SAN ANTONIO – One recent Thursday, Ciara Brown, a junior at Fox Tech High School in San Antonio, climbed onto a small white table, pulled down her face mask and took a test that is still standard in American schools. Far from: a cotton swab up the nose.
“The test is very easy,” she said. “It’s not as scary as I thought – it’s not a big deal on your mind.”
The United States has been battling COVID testing since the early days of the pandemic. Now, nearly two years into the year – and weeks into another Covid-disrupted school year – school systems across the country are grappling with the role of testing in keeping children safe and in the classroom.
Some, like Ciara in Texas, have all moved in; Others offer no COVID testing at all. And still others say they want to do more testing but lack resources or are stuck with bottlenecks and delays.
Many school districts in the San Antonio area reflect the country’s political rifts. Some districts have taken several precautions, including testing, to protect themselves from the virus. Some have some defenses.
Even in the worst of early testing supply shortages, more states have received federal funding, including $10 billion from US rescue plan, To implement school-based COVID testing programs, many school districts are still faltering.
“There’s more to it than just spitting up a nose or a test tube,” said Dr. Laura Faherty, a pediatrician and researcher at the RAND Corporation. who has read School based covid testing.
A Series of Trials in Texas
School systems like Ms. Brown that have managed to set up large-scale testing programs are a case study of how much effort is involved.
The San Antonio Independent School District provides weekly tests to each student and staff member, a commitment that requires the proctor to collect nasal swabs at area campuses three days a week. A single collection event can take hours.
But the program, a partnership with nonprofit community laboratories, is largely voluntary, and despite the district’s efforts, many families have not enrolled; About 30 percent students are participating.
Ms Brown, whose family has two immunocompromised members, was eager to sign up. “I wouldn’t be able to live with myself knowing that if they got Covid it was because of me,” she said. “Knowing that I can keep them safe, keep myself safe, keep friends, even strangers safe, is what I really care about.”
But in the Born Independent School District, where masks are optional, testing is also optional and available at the campus clinic by appointment only.
While the district says that anyone who is sick should not come to school, symptomatic people will not be sent for tests or even sent home unless they “unable to attend instruction“
Dr. Heather Reibel, a pediatrician who has treated Covid patients, said she has been “so careful” not to bring the virus home. Now, she worries that her kids may be more likely to contract it at school.
She has already pulled her fifth grader out of school later this fall, after coming into contact with students infected with the virus five times a week. “It’s extremely disappointing,” Dr. Rebel said. (District officials did not respond to multiple interview requests.)
Elsewhere in San Antonio, the Northside Independent School District has taken a middle ground: rapid testing students and staff members who are symptomatic, though students can only be tested after parental consent.
Superintendent Brian Woods has not ruled out the possibility of mass screening as cases escalate. But there is a huge shortage of staff in the district, which is making it difficult to conduct tests right now. “We’re not at that point yet,” he said.
The district is doing contact tracing, but the rollout is bumpy. An elementary school may consult cafeteria cameras to help identify close contacts of students. But they weren’t working the day Andrea Ochoa’s 10-year-old daughter had lunch with a student who later tested positive.
Ms. Ochoa, who has autoimmune problems, learned about the exposure the following week from her daughter.
“I’m not upset that a child got sick,” Ms. Ochoa said. “But I don’t want young children to gossip the way parents figure out how to advocate for our children.”
San Antonio is a microcosm of a patchwork of programs in schools across the country, even as the federal government invests more resources in testing.
“While some of the logistics are easing, there is a very fragmented view from school district to school district as to whether the test is being used,” Dr. Faherty said.
In Illinois, all public schools outside of Chicago are eligible for the free SHIELD test: the weekly saliva test developed by the University of Illinois at Urbana-Champaign.
But neighboring Iowa turned down the $95 million allocated for testing under a US rescue plan. The state education department says there are other resources available to schools; Some districts are distributing take-home test kits, which are available free of cost from a state laboratory.
Even in states with coordinated programs, participation can be spotty. As of September 21, only 24 percent of Virginia’s public school divisions had signed up for it. federally funded testing program, which provides access to regular pooled PCR tests and at-home testing kits.
Elsewhere, a late summer spike of cases has scrambled schools.
“It’s a matter of playing catch-up,” said Dr. Richard Besser, president of the Robert Wood Johnson Foundation and former executive director of the Centers for Disease Control and Prevention. “You can’t ask schools to implement broad-based testing protocols once the school year starts, when supplies and personnel and logistics are not in place.”
Illinois’ SHIELD program bombed by last-minute sign-ups; A representative for SHIELD said that as of September 21, 43 percent of the public schools that participated after August 23 had attended.
The program takes three to six weeks to launch; Several weeks into the school year, most participating schools have not yet started testing.
Chicago public schools have their oft-delayed schedules. The district initially stated that weekly screening would be available for every student. when schools open on 30 august. The district now says the program will be fully operational by the end of September, delaying the need for background checks on the testing company’s employees.
Local parents have expressed disappointment over the change in timelines and slow updates. “There’s no clear line of communication,” said Deborah Land, who has a high school sophomore in the district and is a parent representative on her local school council. “Parents have been asking, ‘What’s your plan, what’s your plan, what’s your plan?'”
As of September 17, only 3 per cent of the students had enrolled in the testing programme, the district said.
In New Orleans, the district actively encourages families to enroll in its weekly PCR testing program – offering multilingual online sign-ups and enrolling in a state-run program that pays students to receive COVID tests. does, said district spokesman Richard Rainey.
But local schools have faced both Delta and Ida, a Category 4 hurricane that knocked the city out of power, temporarily closed public schools and suspended testing. “We pivoted quickly after the storm passed to start again within a week,” Rainey said.
it takes a village
Rising demand for the test has also affected the supply. In Fresno, Calif., the school district has been unable to rapidly replenish its stock of antigen tests and has had to cut back on its testing of student athletes as a result.
But the biggest challenge facing many schools is the staff. The Berkeley Unified School District used state money to hire seven people to staff its COVID testing team – and then dumped it into its own coffers to hire 14 more people.
For many districts in low-income communities, that kind of financial outlay may be impossible. “We need to make sure the resources are there, particularly, in the communities that have been hardest hit,” Dr Besser said.
Protocols that work when transmission rates are low can become unstable when rates increase. Alachua County, Fla., quarantine allows students to return to school early if they test negative for the virus on the fifth day of their quarantine.
During the worst of August, nurses in some schools were testing 40 to 50 quarantined students every morning.
Superintendent Carly Simon said schools had to hope that no one would need medical attention during the hour or two it took to test all those students. “Like a kid not having an asthma attack or, you know, anyone who needs an EpiPen.” She said: “Before Covid our nurses had full time jobs. Now covid is a job. “
The workload eased, but 15 nurses quit in the first month of school.
In Grapevine, Texas, the school district’s testing center saw so much demand in early September that appointments were already booked. Amy Taldo, who runs the site, said she lacks the staff to expand. “I need an army,” she said.
And testing is only the first step. At the San Antonio Independent, when students or staff test positive, a brigade of nurses conducts a painstaking contact-tracing protocol.
To identify a high school student’s close contacts, Lynn Carpenter, the district nurse, asks all of her teachers for detailed seating charts. “I find out, are they on the desk, are they on the table, how far are the tables?” he said.
If the student is an athlete, the coaches also get calls with questions about practice and sports. “It’s just like mushrooms,” she said.
Ms. Carpenter, who works in a windowless, wall-free office, sometimes requires several days to complete a case. He got a call with seriously ill staff members, some of whom wept. “It’s a heartbreaking job,” she said.
A vaccine for children ages 5 to 11 as soon as next month can be authorized, further protecting primary schools. But even then, it can take months for most young children to be vaccinated — and many may never get the shots, Dr. Besser said.
So schools are moving forward with what they have: limited staffing and limited time.
“I think it’s a very worthwhile thing that we’re doing,” Ms Carpenter said. “I’m just looking forward to the day it’s behind us and I can go home.”