Testing for SARS-CoV-2 infection: a key strategy to keeping schools and universities open
Authors: Archana Koirala, Nicholas Wood, Kristine Macartney
Published in: The Lancet
Introduction: Education has been profoundly affected by the COVID-19 pandemic. Lack of access to education has exacerbated the divide between rich and poor and left vulnerable children exposed to domestic violence and hunger. The best way of keeping educational institutions open for in-person learning is to control transmission of SARS-CoV-2 in the wider community1 and to ensure rapid identification of infected staff and students to support timely and tailored public health responses. A comprehensive testing strategy is a core tenet in control, especially as a majority (40–60%) of children and young people have asymptomatic COVID-19,2 and individuals who are pre-symptomatic also present a transmission risk. Mitigation measures such as physical distancing, use of masks, and ensuring adequate ventilation within classrooms are also key, especially when community based transmission exists.
SARS-CoV-2 infection can be diagnosed by two methods: direct testing for the viral RNA with highly sensitive SARS-CoV-2 RT-PCR tests or viral antigen detection tests, which identify active (or resolving) infection on a nasal, oropharyngeal, or salivary sample and allow early case identification to contain outbreaks. Testing for antibodies against the virus diagnose previous or recent infection (with onset of 10 or more days previously). The delayed nature of virus-specific antibody testing precludes it as tool for rapid outbreak suppression; rather, its predominant public health utility is to understand infection and transmission rates and patterns in a community or clusters.