruses (2023) · cites this paper as Young 2021
Young 2021 reported COVID-19 related absences from school were similar in the two treatment groups (RR 0.80, 95% CI 0.54 to 1.19).
“Young 2021 reported COVID‐19 related absences from school were similar in the two treatment groups (RR 0.80, 95% CI 0.54 to 1.19).”
From Physical interventions to interrupt or reduce the spread of respiratory viruses (2023) · cites this paper as Young 2021
Daily contact testing of school-based contacts was non-inferior to self-isolation for SARS-CoV-2 transmission.
“non‐inferiority of daily contact testing of school‐based contacts (intervention) compared to self‐isolation (control) (Young 2021)”
From Physical interventions to interrupt or reduce the spread of respiratory viruses (2023) · cites this paper as Young 2021
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- Authors
- Young, B. C., Eyre, D. W., Kendrick, S., White, C., Smith, S., Beveridge, G., Nonnenmacher, T., Ichofu, F., Hillier, J., Oakley, S., Diamond, I., Rourke, E., Dawe, F., Day, I., Davies, L., Staite, P., Lacey, A., McCrae, J., Jones, F., Kelly, J., Bankiewicz, U., Tunkel, S., Ovens, R., Chapman, D., Bhalla, V., Marks, P., Hicks, N., Fowler, T., Hopkins, S., Yardley, L., & Peto, T. E. A.
- Affiliations
- University of Oxford (GB)
- National Institute for Health and Care Research (GB)
- Department of Health and Social Care (GB)
- Oxford University Hospitals NHS Trust (GB)
- Office for National Statistics (GB)
- Deloitte (United Kingdom) (GB)
- Queen Mary University of London (GB)
- Public Health England (GB)
- University of Bristol (GB)
- Corresponding author
- Young, Bernadette C
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2021-10
- Volume
- 398
- Issue
- 10307
- Pages
- 1217-1229
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC8439620
- OpenAlex
- W3200929454
- Cited by
- 116
- References
- 24
- Citations by year
- 2026: 3 · 2025: 10 · 2024: 20 · 2023: 22 · 2022: 48 · 2021: 13
- FWCI
- 10.05
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.elsevier.com/tdm/userlicense/1.0/ (tdm)
- www.elsevier.com/legal/tdmrep-license (tdm)
- www.elsevier.com/open-access/userlicense/1.0/ (am, 364 d)
- doi.org/10.15223/policy-017 (stm-asf)
- doi.org/10.15223/policy-037 (stm-asf)
- doi.org/10.15223/policy-012 (stm-asf)
- doi.org/10.15223/policy-029 (stm-asf)
- doi.org/10.15223/policy-004 (stm-asf)
- Locations
- The Lancet (acceptedVersion)
- medRxiv (acceptedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Explore Bristol Research (publishedVersion, cc-by-nc-nd)
- ePrints Soton (University of Southampton) (submittedVersion)
- The Lancet
- Funders
- United Kingdom Department of Health and Social Care
- Topics
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 detection and testing
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Keywords
- SARS-CoV-2, COVID-19 pandemic, self-isolation, school attendance, secondary schools, further education colleges, school absenteeism, non-inferiority, complier average causal effect, 2021 pandemic, free school meals, residential students, sixth form
- MeSH terms
- Educational Personnel, COVID-19, SARS-CoV-2, COVID-19 Testing, COVID-19 Nucleic Acid Testing, COVID-19 Serological Testing, Adolescent, Adult, Aged, Child, Communicable Disease Control, England, Female, Humans, Male, Middle Aged, Quarantine, Schools, Young Adult
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