Policymakers and public health officials have promoted broad, school-based testing for COVID-19 as a strategy to keep schools open for in-person learning and to monitor the success of their mitigation efforts.
But, as districts put such efforts into place, they’ve identified a hurdle that has the potential to weaken the effectiveness of so-called surveillance or screening testing: getting consent to test an adequate number of students, teachers, and staff members within their buildings.
“Figuring out the logistics of testing is sort of the first step,” said Dr. Laura Faherty, a physician policy researcher at the RAND Corporation. “The other really critical component is making sure that the community is heard, engaged, and has their concerns addressed and that the right parties are at the table.”
Faherty, who is also an assistant professor of pediatrics at the Boston University School of Medicine, coauthored a December RAND report that suggested best practices based on interviews with 80 leaders involved in early versions of school-based testing efforts. Schools used a variety of strategies to win support from parents and staff who may be concerned about privacy, stigma, or the inconvenience of quarantines after positive cases are identified.
A variety of testing strategies serve multiple goals
Through surveillance or screening tests, schools test a rotating random sample of students and staff—or sometimes a more targeted group like teachers or athletes—as often as once or twice a week. Their aim goes beyond identifying and isolating individual cases of the virus.
The tests are used to monitor for warning signs that efforts like social distancing aren’t adequate, and they can be used to ensure the rate of virus spread within a building stays below thresholds of concern identified by local health officials.
Some states, like New York, mandate or offer school-based testing if the community surrounding a school has high rates of reported virus cases. Elsewhere, schools have teamed with nonprofit organizations or local universities to pilot testing efforts, offering reassurance to families who may be reluctant to return to the classroom.
“Schools we spoke with experienced a range of reactions to COVID-19 testing, from near-universal enthusiasm to widespread skepticism from staff or parents,” the RAND report found.
Reports from around the country show how differently parents and teachers view coronavirus testing, and the risk presented by the virus itself. In Utah, for example, local health officials warned of an unwritten “mom code” among some parents who agreed not to test their children after possible exposure to COVID-19 for fear that an asymptomatic case could lead to mass quarantines of sports teams or classrooms. In other areas, parents seem relieved to have a testing option in their children’s schools.
North Shore School District 112, north of Chicago, started regular testing of students Feb. 1. Out of 3,000 students, just 1,200 opted into the voluntary program. Of staff members, about 55 percent participate in the weekly tests. But, even though participation rates are low compared to some areas, Superintendent Michael Lubelfeld says the program has value as part of a set of “layered mitigation” strategies that work together to keep students safe.
“We respect individual personal views and because we have so much else in place, this is just another tool in our toolkit,” he said.
North Shore schools have conducted about 5,000 tests since the program began, and they’ve identified just two asymptomatic cases. The district plans to spend about $275,000 in federal aid provided through the CARES Act to continue testing throughout the school year, and Lubelfeld said he would consider continuing it in the fall if virus rates in the community are high.
Some schools have taken a firmer approach, making consent to testing a requirement for students who attend school for in-person instruction.
New York City schools, the largest school system in the country and one of the first to commit to such broad screening efforts, faced a conflict with state officials who said last month that the district could not continue its consent requirement. Officials later backtracked, saying such requirements would be allowed if local health officials agreed to them.
New York state requires schools in high-risk areas, defined by a color-coded scale, to conduct regular testing. But it does not mandate participation of all students in those testing programs.
Elsewhere in the state, where such testing is voluntary, administrators report a variety of responses. When Questar, an educational cooperative that works with 22 New York school districts to conduct testing programs, sent out consent forms for possible testing, about 85 percent of parents agreed, said Gladys Cruz, the superintendent of the cooperative.
“Parents want their children in school. Children want to be in school,” she said. “Everybody is doing their part to follow the health and safety protocols to keep our buildings and schools open.”
The Questar districts haven’t reached the risk level that would spark mandated state testing, and the cooperative has instead limited rapid-testing efforts to athletics programs, especially for high-risk sports that require closer contact between competitors, like wrestling and football.
There is a growing push for school-based testing
It’s likely that more administrators will face such logistical questions in the future as more schools adopt testing programs. Even as more adults are vaccinated, and more teachers are prioritized for the inoculations, public health officials say some mitigation strategies will be necessary in the 2021-22 school year, especially as more-contagious variants of the virus emerge.
“None of these strategies in isolation are going to help us reopen schools, fling the doors open, and have everyone feel safe and completely comfortable,” Faherty said. “All of them are interdependent and kind of amplify the effects of each other.”
Epidemiologists describe varying strategies like slices of Swiss cheese, with potential weaknesses represented by the holes. When you stack five or six pieces of cheese together, each piece covers a hole in the previous layer. If one layer doesn’t eliminate all risk of transmission, hopefully the next one will. And testing programs, even imperfect ones, can play a role in that layered protection, those experts say.
Updated guidance released by the Centers for Disease Control and Prevention in February said weekly widespread testing may make it safer for schools in areas with the highest rates of the virus to offer at least some in-person learning to students, especially older students who may be at higher risk of severe illness.
In an executive order he signed his first week in office, President Joe Biden created a pandemic testing board to come up with recommendations and technical support for school testing efforts. And his proposed COVID-19 relief bill includes money to boost general testing and vaccination efforts and nearly $130 billion in K-12 aid, which could be used to support testing programs.
Strategies for winning trust in school testing programs
The Rockefeller Foundation, which has piloted some COVID-19 testing strategies in schools, released a “playbook” last month that detailed how districts can put them into place.
That playbook recommends strategies to help answer questions to common concerns that keep parents and teachers from consenting to such programs. Among them:
- Clear consent forms should outline the purpose of the testing program, how privacy will be protected, and how data will be used.
- Schools should clearly detail what will happen if a student tests positive: How long will quarantines last? Will others be aware of their status? And how will the transition to remote learning work?
- Districts with wraparound services, like food pantries and social workers, can help communicate with low-income families who may need services to deal with the disruption caused by quarantines.
- Schools should consider making testing convenient and comfortable by thinking about where it is conducted: off-site, on-site, or through samples collected at home.
- Schools can ensure teachers participate in testing programs by providing designated paid leave for any resulting quarantines so that it doesn’t count against their routine sick leave or vacation time.
Schools should also seek buy-in from families on the front end, seeking their input as they design testing strategies, the report said.
“While it seems daunting to launch a testing program, the schools and districts that we interviewed, they saw a lot of value in testing,” Faherty said. “They felt like it was worth it. They felt like the benefits far outweighed the drawbacks.”
