Interim Considerations for K-12 School Administrators for SARS-CoV-2 Testing

Note: This document is intended to provide considerations on the appropriate use of testing and does not dictate the determination of payment decisions or insurance coverage of such testing, except as may be otherwise referenced (or prescribed) by another entity or federal or state agency. CDC is a non-regulatory agency; therefore, the information in this document is meant to assist K-12 schools in making decisions rather than establishing regulatory requirements.

As some communities in the United States open K-12 schools, CDC offers considerations for ways in which schools can help protect students and staff and slow the spread of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). Testing to diagnose COVID-19 is one component of a comprehensive strategy and should be used in conjunction with promoting behaviors that reduce spread, maintaining healthy environments, maintaining healthy operations, and preparing for when someone gets sick.

Schools should determine, in collaboration with state, tribal, territorial, and local health officials, and, in the case of K-12 schools operated by the federal government (e.g., K-12 schools for Department of Defense [DoD Dependents]) appropriate federal health officials, whether to implement any testing strategy, and if so, how to best do so. These CDC considerations are meant to supplement—not replace—any federal, state, local, territorial, or tribal health and safety laws, rules, and regulations with which schools must comply. Implementation should be guided by what is feasible, practical, and acceptable and be tailored to the needs of each community.

Symptom screening and testing are strategies to identify individuals with COVID-19. In addition to screening and testing, contact tracing is an effective disease control strategy that involves investigating cases and their contacts—typically by asking individuals to isolate and contacts to quarantine at home voluntarily. Screening, testing, and contact tracing are actions that can be taken to slow and stop the spread of transmission of COVID-19. These strategies must be carried out in a way that protects privacy and confidentiality consistent with applicable laws and regulations. In addition to state and local laws, regulations and guidance, school administrators should follow guidance from the Equal Employment Opportunity Commissionexternal icon when offering SARS-CoV-2 testing to employees and staff. Schools also should follow guidance from the U.S. Department of Education on the Family Educational Rights and Privacy Act (FERPA)pdf iconexternal icon and its applicability to students and COVID-19 contact tracing and testing.

While schools play a role in identifying students, faculty, and staff who have COVID-19 symptoms or who have had recent known or potential exposure to SARS-CoV-2, school staff are not expected to directly administer SARS-CoV-2 tests. In some circumstances, school-based healthcare providers (e.g., school nurses, physicians) may conduct SARS-CoV-2 testing in their capacity as healthcare providers, such as in school-based health centers. Not every school-based healthcare provider will have the resources or training to conduct testing, and accordingly, should not feel compelled to do so; these providers can help link students and their families and staff to other opportunities for testing in the community.

Types of tests to identify SARS-CoV-2, the virus that causes COVID-19

Viral tests approved or authorized by the Food and Drug Administration (FDA) are recommended to diagnose current infection with SARS-CoV-2, the virus that causes COVID-19. Viral tests evaluate whether the virus is present in a respiratory sample. Results from these tests help public health officials identify and isolate people who are infected in order to minimize SARS-CoV-2 transmission.

Antibody tests approved or authorized by the FDA are used to detect a past infection with SARS-CoV-2. CDC does not currently recommend using antibody testing as the sole basis for diagnosing current infection. Depending on when someone was infected and the timing of the test, the test may not find antibodies in someone with a current COVID-19 infection. In addition, it is not currently proven whether a positive antibody test indicates protection against future SARS-CoV-2 infection; therefore, antibody tests should not be used at this time to determine if someone is immune.

CDC recommendations for SARS-CoV-2 testing are based on what is currently known about the virus SARS-CoV-2 and what is known about it continues to change rapidly. Information on testing for SARS-CoV-2 will be updated as more information becomes available.

When testing might be needed

This document describes scenarios when K-12 students or staff may need to have a SARS-CoV-2 viral test, though ultimate determinations for such a test rest with schools, in consultation with local health officials:

• Testing individuals with signs or symptoms consistent with COVID-19
• Testing asymptomatic individuals with recent known or suspected exposure to SARS-CoV-2 to control transmission

Testing individuals with signs or symptoms consistent with COVID-19

Consistent with CDC’s recommendations, individuals with COVID-19 signs or symptoms should be referred to a healthcare provider for evaluation on whether testing is needed. In some locations, individuals can also visit their state, tribal, territorial or local health department’s website to look for the latest local information on testing.

One strategy to identify individuals with COVID-19 symptoms is to conduct symptom screenings, such as temperature screening and/or symptom checking of staff and students. These screenings are one of many different tools schools can use to help lower the risk of SARS-CoV-2 transmission. However, because symptom screenings are not helpful for identification of individuals with COVID-19 who may be asymptomatic or pre-symptomatic or if infected with an unrelated virus, symptom screening will not prevent all individuals with COVID-19 from entering the school. Screenings should be conducted safely and respectfully and in accordance with any applicable privacy laws and regulations. School administrators may use examples of screening methods in CDC’s supplemental Guidance for Child Care Programs that Remain Open as a guide for screening children and CDC’s General Business FAQs for screening staff.

• Schools should immediately separate students and staff with COVID-19 symptoms at school by identifying an isolation room or area.
• Individuals who are sick should go home or to a healthcare facility, depending on how severe their symptoms are, and they or their caregivers (in the case of minors) should follow CDC guidance for caring for oneself. Individuals should also watch for emergency symptoms and seek emergency medical care if symptoms occur.

As part of symptom screening, schools should be prepared to refer symptomatic individuals to an appropriate healthcare provider or testing site. State, Tribal, territorial, and local health officials and/or healthcare providers will determine when viral testing for SARS-CoV-2 is appropriate. For DoD dependents and personnel, federal or DoD health officials will determine when such testing is appropriate.

Testing asymptomatic individuals with recent known or suspected exposure to a person with COVID-19

SARS-CoV-2 testing is recommended for all close contacts of persons with COVID-19:

• Because of the potential for asymptomatic and pre-symptomatic transmission of the virus, it is important that contacts of students or staff with COVID-19 be quickly identified and tested. This is particularly vital for protecting people who are at increased risk of severe illness from COVID-19. Everyone is at risk for getting COVID-19 if they are exposed to the virus, but some people are more likely than others to become severely ill, which means that they may require hospitalization, intensive care, or a ventilator to help them breathe, or they may even die.
• Additionally, in accordance with state, Tribal, territorial, and local laws and regulations, school administrators should work with local health officials to inform those who have had close contact with a person diagnosed with COVID-19 to stay home and self-monitor for symptoms.
• Healthcare providers or health officials will determine when viral testing of asymptomatic students or staff for SARS-CoV-2 is appropriate.

Testing asymptomatic individuals without known exposure to a person with COVID-19

Universal SARS-CoV-2 testing of all students and staff in school settings has not been systematically studied. It is not known if testing in school settings provides any additional reduction in person-to-person transmission of the virus beyond what would be expected with implementation of other infection preventive measures (e.g., social distancing, cloth face covering, hand washing, enhanced cleaning and disinfecting). Therefore, CDC does not recommend universal testing of all students and staff. Implementation of a universal approach to testing in schools may pose challenges, such as the lack of infrastructure to support routine testing and follow up in the school setting, unknown acceptability of this testing approach among students, parents, and staff, lack of dedicated resources, practical considerations related to testing minors and potential disruption in the educational environment.

More resources for K-12 schools:

• For more information on facility-wide testing for asymptomatic individuals, please see the Standardized procedure for broad-based testing for SARS-CoV-2.
• For additional considerations for reducing COVID-19 spread in K-12 schools, see the Considerations for Schools.
• For information about daily life and coping during COVID-19 for students, staff, and families:

• • Encourage employees and students to take breaks from watching, reading, or listening to news stories, including social media if they are feeling overwhelmed or distressed.
  • Promote employees and students eating healthy, exercising, getting sleep and finding time to unwind.
  • Encourage employees and students to talk with people they trust about their concerns and how they are feeling.
  • Consider posting signages for the national distress hotline: 1-800-985-5990, or text TalkWithUs to 66746
  • Communities, Schools, Workplaces, and Events: Information for Where You Live, Work, Learn, and Play