American Samoa

Note: Recipient-submitted material; content authored by recipient, not ELC
Information current as of October 6, 2021

Management structure for school screening

The Department of Health will support the Reopening Schools Program by assisting in implementing an operational strategy for safe delivery of in-person instruction in K-12 schools through the integration of a package of prevention and control components:

1. Consistent implementation of layered prevention strategies to reduce SARS-CoV-2 transmission in schools
2. Consideration of indicators of community transmission to reflect levels of community risk
3. Phased prevention strategies based on levels of community transmission

The following public health efforts provide additional layers of COVID-19 protection in schools:

• Testing to identify individuals with a SARS-CoV-2 infection to limit transmission and outbreaks
• Vaccination for teachers and staff as soon as possible

Support provided to school districts

Indicators of Community Transmission School administrators, working with ASDOH EpiNet Team Leads, should assess the level of community transmission to understand the burden of disease in the community. The higher the level of community transmission, the more likely that SARS-CoV-2 will be introduced into the school facility from the community, which could lead to in-school transmission if layered prevention strategies are not in use.

ASDOH recommends the use of two measures of community burden to determine the level of risk of transmission: total number of new cases per in the past 7 days, and percentage of nucleic acid amplification tests (NAATs), including RT-PCR tests, that are positive during the last 7 days. The two measures of community burden should be used to assess the incidence and spread of SARS-CoV-2 in the surrounding community and not in the schools themselves. If the two indicators suggest different levels, the actions corresponding to the higher threshold (in Figure 1) should be chosen.

• Figure 1: ASG Threat Level Matrix to assess risk of community Transmission of SARS-CoV-2

Phased Prevention

Monitoring levels of community transmission provides school leaders with an indicator system for the risk of introduction of SARS-CoV-2 virus into a school. Information about levels of community transmission will be combined with information about cases in schools and implementation of prevention strategies to guide decision-making. Implementation of prevention strategies should be intensified if indicators worsen (i.e., moving from low to moderate to substantial to high community transmission). Intensifying prevention might also involve imposing restrictions on sports and extracurricular activities to protect in-person learning. To make decisions about preventive actions, school and ASDOH officials should take the following information into account:

• The numbers of COVID-19 cases among students, teachers, and staff, and number of people in quarantine
• Compliance with prevention strategies outlined by ASDOE or Other Private Schools
• Levels of community transmission reported by ASDOH

Testing Strategies for Schools 

Laboratory testing will not be used alone, but in combination with other prevention to reduce risk of transmission in schools. When schools implement testing combined with prevention strategies, they can detect new cases to prevent outbreaks, reduce the risk of further transmission, and protect students, teachers, and staff from COVID-19.

Diagnostic Testing 

At all levels of community transmission, ASDOH EpiNet Team will conduct diagnostic testing to any student, teacher, or staff member who is exhibiting symptoms of COVID-19 at school.   Diagnostic testing for SARS-CoV-2 is intended to identify occurrence of SARS-CoV-2 infection at the individual level and is performed when there is a reason to suspect that an individual may be infected, such as having symptoms or suspected recent exposure.

Examples of diagnostic testing strategies include testing symptomatic teachers, students, and staff who develop symptoms in school, and testing asymptomatic individuals who were exposed to someone with a confirmed or suspected case of COVID-19. ASDOH will dispatch an EpiNet team who will conduct Binax Now Rapid testing, case investigation and contact tracing. Any positive result will be confirmed with the GeneXpert testing platform.

Considerations for diagnostic testing: 

• Schools must advise students, teachers, and staff to stay home if they are sick or if they have been exposed to SARS-CoV-2. Schools will contact ASDOH EpiNet Team immediately at 219 for appropriate response.
• If a student, teacher, or staff member becomes sick at school or reports a new COVID-19 diagnosis, schools will contact ASDOH EpiNet Team immediately at 219 for appropriate response.
• Schools will ensure that students, teachers, and staff have access to, and training on the proper use of personal protective equipment (PPE). Schools will work in collaboration with ASDOH Epidemiology and Surveillance, and Public Health Preparedness Divisions.
• Signs and Symptoms School Teachers and Staff should be aware of for SARS-CoV-2 infection:
  • Temperature 100.4 degrees Fahrenheit or higher
  • Sore throat
  • Cough (for students with chronic cough due to allergies or asthma, a change in their cough from baseline)
  • Difficulty breathing (for students with asthma, a change from their baseline breathing)
  • Diarrhea or vomiting
  • New loss of taste or smell
  • New onset of severe headache, especially with a fever

Screening Testing 

ASDOH may also conduct screening testing if SARS-CoV-2 transmission is suspected in the Community. Screening testing involves using SARS-CoV-2 viral tests (diagnostic tests used for screening purposes such as Binax Now and other Rapid testing platforms) intended to identify occurrence at the individual level even if there is no reason to suspect infection-i.e., there is no known exposure and no symptoms. This includes, but is not limited to, screening testing of asymptomatic people without known exposure with the intent of making decisions based on the test results. Screening testing is intended to identify infected people without symptoms (or before development of symptoms) who may be contagious so that measures can be taken to prevent further transmission. The intent is to use the screening testing results to determine who may return to in-person school or work and the protective measures that will be taken, and to identify and isolate positive persons to prevent spread.  When combined with prevention measures, such as mask use, physical distancing, and others, testing protocols might be an effective tool in reducing transmission. Screening testing can be administered directly at a school facility by ASDOH EpiNet Teams.

Screening Testing Strategies to consider: 

• If community transmission is suspected, ASDOH will consider to randomly test 20% of students from each school with on campus instructions.
• A complete roster of students will be made available to ASDOH EpiNet team to produce a monthly list of randomly selected student from each school.
• Using the school rosters, ASDOH Epidemiologist will randomly select students from each grade level so that 20% of the total enrollment is achieved.
• ASDOH and ASDOE will work in collaboration to ensure all testing are consistent with privacy and other applicable laws
• ASDOH EpiNet team will conduct the screening test at the school location. Other information will be collected such as temperature and other symptoms.

Reporting test results 

• All test results will be maintained by ASDOH EpiNet teams. Reporting of a positive result will follow ASDOH and LBJ establish reporting policies and procedures.
• Positive test results will be report to the appropriate School official.