Logistical problems stymie US Covid-19 testing trial in schools

New York — A pilot project in which rapid Covid-19 tests were used in an effort to safely reopen some US schools has encountered administrative and logistical hurdles, according to a report released on Thursday.

Through a collaboration between the US department of health & human services and the Rockefeller Foundation, the project received about 140,000 quick-turnaround Covid tests from Abbott Laboratories.

Even with access to testing from the outset, however, schools needed additional resources such as staffing to perform the tests. While they found support in their communities for testing, they also encountered resistance from parents and students.

“It is not just giving somebody a test, having them twirl it in their nose a few times, waiting 15 minutes and then you have the response,” said Andrew Sweet, MD of Covid-19 response and recovery at the Rockefeller Foundation.

Schools in six areas are participating. Central Falls, Rhode Island; Washington, DC; and Tulsa, Oklahoma began screenings late in 2020, while others — including Los Angeles, New Orleans and Louisville, Kentucky — are expected to begin testing pushes in 2021, the report said. Among the difficulties was a surge in virus cases that prevented some schools from opening.

The schools also weren’t equipped to set up locations and infrastructure needed for testing, especially with rapid assays, which are performed on site instead of being sent to a laboratory. Students who test positive, meanwhile, may need access to services that schools may not have.

Research from the US Centers for Disease Control (CDC) and Prevention has said the risk of viral spread at schools appears low when masking and other precautions are taken.

Reopening schools

Still, as the US ramps up a vaccination push that so far lagged behind expectations, schools illustrate the limitations of relying on vaccines alone, even if supply were not a constraint. Most schools across the country have continued operating virtually, despite evidence that remote learning isn’t serving pupils as well and is likely deepening inequities.

“Even if teachers are vaccinated, and let’s say the majority of teachers that want to be vaccinated are vaccinated by the end of March, that still leaves 57-million students that won’t be vaccinated for a long time,” Sweet said. “That is one of the reasons why we still think that doubling down on testing for K [kindergarten] through 12 is important.”

While teachers qualify for vaccines in at least 25 states, according to a tally kept by the publication Education Week, no Covid-19 vaccines have been cleared for use in children.

The Rockefeller Foundation has been pushing for ramping up US testing. Late in 2020, the organisation called for frequent testing of pupils, teachers and staff as a means of reopening public schools, a plan in which a half-year of screenings would cost more than $40bn.

Testing “needs to become a part of school life for the foreseeable future”, Sweet said. With it, “schools can be some of the safest places in the country”.

Sweet said there is a strong appetite for school testing among members of the Biden administration, which has vowed to safely reopen schools. Modelling done by the research firm Mathematica, which issued the report, found that testing could reduce Covid-19 infections by up to 50%.

Test availability

Outside the project, other schools looking to testing as a part of reopening are likely to face barriers in test availability. It’s not yet clear what approach the Biden administration favours as it is caught between pressure to reopen schools and demands from teachers unions.

On Wednesday, CDC director Rochelle Walensky said vaccinating teachers isn’t a prerequisite for the safe reopening of schools.

The agency issued a report late in January that looked at reopening schools in a rural Wisconsin county, finding that few Covid-19 cases were tied to school spread. It concluded that with precautions such as masking and keeping pupils in small group cohorts, “transmission risk within schools appeared low, suggesting that schools might be able to safely open with appropriate mitigation efforts in place”.

However, the schools didn’t use regular random surveillance testing, so “this study was unable to rule out asymptomatic transmission within the school setting”, according to the research.

The HHS-Rockefeller partnership was announced in October. Participating areas received Abbott’s rapid BinaxNOW test for use in elementary, middle and high schools.

Participants are taking different approaches, and are changing them quickly based on factors such as virus prevalence in the community and school reopening plans, Mathematica researcher Divya Vohra said.

Schools found they needed other resources, too, such as personal protective equipment and biohazardous waste-collection bins and removal services, the report said. Each test cost about $80 to conduct, including labour, materials, protective equipment and waste removal, according to one estimate cited in the report.

Bloomberg