Is NYC School’s COVID Testing Program Worth It?

As New York City rolls back virus safety measures at schools, including mask mandates and social distancing guidelines, one tool remains in place: its school COVID testing program that swabs every week a slice of each school community.

But that program comes at a significant cost, about $30 million per month on average, Chalkbeat has learned, raising questions among some public health experts about whether it’s the best use of resources to protect communities. schools against the coronavirus.

Some epidemiologists have said the current level of surveillance testing can be valuable, with the city aiming to test at least 10% of students at each school each week. As the city rolls back some mitigation measures and with a new wave of virus potentially on the horizonregular testing can verify that the virus remains under control in schools across the city.

But other health experts remain skeptical that the school program – which relies on laboratory PCR tests and requires removing students from class to up to 30 minutes – worth the time and money. And the main architect of the testing program acknowledged in an interview with Chalkbeat that it was worth reassessing it given the substantial cost, availability of vaccines, more contagious variants and changing value judgments about the degree of acceptable risk in schools.

“It’s hard to argue that this is the best use of money to keep an individual safe,” said Dr. Jay Varma, one of former Mayor Bill of Wales’ top health advisers. Blasio, who designed the school screening program.

Still, it may make sense to keep the program going for other reasons, including reassuring educators and parents that there aren’t large numbers of virus cases lurking in classrooms.

“From that perspective,” Varma said, “it could very well be worth it.”

For now, city officials say they plan to continue the program and are looking for new sources of funding to make it work this school year as the city exhausts $251 million in federal funds. Funding who supported him.

Put the tests to the test

Launched in the fall of 2020, the school testing program is one of the longest running school safety measures and has been the subject of intense debate as some educators, parents and union officials have pushed for increased the scope and frequency of testing throughout the year. the pandemic.

The aim is to help detect virus outbreaks and measure whether other tools such as masking or ventilation are keeping virus cases low. It was not set up to directly interrupt transmission by removing most infectious people from schools. That would require more frequent and widespread testing, Varma said.

With rapid test kits becoming more widely available – and sent home with students if someone in their class tests positive or starts showing symptoms of COVID – it may be worth remembering the PCR testing program at school, some observers said.

While it’s useful to have a “barometer” for COVID transmission, said Boston University epidemiologist Dr. Benjamin Linas, “it seems like a very costly commitment to this concept.”

Linas argues that resources for PCR testing at the city’s school could be better spent on improving ventilation or speeding up the city’s vaccination efforts, since only 53% of public school students in the city are fully vaccinated. Using rapid tests for students who develop symptoms at school and their close contacts could further help detect outbreaks, he said.

Varma said the city was considering using rapid tests to conduct surveillance testing early on, but said the kits are more cumbersome and take longer to administer in schools compared to rapid student swabs and sending the results to a laboratory. Although PCR test results take longer to come back — about 27 hours on average, city officials said — they are also more accurate.

Some public health experts have said they will not scrap the testing program just yet.

“With the BA.2 variant, we’ve just removed masks in schools, I think it makes sense to keep your finger on the pulse,” said Dr. Anna Bershteyn, assistant professor of population health. at NYU Grossman. Medicine School. “It’s a guarantee of quality.”

Few details on how testing influences policy

The value of the testing program depends to some extent on how the information is used to inform policy decisions, and city officials offered few details. Even at the height of the omicron wave, city officials were largely reluctant to use test data to shut down schools, individual classrooms or conduct investigations into virus transmission, according to public data. The city also has back from contact tracing when individual cases arise.

“If there is no downstream action related to this surveillance, its benefits definitely diminish,” said Dr. Meagan Fitzpatrick, an assistant professor at the University of Maryland School of Medicine who specializes in disease modeling. infectious. “But if there are, then there may be benefits.”

Nathaniel Styer, a spokesperson for the education department, wrote in an email that the testing program “informs all of our COVID decisions.” He said that played a role in the decision to end the city’s mask mandate in schools. This change also came after the Centers for Disease Control and Prevention lifting mask mandates recommended in much of the country based on local infection and hospitalization rates.

Even if the program’s impact on policy-making remains murky, it may be politically untenable for officials to roll it back. The program has strong support from many educators and the city’s teachers’ union, which has consistently called for more testing throughout the pandemic. (The program allows up to 10% of school staff to be tested, but educators said testing staff often refuse to test them.)

At the same time, some parents said the program served as an important accountability tool, allowing them to push for changes to safety measures in the event of an increase in virus cases in schools.

“School testing is one source of data that I wouldn’t want to eliminate just because it’s unclear how the city uses it in decision-making,” wrote Liz Rosenberg, a parent from Brooklyn. of two children who helped launch a dashboard which brings together COVID data from schools as an advocacy tool with a group called Parents for Responsive Equitable Safe Schools.

Most students do not participate

But some experts have questioned the usefulness of the data. The city only tests students who have consented to participate in the program, and less than half of eligible students in grades 1 through 12 have done so, according to city data. In about 400 schools in the city, less than a third of students consented to the tests. If students who do not consent are more likely to take fewer COVID precautions in other settings, this could skew the results.

“The presence of testing can be comforting,” said Dr. Susan Hassig, an epidemiologist at Tulane University. “But the presence of PCR testing as it is currently practiced is probably not that beneficial.”

Varma, the developer of the testing program, said the consent issue was “the program’s biggest weakness,” but city attorneys argued they could not require consent as a condition of participation, saying particular without a distance learning option.

“Why is lice something you can check kids for without parental consent and kick them out of school, but you can’t do that for COVID?” Varma asked. “That baffles me to this day.”

At the start of this school year, city officials ran into another implementation problem: One of the four testing companies the city uses to run the school program, Fulgent Genetics, was returning a higher share of tests. invalid, which means that some test results were not returned.

About 3% of Fulgent tests were invalid in September, according to a Chalkbeat analysis of city data, far higher than any of the other three companies. The city considers an invalid rate of less than 1% to be acceptable.

A spokesperson for Fulgent did not return multiple requests for comment. City officials blamed the type of swab Fulgent used and said they worked with the company to fix the problem by retraining staff and changing the swabs they used.

At this time, the city has no immediate plans to end the in-school testing program, said Adam Shrier, spokesperson for the city’s Test and Trace program, which runs it in partnership with the education department.

“We will continue to follow CDC adviceand lead our science-based and results-based curriculum, which has ensured schools are the safest place for students in New York City,” he said in a statement.

Cam Rodriguez and Thomas Wilburn assisted with data analysis

Ryan H. Bowman