Local Health Systems Can Help Integrate COVID-19 Testing Into K-12 Schools, Report Says

Partnership relieves schools of logistical burdens of staffing, testing, data management, and reporting.

A new RAND Corporation report shows that local health systems can help COVID-19 testing to be integrated into pandemic response plans for K-12 schools.

"Our interviews with K-12 schools show that COVID-19 testing is complex, but doable," said Laura Faherty, lead author and a physician policy researcher at nonprofit, nonpartisan RAND. "Many early adopters found it critical to partner with local public health departments, local health systems, their peers, and testing vendors to launch feasible COVID-19 testing programs."

San Diego Unified School District (SDUSD) in San Diego County, California, was featured in the report for its partnership with the University of California (UC) San Diego Health last fall to co-design a screening program for 10 pilot schools to allow safer in-person instruction. Few students were attending school in person because of locally high COVID-19 rates.

UC San Diego Health relieved the school district of logistical burdens by providing staffing to administer tests; managing testing logistics, such as scheduling appointments; analyzing samples; and collecting and reporting testing data. The health system calls students, teachers, and staff with a positive test, relaying results as quickly as possible, and reports positive results to the county health department.

The school district pays UC San Diego Health to run its testing program out of its district budget. Funding the district received through the CARES Act helped cover a portion of the costs.

The neighboring Del Mar Union School District (DMUSD), a smaller, more affluent district with lower COVID-19 community transmission rates than SDUSD, also has partnered with UC San Diego Health to swab symptomatic students and staff at the health system's testing sites and analyze their samples at its labs.

Turnaround time for results has been fast—24-48 hours, compared with 4-5 days through the county—even as case numbers have risen, which has helped the district make faster quarantine decisions.

The Omaha [Nebraska] Public School District launched a testing programs in three schools, collaborating with the University of Nebraska Medical Center (UNMC) for weekly screenings. UNMC analyzes the samples and shares results with the district and with tested individuals using an online reporting system they developed.

After trying different testing procedures to minimize disruptions during the school day, UNMC helped the pilot schools set up a testing hub in a low-traffic area of each school, according to the report. On testing days, each class is excused to go to the testing hub at a designated time where volunteers assist with collecting samples. Students may opt out if they choose.

UNMC also is conducting a study that involves regular sampling of air, wastewater, and surfaces within the pilot schools to understand the extent to which testing these sources can contribute to understanding COVID-19 transmission risk in schools.

Schools encountered varying degrees of hesitation around testing and used several strategies to encourage participation, the report says. Privacy concerns were most common; staff and parents worried their health information could be shared while others expressed concern about how their test samples would be used. Another hesitancy factor was doubt about the actual risk posed by COVID-19.

The report, funded by The Rockefeller Foundation, provides recommendations for how schools can develop, and policymakers can support, effective COVID-19 testing programs. Recommendations include:

• Expand funding to ensure schools can access tests, hire additional staff, and contract with health systems and other vendors as needed to implement testing.
   
• Provide incentives such as paid sick leave for teachers and families to participate in testing and isolate as needed.
   
• Provide resources to strengthen state and local health departments so they’re fully equipped to help schools design testing programs and respond to positive tests.