SAN ANTONIO – On a recent Thursday, Ciara Brown, a junior at Fox Tech High School in San Antonio, walked over to a small white table, pulled down her face mask, and took a test that is still far from standard in American schools: a cotton swab on the nose.
âThe tests are super easy,â she said. “It’s not as scary as I thought – it’s not a huge thing going up in your brain.”
The United States has struggled with Covid testing since the early days of the pandemic. Now, nearly two years – and weeks after another school year disrupted by Covid – school systems across the country are grappling with the role of testing in keeping children and the classroom safe.
Some, like Ciara, Texas, went all-in; others do not offer any Covid testing. And still others say they want to do more testing but lack resources or have been hampered by obstacles and delays.
The many school districts in the San Antonio area reflect the political divisions of the country. Some districts have taken multiple precautions, including testing, to protect themselves from the virus. Some have few defenses.
Even as the worst of the early testing supply shortages abated and states received federal funds, including $ 10 billion from the US bailout, to implement school-based Covid testing programs, many school districts are still floundering.
“There is much more to testing than rubbing your nose or spitting into a test tube,” said Dr Laura Faherty, pediatrician and researcher at the RAND Corporation. who studied Covid tests in schools.
A range of tests in Texas
School systems like Ms. Brown’s that have been successful in establishing large-scale testing programs are a case study of the scale of effort required.
The San Antonio Independent School District offers weekly tests to every student and staff member, a commitment that requires supervisors to collect nasal swabs on area campuses three days a week. A single collection event can take hours.
But the program, a partnership with nonprofit Community Labs, is largely voluntary, and despite the district’s efforts, many families have not signed up; about 30 percent of students participate.
Ms Brown, who has two immunocompromised family members, was eager to enroll. âI wouldn’t be able to live with myself knowing that if they had Covid it was because of me,â she said. “Knowing that I can keep them safe, myself safe, my friends, even strangers safe, is all that really matters to me.”
But in the independent school district of Boerne, where masks are optional, testing is also optional and only available at the campus clinic by appointment.
While the district says that anyone who is sick should not come to school, symptomatic people will not be referred for testing or even sent home unless they are “unable to participate in training. “
Dr Heather Riebel, a pediatric cardiologist who has treated Covid patients, said she had been “so careful” not to bring the virus home. Now she fears that her children are no longer likely to contract it at school.
She has already pulled her fifth-grader from school once this fall, after being exposed five times in a week to students infected with the virus. “It is extremely disheartening,” said Dr Riebel. (District officials did not respond to many interview requests.)
Elsewhere in San Antonio, the Northside Independent School District has chosen a common ground: to quickly test students and staff who show symptoms, although students can only be tested if parents consent.
Superintendent Brian Woods has not ruled out the possibility of scaling up testing if cases increase. But the district faces serious staff shortages, making it difficult to ramp up testing at this time. “We are not at this stage yet,” he said.
The district is conducting contact tracing, but the deployment has been bumpy. An elementary school can look at cafeteria cameras to help identify close student contacts. 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 issues, only found out about the exposure the following week, through her daughter.
âI am not upset that a child has fallen ill,â Ms. Ochoa said. “But I don’t want gossip between little children to be the way we parents figure out how to stand up for our children.”
Patchwork of policies
San Antonio is a microcosm of the patchwork of programs in schools across the country, even as the federal government invests more resources in testing.
âWhile some of the logistics get easier, there is a fairly fragmented approach from one school district to another as to whether and how tests are used,â Dr. Faherty said.
In Illinois, all public schools outside of Chicago are eligible for the free SHIELD tests: weekly saliva tests developed by the University of Illinois at Urbana-Champaign.
But neighboring Iowa refused the $ 95 million it had been allocated for testing as part of the US bailout. The state’s education department says other resources are available for schools; some districts distribute take-out test kits, which are available free from the state laboratory.
Even in states with coordinated programs, participation can be uneven. As of September 21, only 24% of public school divisions in Virginia had enrolled in its federally funded testing program, which provides regular pooled PCR testing and access to home testing kits.
Elsewhere, the spike in cases at the end of the summer left schools scrambling.
“It’s all about catching up,” said Dr Richard Besser, chairman of the Robert Wood Johnson Foundation and former acting director of the Centers for Disease Control and Prevention. âYou can’t ask schools to implement large-scale testing protocols once the school year has already started, when the supplies, staff and logistics aren’t in place. “
Illinois’ SHIELD program has been bombarded with last minute entries; As of Sept. 21, 43 percent of participating public schools have enrolled after Aug. 23, a SHIELD representative said.
The program takes three to six weeks to launch; several weeks after the start of the school year, most participating schools have not yet started testing.
Chicago Public Schools have their own program delayed several times. The district initially said weekly screening would be available for every student when schools open on August 30. The district now says the program will be fully operational by the end of September, attributing the delay to the need for background checks on employees at the testing company.
Local parents have expressed frustration with the changing timelines and slow updates. âThere is no clear line of communication,â said Debora Land, who has a second year of high school in the district and is a parent representative on her local school council. âParents asked, ‘What’s your plan, what’s your plan, what’s your plan? “”
As of September 17, only 3% of students had enrolled in the testing program, the district said.
In New Orleans, the district has actively encouraged families to enroll in its weekly PCR testing program – offering multilingual online enrollments and enrolling in a state-run program that pays students to take tests. Covid testing, district spokesman Richard Rainey said.
But local schools had to contend with both Delta and Ida, a Category 4 hurricane that cut power to the city, temporarily closed public schools and suspended testing. âWe pivoted quickly after the storm had passed to restart the regime within the week,â Mr. Rainey said.
It takes a village
Growing demand for testing has also strained supplies. In Fresno, Calif., The school district has been unable to replenish its stock of rapid antigen tests and has had to scale back its testing on student athletes as a result.
But the biggest challenge that many schools face is staffing. The Berkeley Unified School District used state money to hire seven people to staff its Covid testing team – then dipped into its own coffers to hire 14 more.
For many districts in low-income communities, this kind of financial expense may be impossible. âWe have to make sure the resources are there, especially in the communities that have been hit the hardest,â said Dr Besser.
Protocols that work when transmission rates are low can become unsustainable as rates increase. Alachua County, Florida allows quarantined students to return to school earlier if they test negative for the virus on day five of their quarantine.
At the height of the August wave, nurses in some schools were testing up to 40 to 50 quarantined students each morning.
Schools had to hope that no one needed medical attention for the hour or two it would take to test all of those students, Superintendent Carlee Simon said. “Like a kid doesn’t have an asthma attack or, you know, anyone needs an EpiPen.” She added: âOur nurses had full-time jobs before Covid. Now, Covid is a job.
The workload eased, but in the first month of school 15 nurses quit.
In Grapevine, Texas, the school district testing center saw such demand in early September that appointments were made days in advance. Amy Taldo, who runs the site, said she was under-staffed to grow. âI need an army,â she said.
And testing is just the first step. At the San Antonio Independent, when students or employees test positive, a squad of nurses goes through a laborious contact tracing protocol.
To identify the close contacts of a single high school student, Lynn Carpenter, a district nurse, asks all of their teachers for detailed room maps. “I need to know, are they at desks, are they at tables, how far away are the tables?” ” she said.
If the student is an athlete, coaches also receive calls with questions about practices and games.
Ms. Carpenter, who works in a windowless office with bare walls, sometimes takes days to complete a single case. She has had calls with critically ill staff members, some of whom have burst into tears. âItâs heartbreaking work,â she said.
A vaccine for children aged 5 to 11 could be authorized as early as next month, further protecting elementary schools. But even then, it could be months before most young children are vaccinated – and many may never receive the vaccines, Dr Besser said.
Schools are therefore moving forward with what they have: limited staff and time.
âI think it’s a very useful thing that we’re doing,â Ms. Carpenter said. “I look forward to the day when it is behind us and I can go home.”