Trial Outcomes & Findings for ReSET Aim 1b: Restarting Safe Education and Testing for Children With Medical Complexity - COVID-19 Testing in School With Children and Staff (NCT NCT04899245)

NCT ID: NCT04899245

Last Updated: 2024-07-17

Results Overview

Feasibility of school based COVID-19 testing will be evaluated by protocol uptake. Data will be retrieved from the study log. Two data limitations to note: * The enrollment rate was not stratified by caregiver and child number at the time of data collection. The data was collected at the level of the child. * The enrollment rate was not stratified by caregiver/child dyad and staff at the time of data collection. This is a limitation of our data. It is not possible to stratify this outcome and it is therefore analyzed together.

• Recruitment status: COMPLETED
• Study phase: NA
• Target enrollment: 112 participants
• Primary outcome timeframe: Study duration (up to 21 months)
• Results posted on: 2024-07-17

Participant Flow

The protocol enrollment, started, and completed values reflect caregiver/child dyads. There were n = 41 caregivers, n = 47 children.

Participant milestones

Measure	Parent/Caregiver of Children With Medical Complexity (CMC) 65 children and their parents will be recruited to participate. School staff will send a letter to all parents with children enrolled in the Waisman Early Childhood Program (WECP) inviting them to participate. Families new to the school or who initially decline participation and then reconsider may join at any time. Participants will also be offered the option of as needed symptomatic home testing. Additionally, parents who are vaccinated will be asked to participate in testing. Siblings may be enrolled in the study. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.	Child With Medical Complexity 65 children and their parents will be recruited to participate. School staff will send a letter to all parents with children enrolled in the Waisman Early Childhood Program (WECP) inviting them to participate. Families new to the school or who initially decline participation and then reconsider may join at any time. Participants will also be offered the option of as needed symptomatic home testing. Additionally, parents who are vaccinated will be asked to participate in testing. Siblings may be enrolled in the study. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.	School Staff 50 school staff from Waisman Early Childhood Program (WECP) will be recruited to participate in this study. School staff will send a letter to all WECP staff inviting them to participate. Staff new to the school or who initially decline participation and then reconsider may join at any time. Additionally, staff who are vaccinated will be asked to participate in testing. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.
Overall Study STARTED	41	47	24
Overall Study COMPLETED	17	19	21
Overall Study NOT COMPLETED	24	28	3

Reasons for withdrawal

Measure	Parent/Caregiver of Children With Medical Complexity (CMC) 65 children and their parents will be recruited to participate. School staff will send a letter to all parents with children enrolled in the Waisman Early Childhood Program (WECP) inviting them to participate. Families new to the school or who initially decline participation and then reconsider may join at any time. Participants will also be offered the option of as needed symptomatic home testing. Additionally, parents who are vaccinated will be asked to participate in testing. Siblings may be enrolled in the study. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.	Child With Medical Complexity 65 children and their parents will be recruited to participate. School staff will send a letter to all parents with children enrolled in the Waisman Early Childhood Program (WECP) inviting them to participate. Families new to the school or who initially decline participation and then reconsider may join at any time. Participants will also be offered the option of as needed symptomatic home testing. Additionally, parents who are vaccinated will be asked to participate in testing. Siblings may be enrolled in the study. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.	School Staff 50 school staff from Waisman Early Childhood Program (WECP) will be recruited to participate in this study. School staff will send a letter to all WECP staff inviting them to participate. Staff new to the school or who initially decline participation and then reconsider may join at any time. Additionally, staff who are vaccinated will be asked to participate in testing. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.
Overall Study Withdrawal by Subject	3	5	2
Overall Study No longer eligible - Left staff position	0	0	1
Overall Study No longer eligible - Child graduated from school program	19	21	0
Overall Study No longer eligible - Moved away from area	2	2	0

Baseline Characteristics

ReSET Aim 1b: Restarting Safe Education and Testing for Children With Medical Complexity - COVID-19 Testing in School With Children and Staff

Baseline characteristics by cohort

Measure	School Staff n=24 Participants 50 school staff from Waisman Early Childhood Program (WECP) will be recruited to participate in this study. School staff will send a letter to all WECP staff inviting them to participate. Staff new to the school or who initially decline participation and then reconsider may join at any time. Additionally, staff who are vaccinated will be asked to participate in testing. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.	Children With Medical Complexity (CMC) n=47 Participants 65 children and their parents will be recruited to participate. School staff will send a letter to all parents with children enrolled in the Waisman Early Childhood Program (WECP) inviting them to participate. Families new to the school or who initially decline participation and then reconsider may join at any time. Participants will also be offered the option of as needed symptomatic home testing. Additionally, parents who are vaccinated will be asked to participate in testing. Siblings may be enrolled in the study. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.	Parent/Caregiver With Children With Medical Complexity (CMC) n=41 Participants 65 children and their parents will be recruited to participate. School staff will send a letter to all parents with children enrolled in the Waisman Early Childhood Program (WECP) inviting them to participate. Families new to the school or who initially decline participation and then reconsider may join at any time. Participants will also be offered the option of as needed symptomatic home testing. Additionally, parents who are vaccinated will be asked to participate in testing. Siblings may be enrolled in the study. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.	Total n=112 Participants Total of all reporting groups
Sex/Gender, Customized Sex · Male	1 Participants n=5 Participants	22 Participants n=7 Participants	9 Participants n=5 Participants	32 Participants n=4 Participants
Sex/Gender, Customized Sex · Not reported	0 Participants n=5 Participants	5 Participants n=7 Participants	1 Participants n=5 Participants	6 Participants n=4 Participants
Ethnicity (NIH/OMB) Hispanic or Latino	0 Participants n=5 Participants	4 Participants n=7 Participants	1 Participants n=5 Participants	5 Participants n=4 Participants
Ethnicity (NIH/OMB) Not Hispanic or Latino	24 Participants n=5 Participants	39 Participants n=7 Participants	39 Participants n=5 Participants	102 Participants n=4 Participants
Ethnicity (NIH/OMB) Unknown or Not Reported	0 Participants n=5 Participants	4 Participants n=7 Participants	1 Participants n=5 Participants	5 Participants n=4 Participants
Race (NIH/OMB) American Indian or Alaska Native	0 Participants n=5 Participants	1 Participants n=7 Participants	1 Participants n=5 Participants	2 Participants n=4 Participants
Race (NIH/OMB) Asian	4 Participants n=5 Participants	2 Participants n=7 Participants	3 Participants n=5 Participants	9 Participants n=4 Participants
Race (NIH/OMB) Native Hawaiian or Other Pacific Islander	0 Participants n=5 Participants	0 Participants n=7 Participants	0 Participants n=5 Participants	0 Participants n=4 Participants
Race (NIH/OMB) Black or African American	0 Participants n=5 Participants	2 Participants n=7 Participants	2 Participants n=5 Participants	4 Participants n=4 Participants
Race (NIH/OMB) White	20 Participants n=5 Participants	32 Participants n=7 Participants	32 Participants n=5 Participants	84 Participants n=4 Participants
Race (NIH/OMB) More than one race	0 Participants n=5 Participants	5 Participants n=7 Participants	1 Participants n=5 Participants	6 Participants n=4 Participants
Race (NIH/OMB) Unknown or Not Reported	0 Participants n=5 Participants	5 Participants n=7 Participants	2 Participants n=5 Participants	7 Participants n=4 Participants
Region of Enrollment United States	24 participants n=5 Participants	47 participants n=7 Participants	41 participants n=5 Participants	112 participants n=4 Participants
Age, Continuous	40 years n=5 Participants	3 years n=7 Participants	36 years n=5 Participants	NA years n=4 Participants
Sex/Gender, Customized Sex · Female	23 Participants n=5 Participants	20 Participants n=7 Participants	31 Participants n=5 Participants	74 Participants n=4 Participants

PRIMARY outcome

Timeframe: Study duration (up to 21 months)

Population: The number analyzed must include those who were approached and not consented in addition to those consented.

Feasibility of school based COVID-19 testing will be evaluated by protocol uptake. Data will be retrieved from the study log. Two data limitations to note:

• The enrollment rate was not stratified by caregiver and child number at the time of data collection. The data was collected at the level of the child.
• The enrollment rate was not stratified by caregiver/child dyad and staff at the time of data collection. This is a limitation of our data. It is not possible to stratify this outcome and it is therefore analyzed together.

Outcome measures

Measure	Staff and Children n=88 Participants The enrollment rate was not stratified by staff and caregiver/child dyad during data collection.	School Staff 50 school staff from Waisman Early Childhood Program (WECP) will be recruited to participate in this study. School staff will send a letter to all WECP staff inviting them to participate. Staff new to the school or who initially decline participation and then reconsider may join at any time. Additionally, staff who are vaccinated will be asked to participate in testing. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.
Change in Protocol Uptake: Number of Children and Staff Consented Compared to Number of Approached Number approached, enrolled	71 Participants	—
Change in Protocol Uptake: Number of Children and Staff Consented Compared to Number of Approached Number approached, not enrolled	17 Participants	—

PRIMARY outcome

Timeframe: Every week up to 21 months

• Tests expected: Children and staff in this study will have nasal swab testing performed at school twice weekly (as well as anytime they have symptoms) for the first 3 months of the study. After 3 months, the twice-weekly testing may decrease to symptom-only testing if the rate of COVID spread decreases in Wisconsin. Symptom-only testing is not included as an "expected" test.
• The number of tests expected was assessed specifically for this outcome measure to determine if testing was proceeding as expected. This value was based on the number of children and staff enrolled at a given time, whether surveillance or symptom-only testing was being conducted, and if any of the participants had COVID-19 (excluding them from testing). This value was not created at baseline, but was dynamic over the course of the study dependent upon the aforementioned factors.
• The tests expected value was not stratified by child and staff at the time of data collection. It is a limitation of the data.

Outcome measures

Measure	Staff and Children n=2368 BinaxNOW Rapid Antigen COVID-19 Tests The enrollment rate was not stratified by staff and caregiver/child dyad during data collection.	School Staff 50 school staff from Waisman Early Childhood Program (WECP) will be recruited to participate in this study. School staff will send a letter to all WECP staff inviting them to participate. Staff new to the school or who initially decline participation and then reconsider may join at any time. Additionally, staff who are vaccinated will be asked to participate in testing. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.
Change in COVID Test Rate at School: Number of Total Child and Staff Tests Completed as Compared to Number of Tests Expected Number of tests completed	2368 BinaxNow Rapid Antigen COVID-19 Tests	—
Change in COVID Test Rate at School: Number of Total Child and Staff Tests Completed as Compared to Number of Tests Expected Number of tests expected	2688 BinaxNow Rapid Antigen COVID-19 Tests	—

PRIMARY outcome

Timeframe: Study duration (up to 21 months)

Data will be retrieved from study log.

Outcome measures

Measure	Staff and Children n=1403 BinaxNOW Rapid Antigen COVID-19 Tests The enrollment rate was not stratified by staff and caregiver/child dyad during data collection.	School Staff n=965 BinaxNOW Rapid Antigen COVID-19 Tests 50 school staff from Waisman Early Childhood Program (WECP) will be recruited to participate in this study. School staff will send a letter to all WECP staff inviting them to participate. Staff new to the school or who initially decline participation and then reconsider may join at any time. Additionally, staff who are vaccinated will be asked to participate in testing. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.
Change in Symptomatic Test Rate: Number of Symptomatic Tests Completed	195 Symptomatic BinaxNow Rapid Antigen Tests	39 Symptomatic BinaxNow Rapid Antigen Tests

PRIMARY outcome

Timeframe: Study duration (up to 21 months)

Data will be retrieved from study log.

Outcome measures

Measure	Staff and Children n=1403 BinaxNOW Rapid Antigen COVID-19 Tests The enrollment rate was not stratified by staff and caregiver/child dyad during data collection.	School Staff n=965 BinaxNOW Rapid Antigen COVID-19 Tests 50 school staff from Waisman Early Childhood Program (WECP) will be recruited to participate in this study. School staff will send a letter to all WECP staff inviting them to participate. Staff new to the school or who initially decline participation and then reconsider may join at any time. Additionally, staff who are vaccinated will be asked to participate in testing. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.
Change in Positive Rate: Number of Positive COVID-19 Tests Compared to Total Number of Tests Performed	30 Positive BinaxNOW Rapid Antigen Tests	5 Positive BinaxNOW Rapid Antigen Tests

PRIMARY outcome

Timeframe: Study duration (up to 21 months)

Data will be retrieved from study log. All children and staff (n = 71) were included in this outcome. However, participants were not required to and were sometimes unable to complete a confirmatory PCR test after a positive in-home rapid test. This explains the difference between the number of positive at-home COVID-19 tests and the number of PCR tests.

Some participants completed multiple confirmatory PCR tests over the study time frame. This explains why the PCR quantity is greater than the number of participants.

Outcome measures

Measure	Staff and Children n=49 COVID-19 PCR Tests The enrollment rate was not stratified by staff and caregiver/child dyad during data collection.	School Staff n=15 COVID-19 PCR Tests 50 school staff from Waisman Early Childhood Program (WECP) will be recruited to participate in this study. School staff will send a letter to all WECP staff inviting them to participate. Staff new to the school or who initially decline participation and then reconsider may join at any time. Additionally, staff who are vaccinated will be asked to participate in testing. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.
Change in False-positive Rate: Number of Negative Confirmatory Polymerase Chain Reaction (PCR) as Compared to Total PCR Run for COVID-19 Testing	22 Negative confirmatory PCRs	1 Negative confirmatory PCRs

PRIMARY outcome

Timeframe: Baseline, 3 month, 6 month, 9 month, 15 month, 18 month, 21 month, 24 month

Population: The number analyzed varies per row due to varied response rates per question at each time point.

• "How many of the people who interact with your child at school have been fully vaccinated?"
• Response options: "None", "A few", "Some" "Most", "All", "Don't Know"
• Dichotomized into: ("Most" or "All") vs. ("None", "A few", "Some", "Don't Know)
• This question was only asked to caregivers.
• Caregivers with multiple children enrolled completed a survey for each child.

Outcome measures

Measure	Staff and Children n=47 Participants The enrollment rate was not stratified by staff and caregiver/child dyad during data collection.	School Staff 50 school staff from Waisman Early Childhood Program (WECP) will be recruited to participate in this study. School staff will send a letter to all WECP staff inviting them to participate. Staff new to the school or who initially decline participation and then reconsider may join at any time. Additionally, staff who are vaccinated will be asked to participate in testing. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.
Caregiver Change in Susceptibility: Number of Fully Vaccinated People Who Interact With Participant's Child at School Baseline · "Most" or "All" of the people who interact with their child at school have been fully vaccinated	21 Participants	—
Caregiver Change in Susceptibility: Number of Fully Vaccinated People Who Interact With Participant's Child at School Baseline · "None", "A few", "Some", "Don't Know"	18 Participants	—
Caregiver Change in Susceptibility: Number of Fully Vaccinated People Who Interact With Participant's Child at School 6 month · "Most" or "All" of the people who interact with their child at school have been fully vaccinated	15 Participants	—
Caregiver Change in Susceptibility: Number of Fully Vaccinated People Who Interact With Participant's Child at School 24 month · "Most" or "All" of the people who interact with their child at school have been fully vaccinated	7 Participants	—
Caregiver Change in Susceptibility: Number of Fully Vaccinated People Who Interact With Participant's Child at School 3 month · "Most" or "All" of the people who interact with their child at school have been fully vaccinated	11 Participants	—
Caregiver Change in Susceptibility: Number of Fully Vaccinated People Who Interact With Participant's Child at School 3 month · "None", "A few", "Some", "Don't Know"	18 Participants	—
Caregiver Change in Susceptibility: Number of Fully Vaccinated People Who Interact With Participant's Child at School 6 month · "None", "A few", "Some", "Don't Know"	12 Participants	—
Caregiver Change in Susceptibility: Number of Fully Vaccinated People Who Interact With Participant's Child at School 9 month · "Most" or "All" of the people who interact with their child at school have been fully vaccinated	9 Participants	—
Caregiver Change in Susceptibility: Number of Fully Vaccinated People Who Interact With Participant's Child at School 9 month · "None", "A few", "Some", "Don't Know"	9 Participants	—
Caregiver Change in Susceptibility: Number of Fully Vaccinated People Who Interact With Participant's Child at School 15 month · "Most" or "All" of the people who interact with their child at school have been fully vaccinated	4 Participants	—
Caregiver Change in Susceptibility: Number of Fully Vaccinated People Who Interact With Participant's Child at School 15 month · "None", "A few", "Some", "Don't Know"	4 Participants	—
Caregiver Change in Susceptibility: Number of Fully Vaccinated People Who Interact With Participant's Child at School 18 month · "Most" or "All" of the people who interact with their child at school have been fully vaccinated	6 Participants	—
Caregiver Change in Susceptibility: Number of Fully Vaccinated People Who Interact With Participant's Child at School 18 month · "None", "A few", "Some", "Don't Know"	2 Participants	—
Caregiver Change in Susceptibility: Number of Fully Vaccinated People Who Interact With Participant's Child at School 21 month · "Most" or "All" of the people who interact with their child at school have been fully vaccinated	7 Participants	—
Caregiver Change in Susceptibility: Number of Fully Vaccinated People Who Interact With Participant's Child at School 21 month · "None", "A few", "Some", "Don't Know"	9 Participants	—
Caregiver Change in Susceptibility: Number of Fully Vaccinated People Who Interact With Participant's Child at School 24 month · "None", "A few", "Some", "Don't Know"	3 Participants	—

PRIMARY outcome

Timeframe: Baseline, 3 month, 6 month, 9 month, 15 month, 18 month, 21 month, 24 month

Population: The number analyzed varies per row due to varied response rates per question at each time point.

The following question from the Participant's perceived susceptibility survey will be answered dichotomously and presented qualitatively:

• How comfortable are you with...the ability of your child's school to take all precautions to stop the spread of COVID-19?
• Response options: "Not at all", "A little", "Somewhat", "Very", "Extremely"
• Dichotomized into: ("Not at all", "A little", "Somewhat") vs. ("Very", "Extremely")
• This question was only asked to caregivers.
• Caregivers with multiple children enrolled completed a survey for each child.

Outcome measures

Measure	Staff and Children n=47 Participants The enrollment rate was not stratified by staff and caregiver/child dyad during data collection.	School Staff 50 school staff from Waisman Early Childhood Program (WECP) will be recruited to participate in this study. School staff will send a letter to all WECP staff inviting them to participate. Staff new to the school or who initially decline participation and then reconsider may join at any time. Additionally, staff who are vaccinated will be asked to participate in testing. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.
Caregiver Change in Susceptibility: School Takes Precautions 18 month · "Very" or "Extremely" comfortable	6 Participants	—
Caregiver Change in Susceptibility: School Takes Precautions 18 month · "Not at all", "A little", or "Somewhat" comfortable	2 Participants	—
Caregiver Change in Susceptibility: School Takes Precautions 6 month · "Very" or "Extremely" comfortable	19 Participants	—
Caregiver Change in Susceptibility: School Takes Precautions 6 month · "Not at all", "A little", or "Somewhat" comfortable	8 Participants	—
Caregiver Change in Susceptibility: School Takes Precautions 9 month · "Very" or "Extremely" comfortable	12 Participants	—
Caregiver Change in Susceptibility: School Takes Precautions 9 month · "Not at all", "A little", or "Somewhat" comfortable	6 Participants	—
Caregiver Change in Susceptibility: School Takes Precautions 15 month · "Very" or "Extremely" comfortable	5 Participants	—
Caregiver Change in Susceptibility: School Takes Precautions 15 month · "Not at all", "A little", or "Somewhat" comfortable	3 Participants	—
Caregiver Change in Susceptibility: School Takes Precautions 21 month · "Very" or "Extremely" comfortable	9 Participants	—
Caregiver Change in Susceptibility: School Takes Precautions 21 month · "Not at all", "A little", or "Somewhat" comfortable	7 Participants	—
Caregiver Change in Susceptibility: School Takes Precautions Baseline · "Very" or "Extremely" comfortable	27 Participants	—
Caregiver Change in Susceptibility: School Takes Precautions Baseline · "Not at all", "A little", or "Somewhat" comfortable	13 Participants	—
Caregiver Change in Susceptibility: School Takes Precautions 3 month · "Very" or "Extremely" comfortable	19 Participants	—
Caregiver Change in Susceptibility: School Takes Precautions 3 month · "Not at all", "A little", or "Somewhat" comfortable	10 Participants	—
Caregiver Change in Susceptibility: School Takes Precautions 24 month · "Very" or "Extremely" comfortable	8 Participants	—
Caregiver Change in Susceptibility: School Takes Precautions 24 month · "Not at all", "A little", or "Somewhat" comfortable	2 Participants	—

PRIMARY outcome

Timeframe: Baseline, 3 month, 6 month, 9 month, 15 month, 18 month, 21 month, 24 month

Population: The number analyzed varies per row due to varied response rates per question at each time point.

Following questions from the Participant's perceived susceptibility survey will be answered dichotomously (agree or disagree) and presented qualitatively.

• In your opinion, how likely is your child to get sick with COVID-19 by attending school in-person?
• Response options: "Not at all", "A little", "Somewhat", "Very", "Extremely"
• Dichotomized into: ("Not at all", "A little", "Somewhat") vs. ("Very", "Extremely")
• This question was only asked to caregivers.
• Caregivers with multiple children enrolled completed a survey for each child.

Outcome measures

Measure	Staff and Children n=47 Participants The enrollment rate was not stratified by staff and caregiver/child dyad during data collection.	School Staff 50 school staff from Waisman Early Childhood Program (WECP) will be recruited to participate in this study. School staff will send a letter to all WECP staff inviting them to participate. Staff new to the school or who initially decline participation and then reconsider may join at any time. Additionally, staff who are vaccinated will be asked to participate in testing. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.
Caregiver Change in Susceptibility: Likely to Get COVID-19 Baseline · "Very" or "Extremely" likely	6 Participants	—
Caregiver Change in Susceptibility: Likely to Get COVID-19 6 month · "Not at all", "A little", or "Somewhat" likely	25 Participants	—
Caregiver Change in Susceptibility: Likely to Get COVID-19 Baseline · "Not at all", "A little", or "Somewhat" likely	33 Participants	—
Caregiver Change in Susceptibility: Likely to Get COVID-19 3 month · "Very" or "Extremely" likely	5 Participants	—
Caregiver Change in Susceptibility: Likely to Get COVID-19 3 month · "Not at all", "A little", or "Somewhat" likely	24 Participants	—
Caregiver Change in Susceptibility: Likely to Get COVID-19 6 month · "Very" or "Extremely" likely	3 Participants	—
Caregiver Change in Susceptibility: Likely to Get COVID-19 9 month · "Very" or "Extremely" likely	3 Participants	—
Caregiver Change in Susceptibility: Likely to Get COVID-19 9 month · "Not at all", "A little", or "Somewhat" likely	15 Participants	—
Caregiver Change in Susceptibility: Likely to Get COVID-19 15 month · "Very" or "Extremely" likely	2 Participants	—
Caregiver Change in Susceptibility: Likely to Get COVID-19 15 month · "Not at all", "A little", or "Somewhat" likely	6 Participants	—
Caregiver Change in Susceptibility: Likely to Get COVID-19 18 month · "Very" or "Extremely" likely	2 Participants	—
Caregiver Change in Susceptibility: Likely to Get COVID-19 18 month · "Not at all", "A little", or "Somewhat" likely	6 Participants	—
Caregiver Change in Susceptibility: Likely to Get COVID-19 21 month · "Very" or "Extremely" likely	7 Participants	—
Caregiver Change in Susceptibility: Likely to Get COVID-19 21 month · "Not at all", "A little", or "Somewhat" likely	9 Participants	—
Caregiver Change in Susceptibility: Likely to Get COVID-19 24 month · "Very" or "Extremely" likely	1 Participants	—
Caregiver Change in Susceptibility: Likely to Get COVID-19 24 month · "Not at all", "A little", or "Somewhat" likely	9 Participants	—

PRIMARY outcome

Timeframe: 15 month, 18 month, 21 month, 24 month

Population: The number analyzed varies per row due to varied response rates per question at each time point.

Parent survey perceived severity construct variables will include:

• If your child was sick with COVID-19, how likely would...their health be severely affected
• Response options: "Not at all", "A little", "Somewhat", "Very", "Extremely"
• Dichotomized into: ("Not at all", "A little", "Somewhat") vs. ("Very", "Extremely")
• This question was only asked to caregivers.
• Caregivers with multiple children enrolled completed a survey for each child.

Outcome measures

Measure	Staff and Children n=39 Participants The enrollment rate was not stratified by staff and caregiver/child dyad during data collection.	School Staff 50 school staff from Waisman Early Childhood Program (WECP) will be recruited to participate in this study. School staff will send a letter to all WECP staff inviting them to participate. Staff new to the school or who initially decline participation and then reconsider may join at any time. Additionally, staff who are vaccinated will be asked to participate in testing. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.
Change in Percentage of Caregivers for Perceived Severity Survey Question: Health Severely Affected 21 month · "Very" or "Extremely" likely	0 Participants	—
Change in Percentage of Caregivers for Perceived Severity Survey Question: Health Severely Affected 15 month · "Very" or "Extremely" likely	1 Participants	—
Change in Percentage of Caregivers for Perceived Severity Survey Question: Health Severely Affected 15 month · "Not at all", "A little", or "Somewhat" likely	7 Participants	—
Change in Percentage of Caregivers for Perceived Severity Survey Question: Health Severely Affected 18 month · "Very" or "Extremely" likely	1 Participants	—
Change in Percentage of Caregivers for Perceived Severity Survey Question: Health Severely Affected 18 month · "Not at all", "A little", or "Somewhat" likely	7 Participants	—
Change in Percentage of Caregivers for Perceived Severity Survey Question: Health Severely Affected 21 month · "Not at all", "A little", or "Somewhat" likely	13 Participants	—
Change in Percentage of Caregivers for Perceived Severity Survey Question: Health Severely Affected 24 month · "Very" or "Extremely" likely	0 Participants	—
Change in Percentage of Caregivers for Perceived Severity Survey Question: Health Severely Affected 24 month · "Not at all", "A little", or "Somewhat" likely	10 Participants	—

PRIMARY outcome

Timeframe: 15 month, 18 month, 21 month, 24 month

Population: The number analyzed varies per row due to varied response rates per question at each time point.

Parent survey perceived severity construct variables will be:

• "If your child was sick with COVID-19, how likely would...their health be permanently reduced"
• Response options: "Not at all", "A little", "Somewhat", "Very", "Extremely"
• Dichotomized into: ("Not at all", "A little", "Somewhat") vs. ("Very", "Extremely")
• This question was only asked to caregivers.
• Caregivers with multiple children enrolled completed a survey for each child.

Outcome measures

Measure	Staff and Children n=39 Participants The enrollment rate was not stratified by staff and caregiver/child dyad during data collection.	School Staff 50 school staff from Waisman Early Childhood Program (WECP) will be recruited to participate in this study. School staff will send a letter to all WECP staff inviting them to participate. Staff new to the school or who initially decline participation and then reconsider may join at any time. Additionally, staff who are vaccinated will be asked to participate in testing. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.
Change in Percentage of Caregivers to the Perceived Severity Survey Question: Health Permanently Reduced 15 month · "Very" or "Extremely" likely	1 Participants	—
Change in Percentage of Caregivers to the Perceived Severity Survey Question: Health Permanently Reduced 21 month · "Very" or "Extremely" likely	0 Participants	—
Change in Percentage of Caregivers to the Perceived Severity Survey Question: Health Permanently Reduced 15 month · "Not at all", "A little", or "Somewhat" likely	7 Participants	—
Change in Percentage of Caregivers to the Perceived Severity Survey Question: Health Permanently Reduced 18 month · "Very" or "Extremely" likely	1 Participants	—
Change in Percentage of Caregivers to the Perceived Severity Survey Question: Health Permanently Reduced 18 month · "Not at all", "A little", or "Somewhat" likely	7 Participants	—
Change in Percentage of Caregivers to the Perceived Severity Survey Question: Health Permanently Reduced 21 month · "Not at all", "A little", or "Somewhat" likely	13 Participants	—
Change in Percentage of Caregivers to the Perceived Severity Survey Question: Health Permanently Reduced 24 month · "Very" or "Extremely" likely	0 Participants	—
Change in Percentage of Caregivers to the Perceived Severity Survey Question: Health Permanently Reduced 24 month · "Not at all", "A little", or "Somewhat" likely	10 Participants	—

PRIMARY outcome

Timeframe: 15 month, 18 month, 21 month, 24 month

Population: The number analyzed varies per row due to varied response rates per question at each time point.

Parent survey perceived severity construct variables will be:

• "If my child was sick with COVID-19, they would have grave health consequences."
• Response options: "Not at all", "A little", "Somewhat", "Very", "Extremely"
• Dichotomized into: ("Not at all", "A little", "Somewhat") vs. ("Very", "Extremely")
• This question was only asked to caregivers.
• Caregivers with multiple children enrolled completed a survey for each child.

Outcome measures

Measure	Staff and Children n=39 Participants The enrollment rate was not stratified by staff and caregiver/child dyad during data collection.	School Staff 50 school staff from Waisman Early Childhood Program (WECP) will be recruited to participate in this study. School staff will send a letter to all WECP staff inviting them to participate. Staff new to the school or who initially decline participation and then reconsider may join at any time. Additionally, staff who are vaccinated will be asked to participate in testing. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.
Change in Percentage of Caregivers to the Perceived Severity Survey Question: Grave Health Consequences 15 month · "Very" or "Extremely" likely	1 Participants	—
Change in Percentage of Caregivers to the Perceived Severity Survey Question: Grave Health Consequences 24 month · "Very" or "Extremely" likely	0 Participants	—
Change in Percentage of Caregivers to the Perceived Severity Survey Question: Grave Health Consequences 24 month · "Not at all", "A little", or "Somewhat" likely	10 Participants	—
Change in Percentage of Caregivers to the Perceived Severity Survey Question: Grave Health Consequences 15 month · "Not at all", "A little", or "Somewhat" likely	7 Participants	—
Change in Percentage of Caregivers to the Perceived Severity Survey Question: Grave Health Consequences 18 month · "Very" or "Extremely" likely	1 Participants	—
Change in Percentage of Caregivers to the Perceived Severity Survey Question: Grave Health Consequences 18 month · "Not at all", "A little", or "Somewhat" likely	7 Participants	—
Change in Percentage of Caregivers to the Perceived Severity Survey Question: Grave Health Consequences 21 month · "Very" or "Extremely" likely	0 Participants	—
Change in Percentage of Caregivers to the Perceived Severity Survey Question: Grave Health Consequences 21 month · "Not at all", "A little", or "Somewhat" likely	13 Participants	—

PRIMARY outcome

Timeframe: Baseline, 3 month, 6 month, 9 month, 15 month, 18 month, 21 month, 24 month

Population: The number analyzed varies per row due to varied response rates per question at each time point.

Participants will answer the following survey question in quite a bit / a great deal vs not:

• "Based on the situation right now, how much do you want your child to attend school in-person at least some of the time?"
• This question was only asked to caregivers.
• Caregivers with multiple children enrolled completed a survey for each child.

Outcome measures

Measure	Staff and Children n=47 Participants The enrollment rate was not stratified by staff and caregiver/child dyad during data collection.	School Staff 50 school staff from Waisman Early Childhood Program (WECP) will be recruited to participate in this study. School staff will send a letter to all WECP staff inviting them to participate. Staff new to the school or who initially decline participation and then reconsider may join at any time. Additionally, staff who are vaccinated will be asked to participate in testing. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.
Caregiver Change in Motivation for Child to Attend School (Quite a Bit / a Great Deal vs Not) 6 month · "Somewhat," "A little," or "Not at all"	1 Participants	—
Caregiver Change in Motivation for Child to Attend School (Quite a Bit / a Great Deal vs Not) 15 month · "Somewhat," "A little," or "Not at all"	0 Participants	—
Caregiver Change in Motivation for Child to Attend School (Quite a Bit / a Great Deal vs Not) Baseline · "Quite a bit" or "A great deal"	30 Participants	—
Caregiver Change in Motivation for Child to Attend School (Quite a Bit / a Great Deal vs Not) Baseline · "Somewhat," "A little," or "Not at all"	9 Participants	—
Caregiver Change in Motivation for Child to Attend School (Quite a Bit / a Great Deal vs Not) 3 month · "Quite a bit" or "A great deal"	26 Participants	—
Caregiver Change in Motivation for Child to Attend School (Quite a Bit / a Great Deal vs Not) 3 month · "Somewhat," "A little," or "Not at all"	4 Participants	—
Caregiver Change in Motivation for Child to Attend School (Quite a Bit / a Great Deal vs Not) 6 month · "Quite a bit" or "A great deal"	26 Participants	—
Caregiver Change in Motivation for Child to Attend School (Quite a Bit / a Great Deal vs Not) 9 month · "Quite a bit" or "A great deal"	15 Participants	—
Caregiver Change in Motivation for Child to Attend School (Quite a Bit / a Great Deal vs Not) 9 month · "Somewhat," "A little," or "Not at all"	3 Participants	—
Caregiver Change in Motivation for Child to Attend School (Quite a Bit / a Great Deal vs Not) 15 month · "Quite a bit" or "A great deal"	8 Participants	—
Caregiver Change in Motivation for Child to Attend School (Quite a Bit / a Great Deal vs Not) 18 month · "Quite a bit" or "A great deal"	8 Participants	—
Caregiver Change in Motivation for Child to Attend School (Quite a Bit / a Great Deal vs Not) 18 month · "Somewhat," "A little," or "Not at all"	0 Participants	—
Caregiver Change in Motivation for Child to Attend School (Quite a Bit / a Great Deal vs Not) 21 month · "Quite a bit" or "A great deal"	16 Participants	—
Caregiver Change in Motivation for Child to Attend School (Quite a Bit / a Great Deal vs Not) 21 month · "Somewhat," "A little," or "Not at all"	0 Participants	—
Caregiver Change in Motivation for Child to Attend School (Quite a Bit / a Great Deal vs Not) 24 month · "Quite a bit" or "A great deal"	10 Participants	—
Caregiver Change in Motivation for Child to Attend School (Quite a Bit / a Great Deal vs Not) 24 month · "Somewhat," "A little," or "Not at all"	0 Participants	—

PRIMARY outcome

Timeframe: Baseline, 3 month, 6 month, 9 month, 15 month, 18 month, 21 month, 24 month

Population: The number analyzed varies per row due to varied response rates per question at each time point.

Parent survey perceived benefits construct survey will be having 6 questions ranging from benefits to child's overall health, therapy needs, impact on family. Survey will be analyzed qualitatively.

• How important is attending school in-person to your child's overall health?
• Dichotomized into: ("Not at all important", "A little important", "Somewhat important") vs. ("Very important", "Extremely important")
• This question was only asked to caregivers.
• Caregivers with multiple children enrolled completed a survey for each child.

Outcome measures

Measure	Staff and Children n=47 Participants The enrollment rate was not stratified by staff and caregiver/child dyad during data collection.	School Staff 50 school staff from Waisman Early Childhood Program (WECP) will be recruited to participate in this study. School staff will send a letter to all WECP staff inviting them to participate. Staff new to the school or who initially decline participation and then reconsider may join at any time. Additionally, staff who are vaccinated will be asked to participate in testing. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.
Caregiver Change in Perceived Benefits to Child Attending School: Important to Health 3 month · "Very important" or "Extremely important"	21 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Important to Health 3 month · "Not at all important", "A little important", or "Somewhat important"	9 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Important to Health 9 month · "Very important" or "Extremely important"	15 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Important to Health 9 month · "Not at all important", "A little important", or "Somewhat important"	3 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Important to Health 15 month · "Very important" or "Extremely important"	8 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Important to Health 24 month · "Very important" or "Extremely important"	9 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Important to Health 24 month · "Not at all important", "A little important", or "Somewhat important"	1 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Important to Health 15 month · "Not at all important", "A little important", or "Somewhat important"	0 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Important to Health 18 month · "Very important" or "Extremely important"	7 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Important to Health 18 month · "Not at all important", "A little important", or "Somewhat important"	1 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Important to Health 21 month · "Very important" or "Extremely important"	13 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Important to Health 21 month · "Not at all important", "A little important", or "Somewhat important"	3 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Important to Health 6 month · "Very important" or "Extremely important"	21 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Important to Health 6 month · "Not at all important", "A little important", or "Somewhat important"	7 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Important to Health Baseline · "Very important" or "Extremely important"	32 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Important to Health Baseline · "Not at all important", "A little important", or "Somewhat important"	8 Participants	—

PRIMARY outcome

Timeframe: Baseline, 3 month, 6 month, 9 month, 15 month, 18 month, 21 month, 24 month

Population: The number analyzed varies per row due to varied response rates per question at each time point.

Parent survey perceived benefits construct survey will be having 6 questions ranging from benefits to child's overall health, therapy needs, and impact on family. Survey will be analyzed qualitatively.

• Compared to fully virtual school, how much better or worse is attending any school in-person for your child?
• Dichotomized into: ("Quite a bit worse", "Somewhat worse", "A little bit worse", "Neither better nor worse") vs. ("A little bit better", "Somewhat better", "Quite a bit better")
• This question was only asked to caregivers.
• Caregivers with multiple children enrolled completed a survey for each child.

Outcome measures

Measure	Staff and Children n=47 Participants The enrollment rate was not stratified by staff and caregiver/child dyad during data collection.	School Staff 50 school staff from Waisman Early Childhood Program (WECP) will be recruited to participate in this study. School staff will send a letter to all WECP staff inviting them to participate. Staff new to the school or who initially decline participation and then reconsider may join at any time. Additionally, staff who are vaccinated will be asked to participate in testing. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.
Caregiver Change in Perceived Benefits to Child Attending School: In-person Schooling 3 month · "A little bit better", "Somewhat better", or "Quite a bit better"	27 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: In-person Schooling 3 month · "Quite a bit worse", "Somewhat worse", "A little bit worse", or "Neither better nor worse"	2 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: In-person Schooling 6 month · "Quite a bit worse", "Somewhat worse", "A little bit worse", or "Neither better nor worse"	2 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: In-person Schooling 9 month · "A little bit better", "Somewhat better", or "Quite a bit better"	16 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: In-person Schooling 15 month · "A little bit better", "Somewhat better", or "Quite a bit better"	8 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: In-person Schooling 18 month · "A little bit better", "Somewhat better", or "Quite a bit better"	7 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: In-person Schooling 21 month · "A little bit better", "Somewhat better", or "Quite a bit better"	15 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: In-person Schooling 24 month · "A little bit better", "Somewhat better", or "Quite a bit better"	8 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: In-person Schooling 24 month · "Quite a bit worse", "Somewhat worse", "A little bit worse", or "Neither better nor worse"	0 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: In-person Schooling Baseline · "A little bit better", "Somewhat better", or "Quite a bit better"	36 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: In-person Schooling Baseline · "Quite a bit worse", "Somewhat worse", "A little bit worse", or "Neither better nor worse"	2 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: In-person Schooling 6 month · "A little bit better", "Somewhat better", or "Quite a bit better"	26 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: In-person Schooling 9 month · "Quite a bit worse", "Somewhat worse", "A little bit worse", or "Neither better nor worse"	2 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: In-person Schooling 15 month · "Quite a bit worse", "Somewhat worse", "A little bit worse", or "Neither better nor worse"	0 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: In-person Schooling 18 month · "Quite a bit worse", "Somewhat worse", "A little bit worse", or "Neither better nor worse"	1 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: In-person Schooling 21 month · "Quite a bit worse", "Somewhat worse", "A little bit worse", or "Neither better nor worse"	0 Participants	—

PRIMARY outcome

Timeframe: Baseline, 3 month, 6 month, 9 month, 15 month, 18 month, 21 month, 24 month

Population: The number analyzed varies per row due to varied response rates per question at each time point.

Parent survey perceived benefits construct survey will be having 6 questions ranging from benefits to child's overall health, therapy needs, impact on family. Survey will be analyzed qualitatively.

• How much of your child's therapy needs are only met by attending school in-person?
• Dichotomized into: ("None", "A few", "Some" vs. "Most", "All")
• This question was only asked to caregivers.
• Caregivers with multiple children enrolled completed a survey for each child.

Outcome measures

Measure	Staff and Children n=47 Participants The enrollment rate was not stratified by staff and caregiver/child dyad during data collection.	School Staff 50 school staff from Waisman Early Childhood Program (WECP) will be recruited to participate in this study. School staff will send a letter to all WECP staff inviting them to participate. Staff new to the school or who initially decline participation and then reconsider may join at any time. Additionally, staff who are vaccinated will be asked to participate in testing. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.
Caregiver Change in Perceived Benefits to Child Attending School: Therapy Needs Baseline · "Most", "All"	9 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Therapy Needs 6 month · "None", "A few", "Some"	10 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Therapy Needs 9 month · "Most", "All"	8 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Therapy Needs 15 month · "Most", "All"	2 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Therapy Needs 15 month · "None", "A few", "Some"	3 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Therapy Needs 18 month · "None", "A few", "Some"	4 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Therapy Needs 21 month · "None", "A few", "Some"	7 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Therapy Needs 24 month · "Most", "All"	2 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Therapy Needs Baseline · "None", "A few", "Some"	22 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Therapy Needs 3 month · "Most", "All"	9 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Therapy Needs 3 month · "None", "A few", "Some"	14 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Therapy Needs 6 month · "Most", "All"	10 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Therapy Needs 9 month · "None", "A few", "Some"	8 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Therapy Needs 18 month · "Most", "All"	2 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Therapy Needs 21 month · "Most", "All"	4 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Therapy Needs 24 month · "None", "A few", "Some"	6 Participants	—

PRIMARY outcome

Timeframe: Baseline, 3 month, 6 month, 9 month, 15 month, 18 month, 21 month, 24 month

Population: The number analyzed varies per row due to varied response rates per question at each time point.

Parent survey perceived benefits construct survey will be having 6 questions ranging from benefits to child's overall health, therapy needs, impact on family. Survey will be analyzed qualitatively.

• How positive or negative is your child attending school in-person for...your family
• Dichotomized into: ("Very negative", "Somewhat negative", "A little negative", "Neutral") vs. ("A little positive", "Somewhat positive", "Very positive")
• This question was only asked to caregivers.
• Caregivers with multiple children enrolled completed a survey for each child.

Outcome measures

Measure	Staff and Children n=47 Participants The enrollment rate was not stratified by staff and caregiver/child dyad during data collection.	School Staff 50 school staff from Waisman Early Childhood Program (WECP) will be recruited to participate in this study. School staff will send a letter to all WECP staff inviting them to participate. Staff new to the school or who initially decline participation and then reconsider may join at any time. Additionally, staff who are vaccinated will be asked to participate in testing. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.
Caregiver Change in Perceived Benefits to Child Attending School: Positive for Family Baseline · "A little positive", "Somewhat positive", or "Very positive"	39 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Positive for Family Baseline · "Very negative", "Somewhat negative", or "A little negative", "Neutral"	1 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Positive for Family 3 month · "A little positive", "Somewhat positive", or "Very positive"	29 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Positive for Family 3 month · "Very negative", "Somewhat negative", or "A little negative", "Neutral"	0 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Positive for Family 6 month · "A little positive", "Somewhat positive", or "Very positive"	27 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Positive for Family 9 month · "A little positive", "Somewhat positive", or "Very positive"	18 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Positive for Family 9 month · "Very negative", "Somewhat negative", or "A little negative", "Neutral"	0 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Positive for Family 15 month · "A little positive", "Somewhat positive", or "Very positive"	8 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Positive for Family 15 month · "Very negative", "Somewhat negative", or "A little negative", "Neutral"	0 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Positive for Family 21 month · "Very negative", "Somewhat negative", or "A little negative", "Neutral"	0 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Positive for Family 24 month · "A little positive", "Somewhat positive", or "Very positive"	10 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Positive for Family 24 month · "Very negative", "Somewhat negative", or "A little negative", "Neutral"	0 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Positive for Family 6 month · "Very negative", "Somewhat negative", or "A little negative", "Neutral"	1 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Positive for Family 18 month · "A little positive", "Somewhat positive", or "Very positive"	8 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Positive for Family 18 month · "Very negative", "Somewhat negative", or "A little negative", "Neutral"	0 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Positive for Family 21 month · "A little positive", "Somewhat positive", or "Very positive"	16 Participants	—

PRIMARY outcome

Timeframe: Baseline, 3 month, 6 month, 9 month, 15 month, 18 month, 21 month, 24 month

Population: The number analyzed varies per row due to varied response rates per question at each time point.

Parent survey perceived benefits construct survey will be having 6 questions ranging from benefits to child's overall health, therapy needs, impact on family. Survey will be analyzed qualitatively.

• How positive or negative is your child attending school in-person for...the staff and teachers
• Dichotomized into: ("Very negative", "Somewhat negative", "A little negative", "Neutral") vs. ("A little positive", "Somewhat positive", "Very positive")
• This question was only asked to caregivers.
• Caregivers with multiple children enrolled completed a survey for each child.

Outcome measures

Measure	Staff and Children n=47 Participants The enrollment rate was not stratified by staff and caregiver/child dyad during data collection.	School Staff 50 school staff from Waisman Early Childhood Program (WECP) will be recruited to participate in this study. School staff will send a letter to all WECP staff inviting them to participate. Staff new to the school or who initially decline participation and then reconsider may join at any time. Additionally, staff who are vaccinated will be asked to participate in testing. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.
Caregiver Change in Perceived Benefits to Child Attending School: Positive for Staff Baseline · "A little positive", "Somewhat positive", or "Very positive"	32 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Positive for Staff Baseline · "Very negative", "Somewhat negative", or "A little negative", "Neutral"	8 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Positive for Staff 6 month · "A little positive", "Somewhat positive", or "Very positive"	22 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Positive for Staff 6 month · "Very negative", "Somewhat negative", or "A little negative", "Neutral"	6 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Positive for Staff 9 month · "A little positive", "Somewhat positive", or "Very positive"	15 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Positive for Staff 15 month · "A little positive", "Somewhat positive", or "Very positive"	7 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Positive for Staff 18 month · "Very negative", "Somewhat negative", or "A little negative", "Neutral"	2 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Positive for Staff 21 month · "A little positive", "Somewhat positive", or "Very positive"	12 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Positive for Staff 21 month · "Very negative", "Somewhat negative", or "A little negative", "Neutral"	3 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Positive for Staff 24 month · "A little positive", "Somewhat positive", or "Very positive"	10 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Positive for Staff 24 month · "Very negative", "Somewhat negative", or "A little negative", "Neutral"	0 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Positive for Staff 3 month · "A little positive", "Somewhat positive", or "Very positive"	23 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Positive for Staff 3 month · "Very negative", "Somewhat negative", or "A little negative", "Neutral"	6 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Positive for Staff 9 month · "Very negative", "Somewhat negative", or "A little negative", "Neutral"	2 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Positive for Staff 15 month · "Very negative", "Somewhat negative", or "A little negative", "Neutral"	1 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Positive for Staff 18 month · "A little positive", "Somewhat positive", or "Very positive"	6 Participants	—

PRIMARY outcome

Timeframe: Baseline, 3 month, 6 month, 9 month, 15 month, 18 month, 21 month, 24 month

Population: The number analyzed varies per row due to varied response rates per question at each time point.

Parent survey perceived benefits construct survey will be having 6 questions ranging from benefits to child's overall health, therapy needs, impact on family. Survey will be analyzed qualitatively.

• Does your child attending school in-person help the adults in your family to keep their jobs?
• Response options: Yes / No
• This question was only asked to caregivers.
• Caregivers with multiple children enrolled completed a survey for each child.

Outcome measures

Measure	Staff and Children n=47 Participants The enrollment rate was not stratified by staff and caregiver/child dyad during data collection.	School Staff 50 school staff from Waisman Early Childhood Program (WECP) will be recruited to participate in this study. School staff will send a letter to all WECP staff inviting them to participate. Staff new to the school or who initially decline participation and then reconsider may join at any time. Additionally, staff who are vaccinated will be asked to participate in testing. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.
Caregiver Change in Perceived Benefits to Child Attending School: Keep Jobs 3 month · Yes	24 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Keep Jobs 3 month · No	5 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Keep Jobs 6 month · Yes	23 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Keep Jobs 15 month · Yes	7 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Keep Jobs 15 month · No	1 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Keep Jobs 18 month · Yes	7 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Keep Jobs 18 month · No	0 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Keep Jobs 21 month · Yes	14 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Keep Jobs 21 month · No	2 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Keep Jobs 24 month · Yes	8 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Keep Jobs 24 month · No	2 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Keep Jobs Baseline · Yes	31 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Keep Jobs Baseline · No	8 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Keep Jobs 6 month · No	5 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Keep Jobs 9 month · Yes	13 Participants	—
Caregiver Change in Perceived Benefits to Child Attending School: Keep Jobs 9 month · No	5 Participants	—

PRIMARY outcome

Timeframe: Baseline, 3 month, 6 month, 9 month, 15 month, 18 month, 21 month, 24 month

Population: The number analyzed varies per row due to varied response rates per question at each time point.

Survey will have following questions which will be answered dichotomously very/extremely [comfortable] vs not.

• How comfortable are you with the number of people around your child at school?
• Dichotomized into: ("Not at all", "A little", "Somewhat") vs. ("Very", "Extremely")
• This question was only asked to caregivers.
• Caregivers with multiple children enrolled completed a survey for each child.

Outcome measures

Measure	Staff and Children n=47 Participants The enrollment rate was not stratified by staff and caregiver/child dyad during data collection.	School Staff 50 school staff from Waisman Early Childhood Program (WECP) will be recruited to participate in this study. School staff will send a letter to all WECP staff inviting them to participate. Staff new to the school or who initially decline participation and then reconsider may join at any time. Additionally, staff who are vaccinated will be asked to participate in testing. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.
Caregiver Change in Barriers to School Attendance: Number of People 3 month · "Not at all", "A little", or "Somewhat" comfortable	19 Participants	—
Caregiver Change in Barriers to School Attendance: Number of People 9 month · "Not at all", "A little", or "Somewhat" comfortable	6 Participants	—
Caregiver Change in Barriers to School Attendance: Number of People 21 month · "Not at all", "A little", or "Somewhat" comfortable	4 Participants	—
Caregiver Change in Barriers to School Attendance: Number of People 24 month · "Very" or "Extremely" comfortable	7 Participants	—
Caregiver Change in Barriers to School Attendance: Number of People 24 month · "Not at all", "A little", or "Somewhat" comfortable	3 Participants	—
Caregiver Change in Barriers to School Attendance: Number of People Baseline · "Very" or "Extremely" comfortable	21 Participants	—
Caregiver Change in Barriers to School Attendance: Number of People Baseline · "Not at all", "A little", or "Somewhat" comfortable	19 Participants	—
Caregiver Change in Barriers to School Attendance: Number of People 3 month · "Very" or "Extremely" comfortable	10 Participants	—
Caregiver Change in Barriers to School Attendance: Number of People 6 month · "Very" or "Extremely" comfortable	15 Participants	—
Caregiver Change in Barriers to School Attendance: Number of People 6 month · "Not at all", "A little", or "Somewhat" comfortable	12 Participants	—
Caregiver Change in Barriers to School Attendance: Number of People 9 month · "Very" or "Extremely" comfortable	11 Participants	—
Caregiver Change in Barriers to School Attendance: Number of People 15 month · "Very" or "Extremely" comfortable	4 Participants	—
Caregiver Change in Barriers to School Attendance: Number of People 15 month · "Not at all", "A little", or "Somewhat" comfortable	4 Participants	—
Caregiver Change in Barriers to School Attendance: Number of People 18 month · "Very" or "Extremely" comfortable	5 Participants	—
Caregiver Change in Barriers to School Attendance: Number of People 18 month · "Not at all", "A little", or "Somewhat" comfortable	3 Participants	—
Caregiver Change in Barriers to School Attendance: Number of People 21 month · "Very" or "Extremely" comfortable	12 Participants	—

PRIMARY outcome

Timeframe: Baseline, 3 month, 6 month, 9 month, 15 month, 18 month, 21 month, 24 month

Population: The number analyzed varies per row due to varied response rates per question at each time point.

Survey will have following questions which will be answered dichotomously very/extremely [comfortable] vs not.

• How comfortable are you with how close people have to be to your child at school?
• Dichotomized into: ("Not at all", "A little", "Somewhat") vs. ("Very", "Extremely")
• This question was only asked to caregivers.
• Caregivers with multiple children enrolled completed a survey for each child.

Outcome measures

Measure	Staff and Children n=47 Participants The enrollment rate was not stratified by staff and caregiver/child dyad during data collection.	School Staff 50 school staff from Waisman Early Childhood Program (WECP) will be recruited to participate in this study. School staff will send a letter to all WECP staff inviting them to participate. Staff new to the school or who initially decline participation and then reconsider may join at any time. Additionally, staff who are vaccinated will be asked to participate in testing. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.
Caregiver Change in Barriers to School Attendance: Proximity Baseline · "Very" or "Extremely" comfortable	20 Participants	—
Caregiver Change in Barriers to School Attendance: Proximity Baseline · "Not at all", "A little", or "Somewhat" comfortable	20 Participants	—
Caregiver Change in Barriers to School Attendance: Proximity 3 month · "Very" or "Extremely" comfortable	9 Participants	—
Caregiver Change in Barriers to School Attendance: Proximity 6 month · "Very" or "Extremely" comfortable	13 Participants	—
Caregiver Change in Barriers to School Attendance: Proximity 24 month · "Not at all", "A little", or "Somewhat" comfortable	4 Participants	—
Caregiver Change in Barriers to School Attendance: Proximity 3 month · "Not at all", "A little", or "Somewhat" comfortable	20 Participants	—
Caregiver Change in Barriers to School Attendance: Proximity 6 month · "Not at all", "A little", or "Somewhat" comfortable	14 Participants	—
Caregiver Change in Barriers to School Attendance: Proximity 9 month · "Very" or "Extremely" comfortable	10 Participants	—
Caregiver Change in Barriers to School Attendance: Proximity 9 month · "Not at all", "A little", or "Somewhat" comfortable	8 Participants	—
Caregiver Change in Barriers to School Attendance: Proximity 15 month · "Very" or "Extremely" comfortable	4 Participants	—
Caregiver Change in Barriers to School Attendance: Proximity 15 month · "Not at all", "A little", or "Somewhat" comfortable	4 Participants	—
Caregiver Change in Barriers to School Attendance: Proximity 18 month · "Very" or "Extremely" comfortable	3 Participants	—
Caregiver Change in Barriers to School Attendance: Proximity 18 month · "Not at all", "A little", or "Somewhat" comfortable	5 Participants	—
Caregiver Change in Barriers to School Attendance: Proximity 21 month · "Very" or "Extremely" comfortable	10 Participants	—
Caregiver Change in Barriers to School Attendance: Proximity 21 month · "Not at all", "A little", or "Somewhat" comfortable	5 Participants	—
Caregiver Change in Barriers to School Attendance: Proximity 24 month · "Very" or "Extremely" comfortable	6 Participants	—

PRIMARY outcome

Timeframe: Baseline, 3 month, 6 month, 9 month, 15 month, 18 month, 21 month, 24 month

Population: The number analyzed varies per row due to varied response rates per question at each time point.

Survey will have following questions which will be answered dichotomously very/extremely [comfortable] vs not.

• How comfortable are you with the amount personal protective equipment (PPE), such as masks and gloves, available at school?
• Dichotomized into: ("Not at all", "A little", "Somewhat") vs. ("Very", "Extremely")
• This question was only asked to caregivers.
• Caregivers with multiple children enrolled completed a survey for each child.

Outcome measures

Measure	Staff and Children n=47 Participants The enrollment rate was not stratified by staff and caregiver/child dyad during data collection.	School Staff 50 school staff from Waisman Early Childhood Program (WECP) will be recruited to participate in this study. School staff will send a letter to all WECP staff inviting them to participate. Staff new to the school or who initially decline participation and then reconsider may join at any time. Additionally, staff who are vaccinated will be asked to participate in testing. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.
Caregiver Change in Barriers to School Attendance: PPE 6 month · "Not at all", "A little", or "Somewhat" comfortable	10 Participants	—
Caregiver Change in Barriers to School Attendance: PPE 21 month · "Very" or "Extremely" comfortable	11 Participants	—
Caregiver Change in Barriers to School Attendance: PPE Baseline · "Very" or "Extremely" comfortable	27 Participants	—
Caregiver Change in Barriers to School Attendance: PPE Baseline · "Not at all", "A little", or "Somewhat" comfortable	13 Participants	—
Caregiver Change in Barriers to School Attendance: PPE 3 month · "Very" or "Extremely" comfortable	16 Participants	—
Caregiver Change in Barriers to School Attendance: PPE 3 month · "Not at all", "A little", or "Somewhat" comfortable	13 Participants	—
Caregiver Change in Barriers to School Attendance: PPE 6 month · "Very" or "Extremely" comfortable	16 Participants	—
Caregiver Change in Barriers to School Attendance: PPE 9 month · "Very" or "Extremely" comfortable	17 Participants	—
Caregiver Change in Barriers to School Attendance: PPE 9 month · "Not at all", "A little", or "Somewhat" comfortable	1 Participants	—
Caregiver Change in Barriers to School Attendance: PPE 15 month · "Very" or "Extremely" comfortable	3 Participants	—
Caregiver Change in Barriers to School Attendance: PPE 15 month · "Not at all", "A little", or "Somewhat" comfortable	5 Participants	—
Caregiver Change in Barriers to School Attendance: PPE 18 month · "Very" or "Extremely" comfortable	5 Participants	—
Caregiver Change in Barriers to School Attendance: PPE 18 month · "Not at all", "A little", or "Somewhat" comfortable	3 Participants	—
Caregiver Change in Barriers to School Attendance: PPE 21 month · "Not at all", "A little", or "Somewhat" comfortable	5 Participants	—
Caregiver Change in Barriers to School Attendance: PPE 24 month · "Very" or "Extremely" comfortable	7 Participants	—
Caregiver Change in Barriers to School Attendance: PPE 24 month · "Not at all", "A little", or "Somewhat" comfortable	3 Participants	—

PRIMARY outcome

Timeframe: Baseline, 3 month, 6 month, 9 month, 15 month, 18 month, 21 month, 24 month

Population: The number analyzed varies per row due to varied response rates per question at each time point.

Survey will have following questions which will be answered dichotomously very/extremely [comfortable] vs not.

• How comfortable are you with the amount of COVID-19 testing among school staff and classmates?
• Dichotomized into: ("Not at all", "A little", "Somewhat") vs. ("Very", "Extremely")
• This question was only asked to caregivers.
• Caregivers with multiple children enrolled completed a survey for each child.

Outcome measures

Measure	Staff and Children n=47 Participants The enrollment rate was not stratified by staff and caregiver/child dyad during data collection.	School Staff 50 school staff from Waisman Early Childhood Program (WECP) will be recruited to participate in this study. School staff will send a letter to all WECP staff inviting them to participate. Staff new to the school or who initially decline participation and then reconsider may join at any time. Additionally, staff who are vaccinated will be asked to participate in testing. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.
Caregiver Change in Barriers to School Attendance: Testing Baseline · "Very" or "Extremely" comfortable	30 Participants	—
Caregiver Change in Barriers to School Attendance: Testing 9 month · "Very" or "Extremely" comfortable	11 Participants	—
Caregiver Change in Barriers to School Attendance: Testing 9 month · "Not at all", "A little", or "Somewhat" comfortable	7 Participants	—
Caregiver Change in Barriers to School Attendance: Testing 24 month · "Very" or "Extremely" comfortable	8 Participants	—
Caregiver Change in Barriers to School Attendance: Testing 24 month · "Not at all", "A little", or "Somewhat" comfortable	2 Participants	—
Caregiver Change in Barriers to School Attendance: Testing Baseline · "Not at all", "A little", or "Somewhat" comfortable	10 Participants	—
Caregiver Change in Barriers to School Attendance: Testing 3 month · "Very" or "Extremely" comfortable	19 Participants	—
Caregiver Change in Barriers to School Attendance: Testing 3 month · "Not at all", "A little", or "Somewhat" comfortable	10 Participants	—
Caregiver Change in Barriers to School Attendance: Testing 6 month · "Very" or "Extremely" comfortable	13 Participants	—
Caregiver Change in Barriers to School Attendance: Testing 6 month · "Not at all", "A little", or "Somewhat" comfortable	13 Participants	—
Caregiver Change in Barriers to School Attendance: Testing 15 month · "Very" or "Extremely" comfortable	3 Participants	—
Caregiver Change in Barriers to School Attendance: Testing 15 month · "Not at all", "A little", or "Somewhat" comfortable	5 Participants	—
Caregiver Change in Barriers to School Attendance: Testing 18 month · "Very" or "Extremely" comfortable	5 Participants	—
Caregiver Change in Barriers to School Attendance: Testing 18 month · "Not at all", "A little", or "Somewhat" comfortable	3 Participants	—
Caregiver Change in Barriers to School Attendance: Testing 21 month · "Very" or "Extremely" comfortable	12 Participants	—
Caregiver Change in Barriers to School Attendance: Testing 21 month · "Not at all", "A little", or "Somewhat" comfortable	4 Participants	—

PRIMARY outcome

Timeframe: Baseline, 3 month, 6 month, 9 month, 15 month, 18 month, 21 month, 24 month

Population: The number analyzed varies per row due to varied response rates per question at each time point.

Survey will have following questions which will be answered dichotomously very/extremely [comfortable] vs not.

• How comfortable are you with how closely parents of classmates follow recommendations to keep your child safe?
• Dichotomized into: ("Not at all", "A little", "Somewhat") vs. ("Very", "Extremely")
• This question was only asked to caregivers.
• Caregivers with multiple children enrolled completed a survey for each child.

Outcome measures

Measure	Staff and Children n=47 Participants The enrollment rate was not stratified by staff and caregiver/child dyad during data collection.	School Staff 50 school staff from Waisman Early Childhood Program (WECP) will be recruited to participate in this study. School staff will send a letter to all WECP staff inviting them to participate. Staff new to the school or who initially decline participation and then reconsider may join at any time. Additionally, staff who are vaccinated will be asked to participate in testing. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.
Caregiver Change in Barriers to School Attendance: Following Recommendations Baseline · "Very" or "Extremely" comfortable	23 Participants	—
Caregiver Change in Barriers to School Attendance: Following Recommendations Baseline · "Not at all", "A little", or "Somewhat" comfortable	17 Participants	—
Caregiver Change in Barriers to School Attendance: Following Recommendations 3 month · "Very" or "Extremely" comfortable	10 Participants	—
Caregiver Change in Barriers to School Attendance: Following Recommendations 24 month · "Very" or "Extremely" comfortable	7 Participants	—
Caregiver Change in Barriers to School Attendance: Following Recommendations 24 month · "Not at all", "A little", or "Somewhat" comfortable	3 Participants	—
Caregiver Change in Barriers to School Attendance: Following Recommendations 3 month · "Not at all", "A little", or "Somewhat" comfortable	19 Participants	—
Caregiver Change in Barriers to School Attendance: Following Recommendations 6 month · "Very" or "Extremely" comfortable	14 Participants	—
Caregiver Change in Barriers to School Attendance: Following Recommendations 6 month · "Not at all", "A little", or "Somewhat" comfortable	12 Participants	—
Caregiver Change in Barriers to School Attendance: Following Recommendations 9 month · "Very" or "Extremely" comfortable	14 Participants	—
Caregiver Change in Barriers to School Attendance: Following Recommendations 9 month · "Not at all", "A little", or "Somewhat" comfortable	2 Participants	—
Caregiver Change in Barriers to School Attendance: Following Recommendations 15 month · "Very" or "Extremely" comfortable	4 Participants	—
Caregiver Change in Barriers to School Attendance: Following Recommendations 15 month · "Not at all", "A little", or "Somewhat" comfortable	4 Participants	—
Caregiver Change in Barriers to School Attendance: Following Recommendations 18 month · "Very" or "Extremely" comfortable	5 Participants	—
Caregiver Change in Barriers to School Attendance: Following Recommendations 18 month · "Not at all", "A little", or "Somewhat" comfortable	3 Participants	—
Caregiver Change in Barriers to School Attendance: Following Recommendations 21 month · "Very" or "Extremely" comfortable	11 Participants	—
Caregiver Change in Barriers to School Attendance: Following Recommendations 21 month · "Not at all", "A little", or "Somewhat" comfortable	4 Participants	—

PRIMARY outcome

Timeframe: Baseline, 3 month, 6 month, 9 month, 15 month, 18 month, 21 month, 24 month

Population: The number analyzed varies per row due to varied response rates per question at each time point.

Survey will have following questions which will be answered dichotomously very/extremely vs not.

• How difficult is it to transport your child to or from school as a result of COVID-19?
• Dichotomized as: ("Not at all", "A little", "Somewhat") vs. ("Very", "Extremely")
• This question was only asked to caregivers.
• Caregivers with multiple children enrolled completed a survey for each child.

Outcome measures

Measure	Staff and Children n=47 Participants The enrollment rate was not stratified by staff and caregiver/child dyad during data collection.	School Staff 50 school staff from Waisman Early Childhood Program (WECP) will be recruited to participate in this study. School staff will send a letter to all WECP staff inviting them to participate. Staff new to the school or who initially decline participation and then reconsider may join at any time. Additionally, staff who are vaccinated will be asked to participate in testing. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.
Caregiver Change in Barriers to School Attendance: Transportation Baseline · "Not at all", "A little", or "Somewhat" difficult	39 Participants	—
Caregiver Change in Barriers to School Attendance: Transportation Baseline · "Very" or "Extremely" difficult	1 Participants	—
Caregiver Change in Barriers to School Attendance: Transportation 3 month · "Very" or "Extremely" difficult	0 Participants	—
Caregiver Change in Barriers to School Attendance: Transportation 3 month · "Not at all", "A little", or "Somewhat" difficult	29 Participants	—
Caregiver Change in Barriers to School Attendance: Transportation 6 month · "Very" or "Extremely" difficult	1 Participants	—
Caregiver Change in Barriers to School Attendance: Transportation 6 month · "Not at all", "A little", or "Somewhat" difficult	27 Participants	—
Caregiver Change in Barriers to School Attendance: Transportation 9 month · "Very" or "Extremely" difficult	1 Participants	—
Caregiver Change in Barriers to School Attendance: Transportation 9 month · "Not at all", "A little", or "Somewhat" difficult	17 Participants	—
Caregiver Change in Barriers to School Attendance: Transportation 15 month · "Very" or "Extremely" difficult	0 Participants	—
Caregiver Change in Barriers to School Attendance: Transportation 15 month · "Not at all", "A little", or "Somewhat" difficult	8 Participants	—
Caregiver Change in Barriers to School Attendance: Transportation 18 month · "Very" or "Extremely" difficult	0 Participants	—
Caregiver Change in Barriers to School Attendance: Transportation 18 month · "Not at all", "A little", or "Somewhat" difficult	8 Participants	—
Caregiver Change in Barriers to School Attendance: Transportation 21 month · "Very" or "Extremely" difficult	0 Participants	—
Caregiver Change in Barriers to School Attendance: Transportation 21 month · "Not at all", "A little", or "Somewhat" difficult	16 Participants	—
Caregiver Change in Barriers to School Attendance: Transportation 24 month · "Very" or "Extremely" difficult	0 Participants	—
Caregiver Change in Barriers to School Attendance: Transportation 24 month · "Not at all", "A little", or "Somewhat" difficult	10 Participants	—

PRIMARY outcome

Timeframe: Baseline, 3 month, 6 month, 9 month, 15 month, 18 month, 21 month, 24 month

Population: The number analyzed varies per row due to varied response rates per question at each time point.

Survey will have following questions which will be answered dichotomously very/extremely vs not.

• In your child's school, do they have access to necessary facilities to wash?
• Dichotomized as: ("Yes, all of the time", "Yes, most of the time") vs. ("Some of the time", "Rarely", "Not at all")
• This question was only asked to caregivers.
• Caregivers with multiple children enrolled completed a survey for each child.

Outcome measures

Measure	Staff and Children n=47 Participants The enrollment rate was not stratified by staff and caregiver/child dyad during data collection.	School Staff 50 school staff from Waisman Early Childhood Program (WECP) will be recruited to participate in this study. School staff will send a letter to all WECP staff inviting them to participate. Staff new to the school or who initially decline participation and then reconsider may join at any time. Additionally, staff who are vaccinated will be asked to participate in testing. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.
Caregiver Change in Barriers to School Attendance: Wash 3 month · "Yes, all of the time" or "Yes, most of the time"	29 Participants	—
Caregiver Change in Barriers to School Attendance: Wash 9 month · "Yes, all of the time" or "Yes, most of the time"	18 Participants	—
Caregiver Change in Barriers to School Attendance: Wash 9 month · "Some of the time", "Rarely", or "Not at all"	0 Participants	—
Caregiver Change in Barriers to School Attendance: Wash 15 month · "Some of the time", "Rarely", or "Not at all"	0 Participants	—
Caregiver Change in Barriers to School Attendance: Wash 18 month · "Yes, all of the time" or "Yes, most of the time"	8 Participants	—
Caregiver Change in Barriers to School Attendance: Wash 21 month · "Some of the time", "Rarely", or "Not at all"	0 Participants	—
Caregiver Change in Barriers to School Attendance: Wash Baseline · "Yes, all of the time" or "Yes, most of the time"	39 Participants	—
Caregiver Change in Barriers to School Attendance: Wash Baseline · "Some of the time", "Rarely", or "Not at all"	0 Participants	—
Caregiver Change in Barriers to School Attendance: Wash 3 month · "Some of the time", "Rarely", or "Not at all"	0 Participants	—
Caregiver Change in Barriers to School Attendance: Wash 6 month · "Yes, all of the time" or "Yes, most of the time"	28 Participants	—
Caregiver Change in Barriers to School Attendance: Wash 6 month · "Some of the time", "Rarely", or "Not at all"	0 Participants	—
Caregiver Change in Barriers to School Attendance: Wash 15 month · "Yes, all of the time" or "Yes, most of the time"	8 Participants	—
Caregiver Change in Barriers to School Attendance: Wash 18 month · "Some of the time", "Rarely", or "Not at all"	0 Participants	—
Caregiver Change in Barriers to School Attendance: Wash 21 month · "Yes, all of the time" or "Yes, most of the time"	16 Participants	—
Caregiver Change in Barriers to School Attendance: Wash 24 month · "Yes, all of the time" or "Yes, most of the time"	10 Participants	—
Caregiver Change in Barriers to School Attendance: Wash 24 month · "Some of the time", "Rarely", or "Not at all"	0 Participants	—

PRIMARY outcome

Timeframe: Baseline, 3 month, 6 month, 9 month, 15 month, 18 month, 21 month, 24 month

Population: The number analyzed varies per row due to varied response rates per question at each time point.

Survey will have following questions which will be answered dichotomously very/extremely [comfortable] vs not.

• While in school, is your child required to be in close contact (i.e., within 6 ft) with others? 'Others' includes teachers, aides, nurses, and classmates.
• Dichotomized as: ("Yes, all of the time", "Yes, most of the time") vs. ("Some of the time", "Rarely", "Not at all")
• This question was only asked to caregivers.
• Caregivers with multiple children enrolled completed a survey for each child.

Outcome measures

Measure	Staff and Children n=47 Participants The enrollment rate was not stratified by staff and caregiver/child dyad during data collection.	School Staff 50 school staff from Waisman Early Childhood Program (WECP) will be recruited to participate in this study. School staff will send a letter to all WECP staff inviting them to participate. Staff new to the school or who initially decline participation and then reconsider may join at any time. Additionally, staff who are vaccinated will be asked to participate in testing. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.
Caregiver Change in Barriers to School Attendance: Close Contact 9 month · "Yes, all of the time" or "Yes, most of the time"	15 Participants	—
Caregiver Change in Barriers to School Attendance: Close Contact 9 month · "Some of the time", "Rarely", or "Not at all"	3 Participants	—
Caregiver Change in Barriers to School Attendance: Close Contact Baseline · "Yes, all of the time" or "Yes, most of the time"	24 Participants	—
Caregiver Change in Barriers to School Attendance: Close Contact Baseline · "Some of the time", "Rarely", or "Not at all"	16 Participants	—
Caregiver Change in Barriers to School Attendance: Close Contact 3 month · "Yes, all of the time" or "Yes, most of the time"	21 Participants	—
Caregiver Change in Barriers to School Attendance: Close Contact 3 month · "Some of the time", "Rarely", or "Not at all"	8 Participants	—
Caregiver Change in Barriers to School Attendance: Close Contact 6 month · "Yes, all of the time" or "Yes, most of the time"	24 Participants	—
Caregiver Change in Barriers to School Attendance: Close Contact 6 month · "Some of the time", "Rarely", or "Not at all"	4 Participants	—
Caregiver Change in Barriers to School Attendance: Close Contact 15 month · "Yes, all of the time" or "Yes, most of the time"	6 Participants	—
Caregiver Change in Barriers to School Attendance: Close Contact 15 month · "Some of the time", "Rarely", or "Not at all"	2 Participants	—
Caregiver Change in Barriers to School Attendance: Close Contact 18 month · "Yes, all of the time" or "Yes, most of the time"	6 Participants	—
Caregiver Change in Barriers to School Attendance: Close Contact 18 month · "Some of the time", "Rarely", or "Not at all"	2 Participants	—
Caregiver Change in Barriers to School Attendance: Close Contact 21 month · "Yes, all of the time" or "Yes, most of the time"	13 Participants	—
Caregiver Change in Barriers to School Attendance: Close Contact 21 month · "Some of the time", "Rarely", or "Not at all"	2 Participants	—
Caregiver Change in Barriers to School Attendance: Close Contact 24 month · "Yes, all of the time" or "Yes, most of the time"	8 Participants	—
Caregiver Change in Barriers to School Attendance: Close Contact 24 month · "Some of the time", "Rarely", or "Not at all"	2 Participants	—

PRIMARY outcome

Timeframe: Baseline, 3 month, 6 month, 9 month, 15 month, 18 month, 21 month, 24 month

Population: The number analyzed varies per row due to varied response rates per question at each time point.

Survey will have following questions which will be answered dichotomously very/extremely vs not.

• While in school, is your child able to wear a mask?
• Dichotomized as: ("Yes, all of the time", "Yes, most of the time") vs. ("Some of the time", "Rarely", "Not at all")
• This question was only asked to caregivers.
• Caregivers with multiple children enrolled completed a survey for each child.

Outcome measures

Measure	Staff and Children n=47 Participants The enrollment rate was not stratified by staff and caregiver/child dyad during data collection.	School Staff 50 school staff from Waisman Early Childhood Program (WECP) will be recruited to participate in this study. School staff will send a letter to all WECP staff inviting them to participate. Staff new to the school or who initially decline participation and then reconsider may join at any time. Additionally, staff who are vaccinated will be asked to participate in testing. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.
Caregiver Change in Barriers to School Attendance: Masking 6 month · "Some of the time", "Rarely", or "Not at all"	5 Participants	—
Caregiver Change in Barriers to School Attendance: Masking 9 month · "Some of the time", "Rarely", or "Not at all"	4 Participants	—
Caregiver Change in Barriers to School Attendance: Masking 15 month · "Yes, all of the time" or "Yes, most of the time"	3 Participants	—
Caregiver Change in Barriers to School Attendance: Masking 15 month · "Some of the time", "Rarely", or "Not at all"	5 Participants	—
Caregiver Change in Barriers to School Attendance: Masking Baseline · "Yes, all of the time" or "Yes, most of the time"	30 Participants	—
Caregiver Change in Barriers to School Attendance: Masking Baseline · "Some of the time", "Rarely", or "Not at all"	10 Participants	—
Caregiver Change in Barriers to School Attendance: Masking 3 month · "Yes, all of the time" or "Yes, most of the time"	23 Participants	—
Caregiver Change in Barriers to School Attendance: Masking 3 month · "Some of the time", "Rarely", or "Not at all"	6 Participants	—
Caregiver Change in Barriers to School Attendance: Masking 6 month · "Yes, all of the time" or "Yes, most of the time"	23 Participants	—
Caregiver Change in Barriers to School Attendance: Masking 9 month · "Yes, all of the time" or "Yes, most of the time"	14 Participants	—
Caregiver Change in Barriers to School Attendance: Masking 18 month · "Yes, all of the time" or "Yes, most of the time"	6 Participants	—
Caregiver Change in Barriers to School Attendance: Masking 18 month · "Some of the time", "Rarely", or "Not at all"	2 Participants	—
Caregiver Change in Barriers to School Attendance: Masking 21 month · "Yes, all of the time" or "Yes, most of the time"	7 Participants	—
Caregiver Change in Barriers to School Attendance: Masking 21 month · "Some of the time", "Rarely", or "Not at all"	9 Participants	—
Caregiver Change in Barriers to School Attendance: Masking 24 month · "Yes, all of the time" or "Yes, most of the time"	5 Participants	—
Caregiver Change in Barriers to School Attendance: Masking 24 month · "Some of the time", "Rarely", or "Not at all"	5 Participants	—

PRIMARY outcome

Timeframe: Baseline, 3 month, 6 month, 9 month, 15 month, 18 month, 21 month, 24 month

Population: The number analyzed varies per row due to varied response rates per question at each time point.

Participants will answer the following survey question in Yes/No:

• "Teachers/staff have asked for my child to attend school."- Y/N
• This question was only asked to caregivers.
• Caregivers with multiple children enrolled completed a survey for each child.

Outcome measures

Measure	Staff and Children n=47 Participants The enrollment rate was not stratified by staff and caregiver/child dyad during data collection.	School Staff 50 school staff from Waisman Early Childhood Program (WECP) will be recruited to participate in this study. School staff will send a letter to all WECP staff inviting them to participate. Staff new to the school or who initially decline participation and then reconsider may join at any time. Additionally, staff who are vaccinated will be asked to participate in testing. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.
Caregiver Change in Cues: Has a Teacher or Staff Member Encouraged Child to Attend School In-person? (Y/N) Baseline · No	31 Participants	—
Caregiver Change in Cues: Has a Teacher or Staff Member Encouraged Child to Attend School In-person? (Y/N) 3 month · Yes	7 Participants	—
Caregiver Change in Cues: Has a Teacher or Staff Member Encouraged Child to Attend School In-person? (Y/N) 15 month · No	4 Participants	—
Caregiver Change in Cues: Has a Teacher or Staff Member Encouraged Child to Attend School In-person? (Y/N) 18 month · Yes	3 Participants	—
Caregiver Change in Cues: Has a Teacher or Staff Member Encouraged Child to Attend School In-person? (Y/N) Baseline · Yes	7 Participants	—
Caregiver Change in Cues: Has a Teacher or Staff Member Encouraged Child to Attend School In-person? (Y/N) 3 month · No	22 Participants	—
Caregiver Change in Cues: Has a Teacher or Staff Member Encouraged Child to Attend School In-person? (Y/N) 6 month · Yes	7 Participants	—
Caregiver Change in Cues: Has a Teacher or Staff Member Encouraged Child to Attend School In-person? (Y/N) 18 month · No	5 Participants	—
Caregiver Change in Cues: Has a Teacher or Staff Member Encouraged Child to Attend School In-person? (Y/N) 21 month · Yes	5 Participants	—
Caregiver Change in Cues: Has a Teacher or Staff Member Encouraged Child to Attend School In-person? (Y/N) 21 month · No	10 Participants	—
Caregiver Change in Cues: Has a Teacher or Staff Member Encouraged Child to Attend School In-person? (Y/N) 24 month · Yes	3 Participants	—
Caregiver Change in Cues: Has a Teacher or Staff Member Encouraged Child to Attend School In-person? (Y/N) 24 month · No	7 Participants	—
Caregiver Change in Cues: Has a Teacher or Staff Member Encouraged Child to Attend School In-person? (Y/N) 6 month · No	20 Participants	—
Caregiver Change in Cues: Has a Teacher or Staff Member Encouraged Child to Attend School In-person? (Y/N) 9 month · Yes	6 Participants	—
Caregiver Change in Cues: Has a Teacher or Staff Member Encouraged Child to Attend School In-person? (Y/N) 9 month · No	12 Participants	—
Caregiver Change in Cues: Has a Teacher or Staff Member Encouraged Child to Attend School In-person? (Y/N) 15 month · Yes	4 Participants	—

PRIMARY outcome

Timeframe: Baseline, 3 month, 6 month, 9 month, 15 month, 18 month, 21 month, 24 month

Population: The number analyzed varies per row due to varied response rates per question at each time point.

Participant will be asked the attendance question in survey. It will be answered in Yes/No.

• Currently, is child attending school in-person, either full-time or as part of a hybrid or part-time schedule? Y/N
• This question was only asked to caregivers.
• Caregivers with multiple children enrolled completed a survey for each child.

Outcome measures

Measure	Staff and Children n=47 Participants The enrollment rate was not stratified by staff and caregiver/child dyad during data collection.	School Staff 50 school staff from Waisman Early Childhood Program (WECP) will be recruited to participate in this study. School staff will send a letter to all WECP staff inviting them to participate. Staff new to the school or who initially decline participation and then reconsider may join at any time. Additionally, staff who are vaccinated will be asked to participate in testing. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.
Caregiver Change in Option and Practice: School Attendance 18 month · No	0 Participants	—
Caregiver Change in Option and Practice: School Attendance 21 month · Yes	17 Participants	—
Caregiver Change in Option and Practice: School Attendance 24 month · No	0 Participants	—
Caregiver Change in Option and Practice: School Attendance Baseline · Yes	38 Participants	—
Caregiver Change in Option and Practice: School Attendance Baseline · No	2 Participants	—
Caregiver Change in Option and Practice: School Attendance 3 month · Yes	29 Participants	—
Caregiver Change in Option and Practice: School Attendance 3 month · No	1 Participants	—
Caregiver Change in Option and Practice: School Attendance 6 month · Yes	25 Participants	—
Caregiver Change in Option and Practice: School Attendance 6 month · No	2 Participants	—
Caregiver Change in Option and Practice: School Attendance 9 month · Yes	17 Participants	—
Caregiver Change in Option and Practice: School Attendance 9 month · No	1 Participants	—
Caregiver Change in Option and Practice: School Attendance 15 month · Yes	8 Participants	—
Caregiver Change in Option and Practice: School Attendance 15 month · No	0 Participants	—
Caregiver Change in Option and Practice: School Attendance 18 month · Yes	8 Participants	—
Caregiver Change in Option and Practice: School Attendance 21 month · No	0 Participants	—
Caregiver Change in Option and Practice: School Attendance 24 month · Yes	10 Participants	—

PRIMARY outcome

Timeframe: Baseline, 3 month, 6 month, 9 month, 15 month, 18 month, 21 month, 24 month

Population: The number analyzed varies per row due to varied response rates per question at each time point. This question is only asked to participants who indicate that their child is not currently attending school. In this aim, few to no participants were asked this question. Only 2 participants were asked this question in Aim 1b.

Participant will be asked the attendance question in survey. It will be answered in Yes/No

• Currently, if participant wanted, could the child attend school in-person, either full-time or as part of a hybrid or part-time schedule?
• Survey branching logic asked this question only to participants whose child was not currently attending school in person, either full-time or as part of a hybrid or part-time schedule. The number analyzed represents the number of participants that answered this question.
• This question was only asked to caregivers.
• Caregivers with multiple children enrolled completed a survey for each child.

Outcome measures

Measure	Staff and Children n=2 Participants The enrollment rate was not stratified by staff and caregiver/child dyad during data collection.	School Staff 50 school staff from Waisman Early Childhood Program (WECP) will be recruited to participate in this study. School staff will send a letter to all WECP staff inviting them to participate. Staff new to the school or who initially decline participation and then reconsider may join at any time. Additionally, staff who are vaccinated will be asked to participate in testing. BinaxNOW Rapid Antigen System: BinaxNOW Rapid Antigen System (Abbott) is a point-of-care, lateral flow immunoassay intended for the qualitative detection of nucleocapsid protein antigen from SARS-CoV-2 in direct anterior nasal (nares) swabs. Internal controls are built into the testing system and results are available in 15 minutes. The use of the BinaxNOW system is authorized under the Food and Drug Administration's Emergency Use Authorization. The test is allowed for over-the-counter, non-prescription use with or without symptoms. The test may be used with children two years and older with the help of sample collection by an adult, and the test may be self-administered by anyone aged 15 years or more.
Caregiver Change in Option and Practice: Option to Attend School 3 month · Yes	1 Participants	—
Caregiver Change in Option and Practice: Option to Attend School 3 month · No	0 Participants	—
Caregiver Change in Option and Practice: Option to Attend School 6 month · Yes	1 Participants	—
Caregiver Change in Option and Practice: Option to Attend School 6 month · No	0 Participants	—
Caregiver Change in Option and Practice: Option to Attend School 15 month · No	0 Participants	—
Caregiver Change in Option and Practice: Option to Attend School Baseline · Yes	1 Participants	—
Caregiver Change in Option and Practice: Option to Attend School Baseline · No	0 Participants	—
Caregiver Change in Option and Practice: Option to Attend School 9 month · Yes	1 Participants	—
Caregiver Change in Option and Practice: Option to Attend School 9 month · No	0 Participants	—
Caregiver Change in Option and Practice: Option to Attend School 15 month · Yes	0 Participants	—
Caregiver Change in Option and Practice: Option to Attend School 18 month · Yes	0 Participants	—
Caregiver Change in Option and Practice: Option to Attend School 18 month · No	0 Participants	—
Caregiver Change in Option and Practice: Option to Attend School 21 month · Yes	0 Participants	—
Caregiver Change in Option and Practice: Option to Attend School 21 month · No	0 Participants	—
Caregiver Change in Option and Practice: Option to Attend School 24 month · Yes	0 Participants	—
Caregiver Change in Option and Practice: Option to Attend School 24 month · No	0 Participants	—

Adverse Events

Children With Medical Complexity (CMC)

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

School Staff

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Dr. Ryan Coller

University of Wisconsin School of Medicine and Public Health

Phone: 608-263-9408

Email: rcoller@pediatrics.wisc.edu

Results disclosure agreements

• Principal investigator is a sponsor employee
• Publication restrictions are in place