ECRI Horizon Scanning has selected the topics below as those with potential for impact relative to COVID-19 in the United States within the next 12 months. All views presented are preliminary and based on readily available information at the time of writing.

Because these topics are rapidly developing, we cannot guarantee the accuracy of this information after the date listed on this publication. In addition, all views expressed in the commentary section are solely those of ECRI Horizon Scanning and have not been vetted by other stakeholders. Topics are listed in alphabetical order.

Description

Although children are at a lower risk of severe illness or death than older people, over 6.6 million children in the U.S. have tested positive for COVID-19 during the pandemic, and at least 625 have died, according to the American Academy of Pediatrics. The Delta variant has caused an increase in cases among children and an increase in the likelihood they will transmit the virus. As schools reopen for in-person learning, students and faculty have more opportunities to transmit SARS-CoV-2. So far, masking, COVID-19 testing, and quarantine procedures have allowed schools to limit disease transmission. However, the CDC states that vaccination is the primary public health strategy to end the pandemic, and children from kindergarten through high school are now eligible for COVID-19 vaccination, which can substantially reduce new infections. Vaccination is a key preventative component of a layered approach to promote safer in-person learning.

To facilitate vaccine rollout, schools are hosting vaccine clinics to protect the health of students, educators, and school communities. They are set up as walk-in clinics where students line up for the vaccine without prior appointments. For example, Ann Arbor Public Schools have opened their school cafeterias to vaccinate eligible school children, and in Washington, DC, vaccination events were held in school gymnasiums.​​ As of November 12, in Talent, Oregon, the school-based vaccine clinics have successfully administered 1500 COVID-19 doses for children between 5 and 11 years old across 3 school districts.

Students between 5 and 11 years of age are given the pediatric Pfizer vaccine; those aged 12 through 17 receive the adolescent Pfizer vaccine, and those 18 or older might receive the adult Pfizer vaccine, Moderna vaccine, or Janssen vaccine. In most states, a legally authorized representative (usually a parent or guardian) must give consent for any student  between 5 and 17 years old to receive the COVID-19 vaccine.

Commentary

School-located vaccine clinics might increase vaccination rates in K-12 school students and prevent their risk of severe illness due to COVID-19. Early feedback from ECRI internal stakeholders suggested that increasing access to COVID-19 vaccines might help reduce the incidence of cases, infection, and death due to COVID-19. School-located vaccine clinics might be a convenient way to vaccinate large groups of children quickly. They might also help offset long-term health care costs related to COVID-19, thereby decreasing disparities for low-income families. This might also improve access for students who live far from health care facilities or have other barriers to care. Disparities could increase though if only a few school districts obtain the necessary vaccine supplies and staff to conduct the vaccinations.

Reducing the spread of COVID-19 in pediatric and adolescent patients might lessen the burden on the health care system. Additionally, school-located vaccine clinics might ease the burden on health care facilities and pharmacies to administer the vaccine or administer regular testing to students. High vaccination rates might decrease the need for quarantine and isolation, and improve the continuity of the in-person learning experience. Such effective public health efforts can provide children with a sense of structure and stability during an otherwise unsettling time. The programs’ potential for disruption might be hindered by fear, hesitancy, and lack of education about the vaccine among parents who must consent to the children getting vaccinated. However, school-located clinics might normalize childhood vaccinations and help convince hesitant parents.

• Categories:Systems and management, public health
• Areas of potential impact: Patient outcomes, population health, patient management, health care disparities, health care costs

Description

Test-to-stay is a public health strategy being implemented in schools to allow children and staff to continue in-person learning after exposure  to COVID-19 but testing negative. The practice might impact population health practices and decrease disparities for students and staff.

Traditional quarantine-after-exposure programs force all exposed students to stay home from school for a specified length of time, even when they test negative for COVID-19. The test-to-stay approach allows children and staff who have been exposed to someone with COVID-19 in schools, but tested negative with a rapid antigen test, to continue in-school learning, rather than quarantining at home.

Following exposure, unvaccinated children and staff get tested multiple times (days 1, 3, 5, and 7) before school to make sure that they are still negative and can remain in classes while also adhering to mask-wearing and social distancing rules. Those who present with symptoms or a positive test are sent to isolate at home. Pilot programs of test-to-stay in 2 Utah high schools found that the strategy successfully identified students and staff who needed to isolate (1% to 2% of the total tested) and allowed for in-person learning to continue for those who tested negative.

The CDC has announced test-to-stay to be a promising practice and is working with schools to evaluate the effectiveness of the program. Schools need written parental permission once per term or per year, depending on the school, before tests can be administered to the student.​

Commentary

COVID-19 has negatively impacted education quality due to children not being in classrooms for over a year. Efforts are needed to ensure that in-person learning remains an option for students who have been exposed to SARS-CoV-2, but are uninfected.

Early feedback from ECRI internal stakeholders suggested that although COVID-19 vaccines are now available for most children, test-to-stay might become an important option for managing potential COVID-19 cases in children. Programs that allow exposed, but uninfected students to remain in class might improve educational continuity and reduce the mental health impacts of quarantine, as well as reduce the burden on teachers to help students catch up to in-person learning after quarantining. Keeping more children in school might help reduce educational disparities that exist across the country. However, the program might increase disparities for children in schools that cannot acquire enough test kits or appropriately staff a testing program due to resource or geographic constraints.

The program might impose significant costs on health insurance companies and schools due to the potential administration of multiple tests on some students. However, the program might prevent financial stress on parents if it prevents unnecessary quarantine arrangements for their children during school hours. Stakeholders also expressed concerns that the use of rapid testing is not as reliable as PCR testing, which might result in increased SARS-CoV-2 exposure in schools compared with the traditional quarantine method. 

• Categories: Systems and management, public health
• Areas of potential impact: Population health, patient management, health care disparities, health care costs

Horizon scanning is a systematic process that serves as an early warning system to inform decision makers about possible future opportunities and threats. Health care horizon scanning identifies technologies, innovations, and trends with potential to cause future shifts or disruptions—positive or negative—in areas such as access to care, care delivery processes, care setting, costs of care, current treatment models or paradigms, health disparities, health care infrastructure, public health, and patient health outcomes.

The PCORI Health Care Horizon Scanning System (HCHSS) conducts horizon scanning to better inform its patient-centered outcomes research investments. Initially, PCORI defined the HCHSS project scope to focus on interventions with high potential for disruption in the United States in 5 priority areas: Alzheimer’s disease and other dementias, cancer, cardiovascular diseases, mental and behavioral health conditions, and rare diseases. In addition, the system captures high-level disruptive trends across all clinical areas, which may lead PCORI to expand the project scope to include other priority areas in the future.

In early 2020, the COVID-19 pandemic created a fast-moving, widespread public health crisis. In May 2020, PCORI expanded its HCHSS to elucidate the landscape of potentially impactful applications for COVID-19. The HCHSS COVID-19 supplement scans for, identifies, monitors, and reports on emerging and available COVID-19-related treatments, diagnostics, preventive measures, management strategies, and systems changes with potential for high impact to patient outcomes—for individuals and populations—in the United States in the next 12 months.

The HCHSS COVID-19 supplement produces 3 main outputs:

• Biweekly COVID-19 Scans (eg, this document) provide ECRI Horizon Scanning with a vehicle to inform PCORI and the public in a timely manner of important topics of interest identified during ongoing scanning and topic identification or through the ECRI stakeholder survey process.
• Status Reports (quarterly) briefly list and describe all COVID-19-related topics identified, monitored, and recently archived.
• High Impact Reports (every 4 months) highlight those topics that ECRI internal stakeholders (eg, physicians, nurses, allied health professionals, public health professionals, first responders, health systems experts, clinical engineers, researchers, business and finance professionals, and information technology professionals) have identified as having potential for high impact relative to COVID-19 in the United States.