Vaccines' success could undercut Biden's multibillion-dollar school testing plans

Now that vaccination is slowing the spread of the virus, some schools are reopening without the widespread Covid-19 screening that Biden once considered crucial. Administrative officials, many education leaders, and some public health experts argue that testing will continue to be important to contain outbreaks in schools over the next school year, as Covid-19 shots are not yet available to children under the age of 12, with a debate looming over the summer What role will widespread screening programs play in a world where more Americans are being vaccinated.

“Tests are really important for monitoring when the majority of people are not vaccinated,” the President’s Chief Medical Officer Anthony Fauci recently told POLITICO. “Once you’ve vaccinated most people, you won’t need to do these types of surveillance tests.”

More schools have returned to hybrid and personal classes since Biden took office, but it remains unclear what percentage of school districts across the country regularly screen students and teachers for Covid-19. An education department spokesman said the department was “not tracking this level of detail.” A spokesman for the Centers for Disease Control and Prevention said that “most states offered or conducted testing programs in schools in the 2020-2021 school year,” adding that an EdWeek poll in February found that only 16 percent of school district leaders said they were testing students.

Education and health groups – including the Association of State and Territorial Health Officials, the Rockefeller Foundation, and the American Federation of Teachers – also said they didn’t have comprehensive statewide data on how many districts had testing programs in place.

School districts in Chicago, New York City, Baltimore, and San Antonio are among those that have implemented Covid-19 testing programs to get students back into class.

Cleo Hirsch, director of priority initiatives at Baltimore City public schools, said the district first began testing only those students and staff who showed symptoms last November, before running more extensive surveillance tests in March The schools started to open again.

The district tests K-8 students weekly using PCR pooling, which involves testing samples from around a dozen children as a unit using laboratory techniques. High school students do individual saliva-based PCR tests. Much of the funding for the testing programs has come from a mix of state and federal funds, but the district is hoping to draw from Biden’s $ 10 billion school test pot retrospectively and in the future.

“We intend to continue testing throughout the summer. We are running an expanded summer school program this year, ”said Hirsch. The district stands ready to resume testing in the fall, but will adjust its strategy based on community conditions and vaccination of young people.

Jennifer Nuzzo, the lead epidemiologist for the Johns Hopkins Covid-19 Testing Insights Initiative, questioned whether massive school screening programs will be valuable in the fall when virus spread is low. Increasingly widespread vaccinations and warmer weather have helped reduce the average number of new Covid-19 cases per day from around 193,000 on the day of inauguration to just under 28,000 on May 19, according to CDC data.

“If we’re going to talk about testing in the fall, it should be antigen testing, as it can better support my concerns about the positive predictive value of tests,” said Nuzzo. “You’re not going to pick up on so many of these positive things that we don’t care.”

Recent research suggests Antigen testing, which is typically done at the treatment site and can provide results in minutes without sending samples to a laboratory, is effective in detecting people when they are at the highest level of infectivity. Lab-based PCR tests, which are more sensitive, can pick up the remains of an infection after a person is no longer contagious.

Others are more cautious, however, partly due to lower vaccination rates among younger Americans, the potential for new coronavirus variants to emerge, and the risk of recurrence in cases of cold weather driving people indoors. Nationwide, fewer than 40 percent of Americans are currently fully vaccinated against Covid-19, and new vaccinations are slowing down.

“I would strongly encourage communities to maintain their robust testing capabilities going forward,” said Jeffrey Duchin, a Seattle health officer and a member of the board of directors of the Infectious Diseases Society of America. “We don’t know what will happen in autumn. The Covid-19 outbreak is far from over: there is still significant uncertainty and there is still significant disease activity. “

Mara Aspinall, who is advising the Rockefeller Foundation on Covid-19 testing, said the key at this point in the pandemic is to make sure that no new outbreaks occur. She agreed with Fauci that the frequency of testing can be reduced for most people who are vaccinated, but said that screening programs are still needed in some situations.

“Now is the wrong time – and it is premature – to eliminate testing in many areas, including schools and workplaces where there is frequent contact with the public or people at high risk,” said Aspinall.

Toni Thompson, assistant director of human resources for the San Antonio Independent Schooling District, said her employer will continue to run weekly tests this fall, partly because adolescent vaccine intake will vary and no vaccine has yet been approved for students under the age of 12.

“We believe this is one of the most important ways we can mitigate risk by quickly identifying, isolating, and contact tracing asymptomatic individuals – whether students or employees -” said Thompson.

Carole Johnson, White House Covid-19 testing coordinator, told POLITICO that the Biden administration is aware that state and local school districts are making different progress in setting up testing programs with $ 10 billion in stimulus money. She said the CDC is working to provide technical assistance and outreach to help states plan testing programs so schools are ready by the fall.

“We think testing is really important right now,” said Johnson. “Of course, it’s a different moment than March and April, May and June last year, but we think testing continues to be of the essence as we work to get as many Americans vaccinated as possible.”

The Biden administration is also still working on contracting the regional coordination centers that Johnson hopes will help schools that may not have experience or be unable to set up tests themselves. Johnson said the government was “surprised at the high level of interest” from groups wanting to run the coordination centers, which “makes it increasingly difficult to get things done quickly”.

“There are schools or places with inadequate resources where tests are harder to pass despite your best efforts,” Johnson said. “As much support as we can give the schools, we want to go into the schools.”

This work could prove critical for communities where vaccination is slower and the number of Covid-19 infections remains stubbornly high. The percentage of people who have received at least one shot ranges from 66 percent in Vermont to 33 percent in Mississippi. The youngest of the agency Instructions for K-12 schools According to testing strategies, “should be part of a comprehensive prevention approach” that also includes other mitigation measures such as masking and physical distancing.

One question for school test supporters is whether attitudes toward screening programs are as diverse across the country as vaccine intake or willingness to wear masks.

“There are certainly regional differences in the way tests are conducted, what concerns teachers and families are,” said Mike Magee, CEO of Chiefs For Change, a nonprofit education institution.

At the national level, testing is starting to slow as the pandemic recedes. However, experts believe that many on-site and at-home tests are not reported to health authorities. CVS and Walgreens executives say the demand for in-store testing has remained relatively constant even during the vaccine’s launch.

And even more Americans are getting vaccinated, testing – including school screening programs – According to Kelly Wroblewski, director of infectious disease programs at the Association of Public Health Laboratories, this could help make contact tracing a tool more like what was thought in the early days of the pandemic.

“I think we now have a chance to really focus on the cases and outbreaks that are occurring and take public health measures to stop the premature spread,” said Wroblewski.

However, high schools in particular may need to adjust their screening protocols as more teens are vaccinated in the fall. CDC now recommends fully vaccinated individuals “if possible, not to do routine screening tests,” and suggests that they generally not seek testing or quarantine after known exposure to an infected person. If a fully vaccinated person develops symptoms of Covid-19, they should still seek a test. In the agency’s guidelines it says.

The recent experience of the New York Yankees illustrates the complexity of interpreting routine tests in vaccinated individuals. The ball club announced last week that it had discovered nine cases of Covid-19 in vaccinated players and coaches. The vast majority were asymptomatic and the rest were mild. Public health experts say the cases demonstrate the ability of Covid-19 vaccines to prevent serious diseases.

As more school-age children are vaccinated, all school exam programs will need to adapt to the possibility of asymptomatic infections that do not warrant disruption to personal learning.

In any event, school screening could have broader benefits for communities as it acts as an early warning system for any virus variant that could pose a threat to the elderly Michael Mina, Professor of Epidemiology and Immunology at Harvard T.H. Chan School of Public Health. Older Americans were among the first to be vaccinated, and it is not yet clear how long the shots protect against infection.

“Something that has to go into the equation is that many older people are likely to become vulnerable again,” Mina said. “Older people do not immunize and retain immunity as well as younger people. So in terms of monitoring and testing, we should continue to monitor and test in nursing homes and senior centers – especially if cases recur or are widespread in a community. “

Others are skeptical of the benefit that widespread asymptomatic testing will continue to be performed on vaccinated people in the fall, also because the predictive value of screening decreases as the level of infection in a community drops.

“At some point we have to think about this disease: ‘Is she taking someone to the hospital? Is it killing someone? If not, how much do we care? “Said Nuzzo.

Work is ongoing at the federal and local levels to ensure schools are ready to test students this fall to prevent the spread of a disease that has killed more than 585,000 people in the United States.

“Testing is an integral part of our national strategy,” said Johnson. “The president made it a priority.”

Back in San Antonio, Thompson hopes that continued care, vaccinations, and testing will help ensure that highly competitive advances against the virus are not lost when students return to classrooms.

“If we think this is completely over, we are deceiving ourselves,” she said. “We just don’t want any other spikes because people are too careless. We continue to want people to be at least thoughtful and reasonably careful and do what they need to do to make sure they are safe and that others around them are safe. “

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