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.