The COVID-19 pandemic has created what feels like an impossible choice for education and child care policy makers, administrators, teachers, and families:
- Halt in-person instruction to prevent COVID-19 transmission among children, staff and their families, or
- Operate schools and child care centers despite the risks to serve children and parents who struggle with remote instruction due to work obligations, poor at-home technical capacity, specific educational needs, or any number of other of social-structural issues.
Accentuating this tension is the fact that communities that have borne the highest burden of illness, death, and long-term disability from COVID-19 are the same communities where children and parents are most likely to struggle with remote online learning. This is because these issues are largely driven by the same upstream factors: poverty, language barriers, immigration status, low quality jobs, and historical mistreatment by medical systems and government entities leading to community distrust.
The United States Centers for Disease Control has emphasized the need for layered risk mitigation strategies to safely reopen schools. Key strategies include:
- vaccine access
- enhanced ventilation
- reasonable sanitation procedures
- good hand hygiene
- ‘respiratory etiquette’
In California, the California Department of Public Health supports but does not require that schools monitor students for potential asymptomatic cases through regular COVID-19 testing. California State Assembly Bill 86 (AB-86), which establishes the rules and provides the funding for school reopenings in California, supports asymptomatic testing every two week in communities with substantial or widespread risk.
Providing onsite diagnostic testing for both surveillance and screening is one important way to mitigate the risk of COVID-19 spread in schools and childcare sites. However, there are approximately 6.1 million students enrolled in over 10,000 public schools across the state of California alone, and some 75 million children across the country’s elementary schools and childcare sites.
The challenge for schools
Developing and diagnostic testing systems at this scale presents a non-trivial hurdle. Critical steps include identifying a laboratory partner; developing databases and data management systems; securing swab, vial and PPE supply chains; providing for courier or other transportation logistics; and deploying clinical staff to perform or oversee nasal (anterior nares) testing while ensuring proper infection control procedures.
Moreover, numerous studies have documented consistent economic, racial and ethnic disparities in COVID-19 diagnostic testing participation. A positive diagnostic test and the subsequent need to isolate or quarantine a child and/or their household can have significant financial implications for caregivers who cannot work from home and do not have access to paid sick leave. Immigrant communities have also voiced concerns related to issues of public charge and data privacy for undocumented family or household members. In the absence of mandated testing, the evidence and our experience suggests that 100% diagnostic testing uptake among students will be unlikely, and that there will be significant overlap between the families at highest risk of COVID-19 infection and those with the lowest likelihood of consenting to diagnostic testing.
The role of SASEA
Given these challenges to mounting screening testing to detect asymptomatic cases, between November 2020 and February 2021, researchers at UC San Diego partnered with San Diego County schools in a pilot program funded by the County of San Diego, with ongoing implementation testing continuing through the end of the 2020-21 school year.