White House officials hoped that sending states rapid COVID-19 tests would encourage their use in reopening schools, and while that’s one way states are using the shipments, they say they need more resources and better data about how to best deploy testing.

Health officials in some states say they are beginning to offer testing to students and teachers, but they are still finessing how to determine who should be tested and how frequently that should occur. 

The Trump administration last month announced that it would provide 150 million rapid antigen tests to detect COVID-19, two-thirds of which would go to states and territories to help reopen schools and their economies. 

When announcing the tests, Assistant Secretary for Health Brett Giroir, who oversees the administration’s testing strategy, named schools as one of several settings in which states may use the tests.

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Marcus Plescia, the chief medical officer at the Association of State and Territorial Health Officials, said states face several challenges in trying to establish testing systems in schools and that many had not yet decided how to roll out the tests.

Most schools don’t have the sort of in-house health system with the capacity to conduct wide-scale testing. Few have the financial resources to hire an outside pharmacy or other provider to help conduct the tests and determine results. 

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States also aren’t sure whether additional rounds of free tests will come in the future and may not want to quickly deplete the tests they receive, which means they need to develop more targeted plans. 

“They don’t want to go down this path and commit to doing this and then not be able to do it a year down the road,” he said, noting schools may not be able to pay for additional tests since many state and local governments are strapped for cash because of the pandemic.

Extracurricular activities may be a more targeted way of using tests in academic settings, Plescia said.

So far, classrooms have not appeared to have caused significant spreading of the coronavirus, according to the limited data available. Students often are able to physically distance from each other and wear masks. But incorporating tests into extracurricular activities, where preventive steps may not be as routine, could help, Plescia said. 

President Donald Trump has urged schools to reopen and stay open during the pandemic, saying children are less likely to experience severe illness if they contract the virus.

But Michael Beach, the Centers for Disease Control and Prevention’s deputy incident manager for the COVID-19 response, told the House Select Subcommittee on the Coronavirus Crisis last week that students can transmit the coronavirus to others. The panel noted a CDC study that found 76 percent of children tested at a Georgia summer camp had the virus, for example.

Beach told the panel in a briefing that the CDC is working to update its guidance for schools that are considering how to reopen and that the agency will release additional reports about the risk to students. 

State decisions

The Department of Health and Human Services on Monday outlined how states are planning to use the rapid tests. In addition to schools, states are sending them to health care settings, long-term care centers, group living facilities, public universities, historically Black colleges and universities, and first responders, among other options. 

According to HHS, states with high numbers of cases now aren’t all directing tests to schools. North Dakota and South Dakota both said a portion of tests would go to schools, but Wisconsin said it provided tests to long-term care facilities and hospitals. 

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The administration also has shipped states 110 million masks, out of a total of 125 million it plans to send by Nov. 30, to distribute to schools, based first on areas that are lower income. 

State health officials say the rapid antigen tests can be a useful tool for schools that are open but simply relying on tests won’t slow the spread of the virus on its own. The rapid antigen tests are most effective for people who are exhibiting symptoms of COVID-19, rather than for surveillance testing to find asymptomatic people. 

“As we’ve come to learn, with the overall response, testing is a tool to tell us how we’re doing on all the rest of the stuff,” said Charissa Fotinos, the deputy chief medical officer at the Washington State Health Care Authority. 

In Washington, officials expect to receive 2.3 million antigen tests by the end of the year. Fotinos said they are still determining with local health departments how best to utilize the tests in schools. A group there is working on recommendations for testing in schools, including how to screen for asymptomatic cases, she said.

Officials are still learning from other regions that have done testing in schools already and are trying to determine how effective the rapid tests are in detecting the virus in people who are asymptomatic or presymptomatic. 

“For people with symptoms, they’re going to be great interventions. But for just throwing them out there and seeing what sticks, it remains to be seen if that will be helpful to reduce community spread,” she said.

Testing strategies

The CDC has not recommended that schools test all students or faculty. The Rockefeller Foundation is one group that is studying how schools in five areas — Louisville, Kentucky; Los Angeles; New Orleans; Tulsa, Oklahoma; and Rhode Island — are using rapid tests.

The organization released a report with Duke University’s Margolis Center for Health Policy last month that found a nationwide screening strategy would require 200 million tests per month, a number the United States could conduct each month by January. According to the report, those tests would cover students and staff at primary and secondary schools, as well as patients and staff at nursing homes. 

Officials in Arkansas are planning to begin rolling out 55 percent of their allocated antigen tests for teachers and school staff, beginning in areas of the state experiencing the highest rates of community spread, said Joel Tumlison, an Arkansas Department of Health physician specialist in outbreak response.

The decision not to test students came largely because the state has limited resources, Tumlison said. The state has seen more cases among teachers than it has among a proportional number of students, and adults are more likely than children to experience severe disease.

Texas announced a pilot program for eight school systems to try using the rapid tests, and other schools have until this week to apply to participate in the program, through which they would also receive personal protective equipment such as masks. 

In Mississippi, officials took a less targeted approach and set up testing sites around the state where teachers and students can get tested as frequently as they want, Liz Sharlot, the communications director for the state health department, said in an email. Those testing sites offer both rapid tests and polymerase chain reaction, or PCR, tests, which are processed at a lab and take longer than the rapid antigen tests but deliver more accurate results.

Schools for younger students can translate some lessons from the experiences of universities.

Colleges should test students every two to three days to reopen safely, according to a July study from the Yale School of Public Health.

Preeti Malani, the chief health officer at the University of Michigan, said testing can be helpful but other preventive measures, like social distancing and mask wearing, are still necessary.

Many universities have conducted some testing, but Malani said it’s easier for smaller campuses that are more contained than big state schools, where the campus borders are more porous.

“Testing helps people feel more comfortable getting back, but I think the communication has to be very, very clear on what testing means and what it doesn’t mean,” she said.