Support voluntary school-based COVID testing
To the Times:
Positive COVID-19 cases appear to be leveling out. Children ages 5-11 now have access to vaccines. As a parent of two young children in the Wallingford Swarthmore School District, I can almost breathe a sigh of relief.
While vaccines are effective against severe illness, concerns over breakthrough infections remain. Achieving a critical mass of children vaccinated takes months, if not years. Currently, an unvaccinated student designated as a SARS-CoV-2 close contact is required to quarantine for 10 days. One positive case in a single classroom may lead to 5-10 children being sent home for nearly two weeks. The good news is that we have a blueprint for a successful way around this — daily contact testing is a safe alternative to home isolation following school-based exposures.
As a nurse and a graduate student at the University of Pennsylvania, I take health and research seriously. Research shows testing programs make schools safer while reducing the number of learning days missed (Young et al, 2021). Programs such as the increasingly, nationally used “Test-to-Stay” allow students identified as “close contacts” to take daily rapid COVID-19 tests so they can continue to go to school in person. A version of “Test to Stay” is currently in the works for WSSD.
However, test-to-stay is reactive. Schools should initiate both routine pool testing and strategic testing programs to minimize risk and keep children in school. Allowing daily testing to be voluntary is important but we must keep in mind that the reduction in missed inschool learning days is relative to the number of participants willing. The number of families comfortable and willing to participate has a direct effect on the level of success in reducing school absences.
COVID is an RNA virus that mutates and alters itself to evade and survive. Often asymptomatic, COVID-19 spreads silently. To come out ahead we can not only test the unwell. Testing must be routine, random, and systematic. Policymakers must monitor transmission rates and adjust testing strategies to the needs of our community. When students come back from holidays, testing may require an increase in frequency. When the transmission is low, the frequency may be reduced.
Children’s Hospital of Philadelphia so strongly recommends school testing programs that they created their very own. CHOP experts we entrusted to speak at our school board meetings told us last March that the resources and tools were already in place for testing to begin last Spring; The only hold-up was training our nurses and staff. It is now nine months later. Why haven’t we seen the execution of this plan? The funding is there. The resources are available. It is time for action.
With the cold and flu season approaching and the holiday season upon us, indoor gatherings across communities and state lines are inevitable. We have 20 months of data and a far better understanding of the layered measures effectively keeping communities safer. Statistics from the World Health Organization (WHO) show solid evidence that when positive infections are contained, transmission remains low. Low transmission rates keep students in classrooms, on athletic teams, and in the extracurricular activities, we all love. These next few months are more critical than ever for enacting such testing in WSSD schools. Our best shot at keeping our children physically and mentally healthy this winter is to act now.
Despite the evidence of support, there are still school leaders and district families stressing concerns:
For those concerned about cost; in August Gov. Wolf approved a multimillion-dollar bill supporting COVID-19 testing for our schools. Pennsylvania departments of Health and Education partnered with Concentric to provide free testing in all PA K-12 schools throughout Pennsylvania. CHOP’s PolicyLab launched a separate free in-school testing program in January 2021 called Project ACE-IT.
I reached out to districts throughout the northeast. Schools in New York City, Vermont, Massachusetts, Connecticut, and Rhode Island began testing staff and students regularly in January. Several of these districts are less privileged with fewer resources and yet they’ve managed to implement testing within their home schools. Families in these districts are not required to bring their children to community-based drive-through test sites or neighboring schools. It’s simplified. Children are tested at their home school before entering the classroom.
For those with apprehension surrounding staffing, this is a legitimate concern. Massachusetts expected 500 schools to enroll in their statewide program, meanwhile, 2,200 enrolled. The surprising turn-out inundated their hired testing vendor, requiring tweaks to their design protocol in real-time. To avoid overburdening school nursing staff and prevent the need for assistance from organizations like the National Guard, strategically designing a carefully thought-out plan of implementation is recommended. Preemptive focus on increasing staff during times of greater transmission, while reducing staff when the transmission is low, is another recommendation. Luckily, states that plowed this path ahead of us already have a running blueprint in place for us to follow. The Center for Disease Control, which is in support of the “testto-stay” protocol, is also providing suggestions based on other states’ successes and failures.
For those opposed to testing, testing is voluntary. The district
does not have to test every student or staff member to obtain a far more accurate account of the spread of illness. In pooled testing, regular tests are completed on a small portion of voluntary students. Only when one test comes back positive is the rest of the classroom tested. In this way, you allow parents who are uncomfortable with regular testing the opportunity to opt-out, while still doing everything within the district’s power to keep us all healthy and safe.
For those concerned about the discomfort of deep nasopharyngeal swabs, rapid molecular testing for SARS-CoV-2 is reliably detected in saliva, particularly when used frequently. Saliva testing is quick, easy and because it does not require laboratory processing, is far less expensive. This is the testing I participate in bi-weekly to attend classes at UPenn. “Saliva nucleic acid amplification tests (NAAT) are accurate, with sensitivity and specificity similar to that of the nasopharyngeal NAAT” (Butler-Laporte et al, 2021).
School leaders and community members have expressed concern that with testing, more cases will be discovered, and schools would be forced to shut their doors. Although
I see where this fear stems from, it couldn’t be further from what is occurring. More than 200 Massachusetts schools participated in a 10wk randomized control trial led by the Harvard School of Medicine. Even during rates of low transmission and lower than expected voluntary participation, pooled data still showed an overall 20% reduction in the number of school days missed (Young et al., 2021). With increased participation, a carefully designed protocol, and strategically planned staffing, the number of school days missed is expected to be reduced far further.
Rather than forcing schools to close doors, testing provides reassurance that mitigating factors in place are keeping children and staff safe. The more data we collect from our schools, the more reassurance we have when the time is right to relax our layered mitigation measures. Daily testing close contacts allow for increased in-person attendance rather than quarantine. Massachusetts Department of Education demonstrated that their daily volunteer testing saved greater than 48,000 in-person school days as of October 2021.
With the combination of climate change, a global economy, and more people traveling, as we emerge from pandemic life, scientists are predicting more novel infectious diseases in our near future. It is important to enact and fine-tune these strategies now, so we are well equipped the next time we encounter a novel illness. We are a top-rated district with educated, informed parents and more resources than most of our country’s public schools. We can do this and do it well.
I encourage you to learn more about in-school testing. I urge you to write letters and make calls to our district school board in support of voluntary school-based testing. When the time comes, volunteer for testing.