Project Summary/Abstract Schools serve important community roles beyond academic education. In historically marginalized communities they are trusted providers for a range of support services for families in need. The tradeoff between these crucial benefits of in-person learning against the risk of SARS-CoV-2 transmission in school settings has been hotly debated throughout much of 2020 and 2021. The stakes are particularly high in historically marginalized communities which rely most heavily on school services, but have also been hit the hardest by COVID-19 primarily due to structural issues. The Safer at School Early Alert (SASEA) program was co-developed by the University of California, San Diego, the County of San Diego, and 15 partner schools serving socially vulnerable students in 5 school districts across San Diego County. SASEA utilizes daily wastewater and surface (floor) environmental monitoring to detect asymptomatic SARS-CoV-2 infections among students and staff on campus. Positive environmental signals are immediately followed by targeted responsive testing for a whole school (in the case of wastewater) or classroom (for a positive surface sample). In this project, we will develop the Safer at School Early Alert School-Neighborhood Asset Portal (SASEA- SNAP), an online school environmental monitoring report dashboard with resources to address structural barriers to COVID-19 diagnostic testing in historically marginalized communities (Aim 1). We will also create a toolkit to allow any school to rapidly adapt the template to their specific setting. In Aims 2 and 3, we will use a randomized stepped wedge trial to compare SASEA (control) vs SASEA-SNAP (intervention) in 50 schools across 4 diverse school clusters in San Diego County. Our primary outcome (Aim 2) is higher rates of diagnostic testing in intervention schools. Our secondary outcome (Aim 3) is increased risk mitigation behaviors in school community members when environmental surveillance data suggests a potential case on campus. In Aim 4, we will use parent-child narrative interviews with 40 parent-student pairs to understand how children perceive COVID-19 risk at school, assess differences in perceptions of testing barriers between intervention and control sites, and better understand how children understand the process of environmental surveillance and responsive testing.

Project Narrative Public schools are often cornerstones of their community, providing numerous social and support services beyond just academics, but their role as potential drivers of SARS-CoV-2 infection has also been hotly debated since the Spring of 2020. The Safer at School Early Alert – School to Neighborhood Asset Portal (SASEA-SNAP) project builds on a successful pilot of wastewater and environmental monitoring in schools serving vulnerable community to create a school-based diagnostic testing hub and community resource. SASEA-SNAP will support community schools to provide COVID-19 sentinel surveillance in neighborhoods with substantial structural barriers to testing and low vaccine uptake, while also providing a tailored resource set to address structural barriers and local concerns.