April 26, 2022

Testing was a critical part of camps’ strategy to prevent and contain COVID-19 in summer 2021, and we see it playing an important role this summer as well. The right strategy for each camp may well differ due to your ‘COVID-19 goal’. Is your approach to do everything possible to keep COVID-19 out of camp? Or will you accept some risk in exchange for more flexibility?

Pre-camp testing

We highly recommend that camps have staff and campers test in the day or two before coming to camp. In addition to identifying positive cases, this will hopefully also encourage low-risk behaviors as people anticipate testing. Some camps are asking if they should test further out to identify positives, thinking that any positive cases could isolate for 5 days and still make camp on arrival day. For myriad reasons, we caution against testing either too often or trying to game isolation periods. 

Rapid antigen tests will function quite well in this screening scenario where we are testing people without symptoms. It is important to know that rapid antigen tests can have false negatives in this scenario, meaning people can test negative even if they do indeed have COVID-19. However, with the recent surges we are increasingly concerned that PCR tests may pick up people who have had COVID-19 somewhat recently but are no longer infectious. 

How to test prior to coming? There are two ways to get an antigen the day prior to camp:

• First, attendees could do a home test. Upsides of this approach are that they are readily accessible, transportable and photos of tests (with date and time) can be sent in as documentation. Downsides is that without being monitored or performed by a lab technician the reliability of the home test is less and falsification of results is possible. 
• The second option is the use of a lab performed or home-monitored antigen test. By this we mean going to the local pharmacy or physician’s office and getting a rapid antigen test. Another option is to work with services that will allow persons to purchase rapid antigen tests with a “monitored” option. The upsides of this ‘monitored’ antigen option is increased reliability, decreased falsification of testing and ease of reporting. Downsides are the need for planning and potential costs. 

Arrival testing

Like last summer, we recommend testing staff and campers as they arrive at camp with a rapid antigen test. Should attendees test positive, they would either need to return home (campers with their families) or stay at camp to wait out the isolation period (recall that the isolation should be a minimum of five days, plus masking for an additional 5 days). False positives are possible, though very uncommon, with rapid antigen tests. Accordingly, you could consider getting PCR/molecular tests for someone who has tested positive with a rapid antigen test to confirm the diagnosis.

Post-arrival testing

Two negative antigen tests >24 hour apart is a solid way to determine COVID status heading into camp. However, it is important to remember that a negative test taken the day of travel, particularly if travel was on a crowded maskless bus or train should NOT completely reassure you the person is COVID negative. It is for this reason that, depending on your COVID goals, post-arrival testing will help deliver that final layer of knowledge if/to what degree of COVID you are starting camp. Last summer we did see a few cases of COVID in people who only turned positive after they arrived at camp. 

Camps may desire to have some public health measures in place while waiting for the day of post-arrival testing. Cohorts and masking may be the most useful interventions during this time to prevent spread. Omicron, including BA2, spreads rapidly and easily among persons, especially as the time increases since the last infection, vaccination or booster. Based on what I have seen in schools, it would not be surprising to see a case of BA2  spread to 50% of bunkmates within a matter of days.

What day after arrival should I test? The range of possible testing days after arrival (if arrival day is day 0) is from day 3 to day 7. Testing early would potentially catch cases earlier, but false negative tests could still occur. Testing on day 7 would ensure an accurate test on all persons from arrival day– but secondary transmission (the initial case transmitting to others within camp) will have certainly occurred by that time. So day 5 might be a sweet spot balancing both of these issues. Remember, though, there is no ONE CORRECT day to test. All tests and days have caveats for their interpretation. 

Should attendees test negative, camps could proceed to operating camp more or less as ‘normal’. Camps that are willing to accept the risk of COVID in camp could consider not doing any post-arrival testing, though they need to be prepared to deal with the consequences should a case(s) of COVID-19 emerge. 

The community prevalence rates in the areas that campers and staff are coming from should also play a role in making this decision. Should the rates be at the medium or high levels, we would lean towards doing post-arrival testing.

Symptomatic testing

As with last summer, we recommend using rapid antigen tests for persons who develop symptoms consistent with COVID-19 (cough, fever, etc.). Should that test be negative, we do not think that a follow-up PCR is needed unless there have been cases of COVID-19 in your camp already. We will be writing more about the management of symptoms in camp later. 

*We have no financial disclosures to share in relation to this post.