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

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A growing number of the nation’s school districts are experimenting with a Covid-19 testing regime they hope will get millions of children back into their classroom — if they can keep up with the price tag.

The Biden administration’s $1.9 trillion Covid relief law is steering $10 billion toward developing a national school coronavirus testing strategy as its latest bid to reopen schools. That plan is still in flux but some attention has turned to the practice of “pooled” testing that uses a collection of swabs from a fixed group of kids attending classes together. The process is meant to limit the spread of a potential outbreak while minimizing the costs of the frequent large-scale testing needed to keep the disease in check. Pooled testing can extend testing capacity by testing groups of samples at once rather than each person individually. If a pool sample comes back positive, each individual in the pool is then tested.

Massachusetts is the only state to deploy a broad pooled testing program made available to all of its students and staff — about 1 million K-12 children and educators — to reopen this spring. For the first six weeks, the Bay State expects to spend somewhere between $15 million and $30 million doing pooled testing for about half of its more than 1,800 public schools that have opted in. When the state-funded program ends April 30, school districts will be able to funnel money in from the latest round of federal relief. A Rockefeller Foundation-funded study by Mathematica and RAND Corporation of early pooled-testing results found weekly testing of all students, teachers and staff can reduce in-school infections by an estimated 50 percent.

Similarly, in Maryland, Baltimore City Public Schools has put $5.7 million dollars from the federal stimulus toward launching its own program. Montgomery County Public Schools, the largest district in the state, is spending $5 million to kickstart one.

Most schools across the country would implement a pooled testing program if the Biden administration moves that direction and resources are put there, said Dan Domenech, who heads a national association representing school superintendents. Testing, he said, would be critical for large urban school districts to reopen safely.

Each program is a massive undertaking that has already kicked up some challenges for superintendents and other local school officials who are struggling most with getting parental consent. Schools have also found they can’t make testing mandatory, or get the logistics to work in most high schools, and positive cases can spook teachers. Still, the injection of federal money — and President Joe Biden’s commitment to open most K-8 classrooms by May 1 — has fueled some optimism.

“We’re feeling that Massachusetts has cracked this nut and the feds have gotten on board,” said Tim Rowe, CEO of CIC Health, a Cambridge, Mass.-based “coordination hub” that facilitates testing materials, lab work, and results for about 160,000 students and staff in the state. “Now that they told the country they’re going to be doing this for all the schools in the country … the next hurdles are getting the world better informed about it so that when this becomes a possibility, it’s actually done.”

How it works

Once a week, students will get a Q-tip-sized swab to rub against the lower part of their nose. The swabs for up to 25 students and staff — a classroom — are then tested at once. Most schools can collect the samples in 30 minutes, district officials say.

Most kids can swab themselves with supervision, said Cleo Hirsch, Baltimore City Public Schools director of special initiatives, who is overseeing the district’s program. Additional support is given to students who need it, especially the youngest ones.

“The baby can just put it in their nose four circles on the right, four circles on the left and then we say you put it ‘boogers down’ into the tube,” Hirsch said in an interview.

A nurse or another school official scans, packs and ships the samples off to a nearby lab. It’s a process that doesn’t require medical training and results come back within 48 hours. Contact tracing kicks off if a pool comes back positive but spares others at the school.

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

“You need to make it possible for staff that’s already at the school to do it without needing to bring in a whole new health care provider staff that doesn’t exist at that scale at every school in the country,” he said.

While the process is straightforward for lower grades, Hirsch said pooled testing doesn’t work for high schoolers because they do not learn as a single pod in the same classroom all day. Instead, each student is administered a saliva-based test individually — a more costly process for the district.

Getting parents and teachers on board

Early adopters of pooled testing programs in schools said they faced “a variety of reactions to Covid-19 testing, from near-universal enthusiasm to widespread skepticism from staff or parents,” according to a March report from the RAND Corporation.

School leaders told researchers that “privacy concerns were a common reason for hesitation to be tested,” the report states. But parents were also uncomfortable with a medical procedure being performed by school staff rather than medical professionals, and families and staff were worried their health information would be shared with others.

While some parents expressed “doubt about the actual danger posed by Covid-19,” the report found there were fears of being stigmatized and socially isolated by a positive test result.

“The trickiest part has been the consent process,” Julie Kukenberger, the superintendent of Melrose Public Schools in Massachusetts, said in an interview. Still, she believes that’s because the state adopted pooled testing before most people had heard about it.

Newer, shallower nose swabs make sampling less jarring than it was in the early months of the pandemic, Hirsch said. Mild responses from kids have helped put parents at ease, and the pooled testing is a mitigation strategy that the teachers union wanted before returning for in-person learning.

Educators, some who are waiting to be vaccinated, are still hesitant to be back in the classroom, according to the Baltimore Teachers Union. Union members on Twitter have raised concern about the number of pools testing positive.

“Being in school buildings is scary right now, and members have shared with me that they are afraid,” said BTU President Diamonté Brown in a March letter to her members. “Many of our members who are reporting to work in school buildings don’t want to be in the position they are in.”

Paying for it

About 100 schools started screening students and staff individually for Covid-19 last summer, said CIC Health’s Rowe. Most of those schools were in New England and California, and it was expensive to implement because they were using PCR tests for each student.

Massachusetts launched its pooled testing program at public schools through testing providers Ginkgo, CIC Health and Project Beacon. And state officials encouraged schools looking to reopen at least part-time for in-person instruction to apply and get connected to the coordination hubs, testing materials and software.

When the program was first discussed, the state was concerned about the cost because each test was in the $50 to $60 range. “The tension was really between the parents wanting it and then the price,” Rowe said.

Through the contract with the state, CIC Health charges $5 per swab, which comes out to $1 per kid, if testing is conducted once a week. “It was the fact that they rolled it out statewide that allowed us to get to this price point,” he said.

Boston Public Schools has been conducting pooled tests since the beginning of March and says it will continue the program with federal stimulus money (Baltimore City Public Schools plans to do the same).

“It is definitely expensive — it’s an investment that we are making,” Hirsch said. “We don’t yet know how much it will cost overall because we don’t know the course of the pandemic.”

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