'Boogers down': Biden’s bid to reopen schools may hinge on ‘pooled’ testing

In Maryland, Baltimore City public schools have allocated $ 5.7 million from the federal incentive to launch their own program. The largest county in the state, Montgomery County Public Schools are spending $ 5 million to start one.

Most schools across the country would implement a pooled testing program if the Biden government took this direction and provided the resources there, said Dan Domenech, who heads a national association that represents school principals. Testing, he said, would be vital for large urban school districts to reopen safely.

Any program is a daunting undertaking that has already presented some challenges to superintendents and other local school officials, who are most struggling with parental consent. Schools have also found they can’t make tests mandatory or get the logistics working in most high schools, and positive cases can scare teachers. Still, the federal grant – and President Joe Biden’s commitment to opening most of the K-8 classrooms by May 1 – has sparked optimism.

“We feel like Massachusetts cracked this nut and the government got on board,” said Tim Rowe, CEO of CIC Health, a Cambridge, Massachusetts-based “coordination center” that provides testing of materials, lab work and results facilitated for around 160,000 students and employees in the state. “Now that you have told the country that they will do this for all schools in the country … the next hurdle is to better inform the world about it so that it is actually done when it becomes possible.”

How it works

Once a week, students are given a Q-tip size swab to rub on the bottom of their nose. The swabs for up to 25 students and employees – one classroom – are then tested immediately. Most schools can pick up the samples in 30 minutes, district officials say.

Most children can wipe themselves under supervision, said Cleo Hirsch, director of special initiatives at Baltimore public schools who oversees the district’s program. Additional support will be given to students who need it, especially the youngest.

“The baby can just stick it four circles on the right and four circles on the left, and then let’s say you stick it boogers down,” said Hirsch in an interview.

A nurse or other school official will scan, pack, and ship the samples to a nearby laboratory. It’s a process that doesn’t require medical training. Results will be returned within 48 hours. Contact tracing begins when one pool is positive but others at school are spared.

“If you want to get something working in K-12, you have to minimize the disruption to the school day,” said Jason Kelly, CEO of Ginkgo Bioworks, who coordinates testing for the districts in Maryland and some in Massachusetts, in an interview.

“They need to enable staff who are already at the school to do so without hiring entirely new health care workers that are not of all sizes in every school in the country,” he said.

While the process is straightforward for lower grades, Hirsch said pooled tests don’t work for high schoolers because they don’t study as a single capsule in the same classroom all day. Instead, each student is given an individual saliva-based test – a more costly process for the district.

Bring parents and teachers on board

Early adopters of pooled testing programs in schools said they experienced “a variety of reactions to Covid-19 tests, from near universal excitement to widespread skepticism from employees or parents,” according to a March report by RAND Corporation.

School principals told researchers that “privacy concerns were a common reason for reluctance to get tested,” the report said. However, parents were also uncomfortable with a medical procedure performed by school staff rather than healthcare professionals, and families and staff feared their health information would be shared with others.

While some parents expressed “doubts about the real risk of Covid-19,” the report noted that there were fears of being stigmatized and socially isolated from a positive test result.

“The hardest part was the consent process,” said Julie Kukenberger, the superintendent of Melrose Public Schools in Massachusetts, in an interview. Still, she believes this is because the state introduced pooled testing before most people had heard of it.

Newer, shallower nasal swabs make sampling less disruptive than it was in the first few months of the pandemic, Hirsch said. Mild responses from children have helped parents feel comfortable, and the pooled tests are a mitigation strategy that the teachers’ union wanted before they returned to face-to-face learning.

Educators, some of whom are waiting to be vaccinated, are still reluctant to be back in the classroom, according to the Baltimore Teachers Union. Union members on Twitter I have raised concerns about the number of pools that tested positive.

“Being in school buildings is scary right now, and members have told me they are scared,” said BTU President Diamonté Brown in one March letter to their members. “Many of our members who say they work in school buildings do not want to be in the position they are in.”

I pay for it

About 100 schools started testing students and staff individually for Covid-19 last summer Rowe from CIC Health. Most of these schools were in New England and California, and it was expensive to implement because PCR testing was used for every student.

Massachusetts launched its pooled public school testing program through testing providers Ginkgo, CIC Health, and Project Beacon. And state officials encouraged schools looking to reopen, at least part-time, to teach in-person, apply, and connect with the coordination centers, testing materials, and software.

When the program was first discussed, the state was concerned about the cost as each test ranged from $ 50 to $ 60. “The tension was really between the parents who wanted it and then the price,” Rowe said.

Under the contract with the state, CIC Health charges $ 5 per swab, which is $ 1 per child if the tests are done once a week. “It was the fact that they rolled it out across the country that allowed us to get that price,” he said.

Boston Public Schools have been running pooled tests since early March and say they will continue the program with state stimulus money (Baltimore City Public Schools plans to do the same).

“It’s definitely expensive – it’s an investment we’re making,” said Hirsch. “We don’t yet know how much it will cost in total because we don’t know how the pandemic has progressed.”

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