Omicron has states rethinking 'broken' school Covid testing

State leaders and health experts are weighing a counterintuitive school Covid strategy: Less testing and contact tracing.

Utah’s legislature suspended school testing requirements this month after high Covid rates strained the state’s system. Omicron’s quick spread left Vermont officials abandoning their onetime school test-and-trace program, while Massachusetts officials strongly encouraged schools to give up a diagnostics program endorsed by federal officials.

The approaches conflict with White House plans. President Joe Biden’s administration is promoting school “Test To Stay” programs to keep exposed students inside classrooms, and the federal government said it would begin delivering millions of rapid tests to schools this month.

But the Omicron variant has challenged schools to keep pace. The Centers for Disease Control and Prevention is telling states to narrow requests for rapid tests under the White House initiative, all while some authorities simply begin to rethink school testing and contact tracing.

“Our testing infrastructure was not there, it was broken,” said Hilario "Larry" Chavez, superintendent of Santa Fe Public Schools, of his decision to close New Mexico’s capital city system for several days earlier this month.

The CDC said it has urged states to prioritize a small number of school districts for rapid test requests under the White House initiative — and focus on places where quick tests would help students return to school immediately, keep them in classes and assist government-endorsed testing programs for exposed children touted by Education Secretary Miguel Cardona.

While falling case counts are starting to bring East Coast states relief from the testing strain, schools elsewhere are still struggling with the Omicron surge. Curtailing school testing, cutting back contact tracing or rationing resources are now in play to free up staff and concentrate on the actively sick.

“Testing, contact tracing and quarantining in the face of so many infections are likely to have little or no impact whatsoever,” said Ali Mokdad, a former CDC official who is now a professor of epidemiology at the University of Washington’s Institute for Health Metrics and Evaluation.

“Testing of asymptomatic individuals may put a lot of pressure, impose labor shortages and cause disruption in our schools. The main strategy, right now, should really be to manage our hospitals,” he said.

The debate is unfolding as the White House encourages schools to layer testing programs atop proven protections: vaccinations, masks, social distancing and ventilation.

“Testing is a challenging endeavor in schools,” Mary Wall, a senior White House Covid-19 response policy adviser, said this month during a government-sponsored call on testing with education officials. “It takes a good amount of setup to make sure that you have all the requisite pieces in play. But we think that with support, like the support that the federal government has provided, we really do think that it's become much easier for schools to do testing.”

A promising idea

Test-to-stay programs try to limit student quarantines with frequent tests and contact tracing. Children exposed to infected classmates can remain at school, typically as long as they're asymptomatic, wear masks and regularly test negative. The concept was taking hold before the CDC embraced the practice in mid-December.

It was a promising idea. The Duke-Margolis Center for Health Policy, in collaboration with the Rockefeller Foundation, concluded such testing programs could help schools stay open if they planned to avoid supply shortages and logistical problems. Then Omicron’s surge exposed problems.

“When the numbers started to come down from the holiday surge, that's when we instituted ‘Test to Stay,’ because we knew it would have far exceeded our capacity during that surge,” said Joseph Ricca, the superintendent of the White Plains Public Schools system just north of New York City. “In terms of the identified number of cases, it would've absolutely overwhelmed us.”

New guidance from the Children’s Hospital of Philadelphia notes many schools are overburdened with unfeasible and unsustainable contact tracing and testing programs, and suggests schools halt required weekly testing for students and school workers who aren’t showing symptoms.

School’s back in session and tests are now in better supply in Santa Fe. But Chavez said his staff is struggling to trace cases, even as National Guard and state employees will soon assist overtaxed classrooms.

“Anytime you have a positive test, on campus or off, you have to perform contact tracing. That could take a day, it could take an hour, it could take a week or two”, Chavez said. “When you add that onto the testing requirement, it's a lot to ask of any school district.”

In Massachusetts, Republican Gov. Charlie Baker’s administration wants schools to abandon a “test and stay” program the state helped pioneer last summer in favor of a new plan to scrap contact tracing and concentrate on finding symptomatic people with help from rapid tests taken at home instead of school. Vermont is taking a similar approach with a “test at home” effort that scales back the use of sweeping, laboratory-based virus tests.

Meanwhile, the CDC said it’s evaluating whether tests done at home can play a role in Test to Stay programs — to determine if and how K-12 schools should monitor at-home test results.

High demand persists

School testing is still in high demand. More than 25 states peppered the CDC with requests for supplies and information about the White House plan to dedicate a combined 10 million lab-based PCR and rapid antigen tests to the nation’s K-12 schools each month, barely a week after the administration first unveiled the program.

Cardona also set out guidance this month for school officials who are looking to secure tests.

The Abbott pharmaceutical giant started shipping batches of rapid tests earmarked under that initiative directly to schools earlier this month, according to the CDC. Those were expected to start arriving within the past week, the agency said, though it’s unclear how many have actually been delivered.

The Department of Health and Human Services would not disclose how many rapid tests had been distributed to schools under the latest White House plan, nor would the department identify which states were receiving them. Instead, a spokesperson said HHS will share more information as tests reach schools in the coming weeks.

The CDC acknowledges testing programs’ sheer demand on resources means the idea might not work for every school. At a minimum, the agency recommends schools that are testing concentrate on unvaccinated teachers and staff — and on students who aren’t fully vaccinated when community transmission of the virus is at moderate, substantial or high levels.

“When resources are constrained, we need to prioritize who we test,” said Leah Perkinson, the pandemic manager for the Rockefeller Foundation, which has collaborated with the Education Department and CDC to expand the country’s school testing programs.

“That has to be a risk-based prioritization. If you know there are more vulnerable students, like students with disabilities who are immunocompromised, they are priority populations for testing when supply is limited.”

For now, schools will likely have to double down on virus-busting measures known to help limit outbreaks and stretch whatever testing resources they have on hand to comply with White House demands to remain open.

“We can talk about the fact that we should've had rapid tests a long time ago,” said Yvonne Maldonado, chair of the Committee on Infectious Diseases for the American Academy of Pediatrics and a professor of epidemiology at Stanford University.

“That ship has sailed,” she said. “In the meantime, we know the principle of the way this virus works. Inherently, it's in your mouth and nose. So the more you keep your mouth and nose away from other people's mouth and nose, the more you're going to prevent outbreaks. We can't let perfect be the enemy of good.”