“Scuola Sicura”: a school screening program to prevent the spread of COVID-19 among students in Piedmont, Italy
Authors: Farina Elena , Eboli Ilenia , Spadea Teresa , Saugo Carlo , Richiardi Lorenzo , Maule Milena , Presti Pietro , Bena Antonella 
Published: September 2021

Abstract
ObjectivesThe regional government of Piedmont approved an experimental screening testing program entitled “Scuola Sicura” with the aim to: rapidly contain thes spread of COVID-19 in the school population together with general mitigation strategies such as contact tracing, and case isolation, and to monitor the transmission rate in this population. In this paper we report the initial process and outcome evaluation results and the criticalities encountered during program rollout.DesignDescriptive study of the trend in the period Janaury-March 2021.The evaluation of the preventive capacity of the program is limited to the period of in-class learning. The data sources used are the COVID-19 platform Piedmont, the archives of the local health Departments and the CedAP-SDO archive. Setting and participantsThe screening program targeted second and third grade students in first level secondary schools throughout Piedmont. Each class was subdivided into four groups; one group each week underwent screening, yielding one test per student per month.Main outcome measuresThe following indices were calculated with a 95% confidence interval: 1. number of positive cases detected vs. total number of students tested in the “Scuola Sicura” program;2. number of positive cases detected outside the “Scuola Sicura” program vs total number of students enrolled in the 2nd and 3rd grades of first-level secondary schools in Piedmont.To evaluate the preventive capacity, quarantines were detected. In order to investigate the spread of COVID-19 in households, the mother-child pair was tracked and cases of positivity among mothers were identified. Results69% of schools in Piedmont participated in the program; the actual participation was 19.5% of the total number of students enrolled in second and third grades of first-level secondary schools. SS detected 114 positives cases for SARS-CoV-2, yielding a prevalence of 0.52% (95%CI 0.42-0.61) when calculated for the total number of students tested by the program. Starting from 08.03.2021, the target classes have started distance learning: 69 of the 114 positive students were identified before that date, leading to the activation of 67 quarantine measures. For 61 of the 69 cases (88%) identified by SS before 8 March, the mother-child couple was reconstruncted through record linkage between the CedAP and SDO archives. Forty-six mothers perfomed a swab test after that of the child with a positive result in 24% of cases (n=11). Asymptomatic cases identified at screening accounted for 26.5% of the total number of cases occurred in the participating classes.ConclusionsThis is one of the few studies (and the first in Italy) to describe the functioning and predictive capacity of school screening testing for COVID-19 in a real-world situation. Our findings provide data-driven suggestions for government agencies when planning large-scale school screening testing programs. When well organized and implemented jointly with other transmission prevention measures and contact tracing, school screening may be a viable strategy to keep schools open when high levels of the virus are circulating in the community.