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Reopening Schools - A Battleground of Policy Implications Without Surveillance Testing

by Gerald Commissiong
September 2, 2021

https://www.linkedin.com/pulse/reopening-schools-battleground-policy-implications-commissiong/



The violent surge of the Delta variant has taken many school policy makers by surprise. In the spring of this year, the Biden Administration allocated $10 billion for testing to help get kids back to school to experience in-person learning before the summer break. This was part of the American Rescue Plan and its goal to reopen the schools. Studies researched by the CDC in support of this plan showed 0.7% to 2.0% infectivity within the school population even in areas with high community transmission rates. The concept behind the testing was to limit the community spread of the virus within the schools. Let’s face it, there were major challenges in deploying the plan broadly throughout the US in the second quarter of 2021, but ultimately when implemented surveillance testing appeared to work and there was very little community spread. Surveillance was run at the local level, which is why there are no national statistics to rely upon, but a Nature Article published in July 2021 confirmed that there was less than 1% infectivity in children with full mitigation measures in place. Without masks and ventilation one school in Utah recorded an infectivity rate of 13.2% in students and 16.6% in staff. Clearly mitigation measures work, but we can’t give all the credit to testing because it was a combination of mask usage, ventilation, social distancing, and hand washing.

Changes at the CDC this spring have dramatically altered our understanding of the risk the Delta variant poses to adults and children and I hope to shed some light on the topic by looking at some case studies. On May 14, 2021 the CDC stopped tracking symptomatic breakthrough infections. If you are wondering how one stat could be so influential it is because breakthrough infections are essentially a measure of the effectiveness of the vaccines against transmission. We have practically no data at the national level and I pointed this out in my last article. We really need this surveillance data because it will help us better understand the effectiveness of the vaccine and lead us to data driven policy guidance. Without the data we have to look elsewhere.

Public Health England Report

We can get a glimpse of how effective our policies will be for the coming school year by looking at the Public Health England Report that breaks out some useful data for consideration. The Delta variant became the dominant strain by the third week of May while kids were still in school. The United States lagged the United Kingdom by approximately one month and most were on summer break.



It may be hard to see on this chart, but on week 20 which represents May 23, we saw the first uptick in school cases that corresponded with Delta becoming the dominant strain. As the kids remained in school the infections spiked exponentially. At week 25 which represents June 27, the new cases were experiencing exponential growth and it was probably fortunate that school ended.



The graph above provides an assessment of the infectivity rate we could see in schools using the existing protocols. Here we see that within 6 weeks the infectivity rate could topple 10%. The United States and England use similar protective protocols which means that this study likely represents a good estimate of what to expect in the US.

It's unclear what policy makers are going to do at this point. Will they go back to distance learning if the infectivity level rises? What level is unacceptable and triggers this? Right now, it's unclear if they are even going to do testing!

Policy Implications

The American Rescue Plan which created a framework to return to school with closely monitored surveillance testing ended. There are currently no federal programs or policy recommendations at the Federal Level except from the CDC. The CDC still believes in surveillance testing yet they are not aggregating any data. Their recommendations are based on studies done last year before the arrival of the Delta variant. There are 13,000 school districts and each of them has a unique policy on how to handle the reopening according to Randy Weingarten with the Federation of Teachers. It is becoming increasingly clear with the data from Israel how dangerous the Delta variant has become. The protection from the vaccines to the Delta variant is considerably less than what many expected. The data from the UK in schoolchildren was alarming at how quickly the infectivity could rise. While this outlook appears gloomy, we believe surveillance testing along with contact tracing might be able to quell the community spread within our schools and universities.

Surveillance Testing - Path Forward

The real issue is the lack of a standing federal mandate for surveillance testing. We had a mandate 6 months ago, but that has since expired. The American Rescue Plan also came with a pot of testing money. Without this government backing, school districts may be forced to craft policy according to their budget. Testing isn't a political hot button and all parties regardless of their affiliation tend to agree that testing is a socially acceptable practice. Since the return to school policy is so embroiled at this time, perhaps we should start with a topic like testing where there is common ground.

Ideas like vaccination mandates for children without going through testing have no business being in the debate right now especially when an FDA approved vaccine for children under 12 doesn’t even exist. Moreover the existing vaccination is unlikely to stem community spread. Given the recent transmissibility data on the Delta variant we have to stop doubling down on a vaccination-will-fix-all strategy.

HHS Acting Secretary Norris Cochran really had the right idea when it comes to testing.

“COVID-19 testing is critical to saving lives and restoring economic activity. As part of the Biden Administration’s National Strategy, HHS will continue to expand our capacity to get testing to the individuals and the places that need it most, so we can prevent transmission of the virus and defeat the pandemic.” - Norris Cochran HHS Acting Secretary

We think it's time to end the debate and move forward on something we all agree on, that is extensive surveillance testing.

We desperately need data on this Delta variant with respect to the effectiveness of the vaccine and the extent of the community spread within our general population and schools. The administration is clearly operating at a disadvantage without any federal plan to encourage widespread surveillance testing. Since it's clearly going to be mandatory in schools this would be an ideal way for the government to pay for the testing which would enable it to get the data on how the variants are spreading while monitoring and protecting our children. The government would be the central repository of the data in this scenario giving it a look at COVID-19 over a vast geographical region.

By mandating surveillance testing in schools we will be protecting our children and getting valuable information on the spread of the variants. A win for the country and a win for our schools and children.

Provista Diagnostics is capable of handling large government contracts because it invested in automation after COVID infections started to dwindle. While other retooled their labs Provista saw the need for additional testing capacity should a third wave occur. It’s here. The lab can also do variant testing to track what’s there and uncover any new rising variants of concern. The lab is also capable of quantifying the level of neutralizing antibody levels that are capable of thwarting a delta virus infection. This is called the cPass neutralizing antibody test. We are also working on validation of the Tollo Test which will measure the active COVID-19 infection via the 3CL protease test.