It was a struggle to keep daycare sites open during the COVID-19 pandemic. If one child or staff tested positive, the entire site had to shut down until the quarantine period ended.
In an article entitled “SARS-CoV-2 Test-to-stay in Daycare,” Felix Dewald, MD, from the University of Köln, Germany, and colleagues from 9 institutions in Germany compared a strategy of daily COVID-19 testing (and keeping children in daycare if they tested negative) to the traditional strategy of quarantine (10.1542/peds.2023-064668). While daily testing has been studied in school-aged populations (who wore masks during school hours), it had not been tested in younger children for whom mask wearing is not possible.
The authors conducted this study in 714 daycare facilities for approximately 50,000 children younger than 6 years of age in Köln, Germany, between March 2021 and April 2022. When a COVID-19 exposure was reported in a daycare facility, all children attending the daycare had nasal swabs sent for COVID-19 PCR testing for 5 days. Initially the swabs were sent in pooled samples (samples from all children in the daycare in one vial). If the pooled test was negative, no further testing was done. If the pooled test was positive, the samples from all the children in that daycare were tested separately for the remainder of the 5 days. Only those children whose individual swabs were positive were sent home from daycare.
The authors performed almost 220,000 pooled PCR tests and 350,000 single PCR tests and found that:
- Fewer than 3% of the pooled PCR tests were positive.
- The test-to-stay strategy resulted in 13 fewer days of quarantine for each exposed child.
- There was no increase in the rate of COVID-19 infection with the test-to-stay strategy, compared to the quarantine-everyone strategy.
While we hope not to be in another pandemic any time soon, it is helpful to know that this test-to-stay strategy was successful at keeping children in daycare without increased risk for infection spread.
