Is Symptom Screening Useful for Identifying COVID-19 Infection in School Settings? Georgia, USA.
Megan Swanson, Marisa Hast, Eleanor Burnett and 11 others
PMID 34612108WHAT IT FOUND
Symptom screening after school exposure missed infections: 31 of 568 asymptomatic contacts tested positive, and only 37% of positive elementary students and 42% of positive middle/high students reported symptoms, so exposed contacts needed testing regardless of symptoms.
Key findings
01Among 669 contacts, 31 of 568 asymptomatic contacts tested positive, while 24 of 101 contacts reporting symptoms tested positive.
02Only 37% of positive elementary students and 42% of positive middle/high school students reported symptoms; the chance that a symptomatic elementary student tested positive was 20%, and for a symptomatic middle/high school student it was 35%.
03Symptomatic students had 5 times greater odds of testing positive than asymptomatic students, with 5.5 times for ages 8 to 12 years and 10.8 times for ages 13 to 20 years, but no significant association for ages 5 to 7 years.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 669 of 1,116 enrolled contacts with valid tests were included because symptom status data were missing. Some contacts refused testing because they had no symptoms (48), which may have made asymptomatic contacts less likely to be tested and results not representative of the whole district. Only 114 of 174 household members were tested, so household infections may have been underestimated. The study could not determine whether school contacts infected household members or household members infected school contacts. Symptom data could have been missed if contacts did not respond to daily text monitoring. Survey answers may have been affected by recall or by wanting to give expected answers. Only 6 positive staff contacts were included, so staff estimates were unstable.
Declared interests
The authors declared no potential conflicts of interest. CDC collaborated with Cobb and Douglas Public Health, the Georgia Department of Public Health, and the school district.
The easy way to misread this
Do not conclude that only symptomatic contacts need testing. Symptoms were associated with positive results, but screening missed many infections: 31 of 568 asymptomatic contacts tested positive.