1. A cluster randomised trial of the impact of a policy of daily testing for contacts of COVID-19 cases on attendance and COVID-19 transmission in English secondary schools and colleges
- Author
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Christopher W. White, Andrea Lacey, Urszula Bankiewicz, James McCrae, Peter W. Marks, Saroj Kendrick, Paul Staite, Bernadette C. Young, David Chapman, Emma Rourke, Tim E. A. Peto, Sarah Tunkel, Toby Nonnenmacher, Lisa Davies, Fegor Ichofu, Tom Fowler, Sylvester Smith, David W Eyre, Joseph F. Kelly, Ian Diamond, Susan R. Hopkins, Nick Hicks, George Beveridge, Ieuan Day, Lucy Yardley, Richard Ovens, Joseph Hillier, Fiona Dawe, and Ffion Jones
- Subjects
medicine.medical_specialty ,Intention-to-treat analysis ,business.industry ,Attendance ,Odds ratio ,Rate ratio ,Disease cluster ,Asymptomatic ,Intervention (counseling) ,Physical therapy ,medicine ,Cluster randomised controlled trial ,medicine.symptom ,business - Abstract
SummaryBackgroundSchool-based COVID-19 contacts in England are asked to self-isolate at home. However, this has led to large numbers of missed school days. Therefore, we trialled daily testing of contacts as an alternative, to investigate if it would affect transmission in schools.MethodsWe performed an open-label cluster randomised controlled trial in students and staff from secondary schools and further education colleges in England (ISRCTN18100261). Schools were randomised to self-isolation of COVID-19 contacts for 10 days (control) or to voluntary daily lateral flow device (LFD) testing for school contacts with LFD-negative contacts remaining at school (intervention). Household contacts were excluded from participation.Co-primary outcomes in all students and staff were symptomatic COVID-19, adjusted for community case rates, to estimate within-school transmission (non-inferiority margin: FindingsOf 99 control and 102 intervention schools, 76 and 86 actively participated (19-April-2021 to 27-June-2021); additional national data allowed most non-participating schools to be included in the co-primary outcomes. 2432/5763(42.4%) intervention arm contacts participated. There were 657 symptomatic PCR-confirmed infections during 7,782,537 days-at-risk (59.1/100k/week) and 740 during 8,379,749 days-at-risk (61.8/100k/week) in the control and intervention arms respectively (ITT adjusted incidence rate ratio, aIRR=0.96 [95%CI 0.75-1.22;p=0.72]) (CACE-aIRR=0.86 [0.55-1.34]). There were 55,718 COVID-related absences during 3,092,515 person-school-days (1.8%) and 48,609 during 3,305,403 person-school-days(1.5%) in the control and intervention arms (ITT-aIRR=0.80 [95%CI 0.53-1.21;p=0.29]) (CACE-aIRR 0.61 [0.30-1.23]). 14/886(1.6%) control contacts providing an asymptomatic PCR sample tested positive compared to 44/2981(1.5%) intervention contacts (adjusted odds ratio, aOR=0.73 [95%CI 0.33-1.61;p=0.44]). Rates of symptomatic infection in contacts were 44/4665(0.9%) and 79/5955(1.3%), respectively (aOR=1.21 [0.82-1.79;p=0.34]).InterpretationDaily contact testing of school-based contacts was non-inferior to self-isolation for control of COVID-19 transmission. COVID-19 rates in school-based contacts in both intervention and control groups were
- Published
- 2021
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