In summary

Communities and school districts must take proactive measures, like pool testing, to keep COVID transmission low and kids in school.

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By Karen Smith, Special to CalMatters

Dr. Karen Smith, an infectious disease specialist, is a partner at Healthy Community Ventures, a consulting collaborative. She also served as director of the California Department of Public Health under Gov. Jerry Brown.

While California schools have implemented programs to help keep kids in class while keeping COVID-19 out, these new programs and the protocols in place may be confusing. 

As a former public health officer for the state of California and a doctor of internal medicine and infectious diseases, I have deep empathy for the anxious place many families are in. I also know that if we work together, we can promote our collective health – in all its mental, physical, economic and educational dimensions – as the school year continues.

Consider the evolution of the pandemic this school year. We began with an early wave of cases in schools, coinciding with our return to school from a year of at-home instruction. Since then, reported infections and hospitalizations have steadily declined, a testament to the effectiveness of the multi-layered prevention strategies: vaccines, masks, sanitation, social distancing and testing. 

Nonetheless, young people still represent a great deal of the new infections today. The winter months – when more activities move indoors, making distancing more challenging – threaten to fuel spikes in COVID cases. This is also the season when influenza and other respiratory infections increase. 

Without continued COVID testing strategies, that combination will make it difficult for parents and schools to tell whether a child’s runny nose is from a cold, COVID, the flu or any of the other respiratory viruses that we experience every winter.

It is going to be very difficult to keep kids in school if we have to send home every child with a sniffle because we don’t know whether it is a simple cold or a life-threatening COVID infection. 

Just as kids suffer from illnesses, they also suffer from isolation and interrupted learning if they can’t attend in-person schooling. It is paramount that we do everything possible to make sound, scientifically-based decisions that keep more kids in school where they belong while protecting them and the community from COVID-19. 

Amidst all the uncertainty, one thing is sure: communities and school districts must take proactive measures to keep COVID transmission low and kids in school. This is most effectively done by catching transmission from individuals without symptoms before a few cases become a fast-spreading outbreak.

The best way to gauge whether prevention efforts are keeping transmission low is to routinely test for COVID within a school population, even among those who are asymptomatic. This requires schools to shift from only testing students who are displaying symptoms, to testing groups of students without symptoms. 

So how do we do that in a way that doesn’t disrupt classrooms?

Since the early days of the pandemic, I have been a proponent of “pooled testing” in circumstances where COVID transmission is low. In the school setting, pooled testing is the practice of regularly testing up to 25 kids in a classroom, cohort or sports team, at the same time and combining those samples (without individual identification) in a single lab test that can detect the presence of the virus in the group. 

If any group of samples is positive – and, statistically, they will be overwhelmingly negative – all the students in the positive group are tested individually to identify who is infected and who is not, so that appropriate measures, like quarantine, can be taken to limit transmission. 

Pooled testing is easy, cost-effective, quick and far less reliant on the rapid antigen test kits that are in short supply. 

Additionally, pooled testing is highly effective in identifying asymptomatic infections which are the biggest source of transmission, even without full participation within a group or classroom. There is a pooled testing program offered at zero cost to all public and charter California K-12 schools through the California Department of Public Health. The program also provides, for zero cost in most cases, the staff needed to conduct the tests. This can decrease the workload of already overburdened school staff. 

Now that kids are thankfully back in school, pooled COVID testing can prove to be an essential tool to keep kids healthy and in school, by keeping COVID out of classrooms, and keeping all of us confident that we are doing everything we can to support one another during this unprecedented school year. 

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