SARS-CoV-2 screening testing in schools for children with intellectual and developmental disabilities
Authors: Sherby Michael R. , Walsh Tyler J. , Lai Albert M. , Neidich Julie A. , Balls-Berry Joyce E. , Morris Stephanie M. , Head Richard , Prener Christopher G. , Newland Jason G. , Gurnett Christina A. ,   for the COMPASS-T Study Group, Baldenweck Megan , Bono Kelly , Brodsky Victor B. , Caburnay Charlene A. , Constantino John N. , Dougherty Nikole Lobb , Dubois James M. , Fritz Stephanie A. , Gotto George S. , Imbeah Adwoa , Kalb Luther G. , Liu Jingxia , Maricque Brett B. , McKay Virginia R. , Myers Linda S. , Poor Timothy J. , Powell Byron J. , Mueller Nancy B. , Schlaggar Bradley L. , Schmidt Ann , Snider Elsa , Traughber Matthew C. , van Stone Maureen , Vestal Liz , Wilcher-Roberts Myisha 
Published: September 2021

Abstract
Background
Transmission of SARS-CoV-2 in schools primarily for typically developing children is rare. However, less is known about transmission in schools for children with intellectual and developmental disabilities (IDD), who are often unable to mask or maintain social distancing. The objectives of this study were to determine SARS-CoV-2 positivity and in-school transmission rates using weekly screening tests for school staff and students and describe the concurrent deployment of mitigation strategies in six schools for children with IDD.

Methods
From November 23, 2020, to May, 28, 2021, weekly voluntary screening for SARS-CoV-2 with a high sensitivity molecular-based saliva test was offered to school staff and students. Weekly positivity rates were determined and compared to local healthcare system and undergraduate student screening data. School-based transmission was assessed among participants quarantined for in-school exposure. School administrators completed a standardized survey to assess school mitigation strategies.

Results
A total of 59 students and 416 staff participated. An average of 304 school staff and students were tested per week. Of 7289 tests performed, 21 (0.29%) new SARS-CoV-2 positive cases were identified. The highest weekly positivity rate was 1.2% (n = 4) across all schools, which was less than community positivity rates. Two cases of in-school transmission were identified, each among staff, representing 2% (2/103) of participants quarantined for in-school exposure. Mitigation strategies included higher than expected student mask compliance, reduced room capacity, and phased reopening.

Conclusions
During 24 weeks that included the peak of the COVID-19 pandemic in winter 2020-21, we found lower rates of SARS-CoV-2 screening test positivity among staff and students of six schools for children with IDD compared to community rates. In-school transmission of SARS-CoV-2 was low among those quarantined for in-school exposure. However, the impact of the emerging SARS-CoV-2 Delta variant on the effectiveness of these proven mitigation strategies remains unknown.

Trial registration
Prior to enrollment, this study was registered at ClinicalTrials.gov on September 25, 2020, identifier NCT04565509, titled Supporting the Health and Well-being of Children with Intellectual and Developmental Disability During COVID-19 Pandemic.