Hollywood tests actors three times a week for COVID-19. The NBA tests players daily. Congress required testing anyone attending President Joe Biden’s April 28 State of the Union address who had not been vaccinated.
These are examples of what are called “screening tests”—a way to ensure Biden, Tom Cruise and Damian Lillard can do their jobs through the pandemic without major outbreaks.
Some Portland parents and teachers want to see a version of this regimen in Portland Public Schools. And they fault the Oregon Health Authority for choosing a smaller, slower testing system as students return to classrooms in neighborhoods overrun by the coronavirus, even as the federal government has provided funding for screening tests.
“OHA is not actively seeking to implement a test screening program that would help keep my daughter safe,” says Sabina Haque, a Portland Public Schools parent and first-generation immigrant from Pakistan who lives in a three-generational household.
Haque says ZIP codes with some of the lowest vaccination rates and highest rates of COVID-19 should be prioritized for screening tests so parents can know if the disease is present in schools. The Rockwood neighborhood of Gresham, for example, had just 22% of its residents vaccinated as of April 14, according to an analysis by The Oregonian. And the neighborhood had more than 200 cases per 100,000 residents in the week ending April 21.
One PPS board member agrees. “It’s an important tool to ensure safety and persuade families that in-person classrooms will be safe,” says Rita Moore. “This is a standard kind of public health measure. We as a country have had a very spotty record over the last 14 months in implementing appropriate public health measures. This is a continually evolving pandemic, and we need to be responsible.”
The U.S. Centers for Disease Control and Prevention suggests schools offer a modest version of screening tests as part of reopening classrooms. That testing can range from 10% of students and staff every week to everyone who sets foot in the building.
Massachusetts, New York City, Los Angeles, Baltimore and Washington state are among the places that have already adopted screening tests as a way to keep kids and families safe and increase confidence in schools.
Oregon does not have such a program in any of its school districts. Currently, districts test children who display symptoms.
That gap appears more significant as COVID case counts rise again in a fourth wave in Multnomah County and Oregon. “Screening testing is particularly valuable in areas with moderate, substantial and high levels of community transmission,” the CDC guidance states.
Portland certainly qualifies. Over the course of three weeks in April, Portland went from low to high spread of COVID-19, making such testing even more imperative, say advocates.
Opponents argue it’s a waste of money. Oddly, so has OHA (more or less), even as the agency says it will implement a program like this for next year.
“We plan to expand screening to students during the 2021-2022 academic year,” says OHA spokesman Tim Heider.
But state epidemiologist Dr. Dean Sidelinger was equivocal while testifying April 14 before the Oregon House COVID-19 Subcommittee. “We don’t have significant evidence for or against screening in schools,” he said. “Evidence base for screening on this scale is problematic,” he added, citing a cost estimate for existing programs of $25,000 per positive test result.
Outright critics of the approach are more emphatic.
“Surveillance testing sends a message that school is not safe, when data overwhelmingly show the opposite is true,” says Leslie Bienen, a veterinarian and faculty member of the Oregon Health & Science University-Portland State University School of Public Health, who is working with the school-reopening advocacy group ED300. “School is one of the safest places to be in any community. Why would we surveillance-test in schools when that is not where COVID-19 is still spreading (e.g., we have 24 active outbreaks in nursing homes right now in Oregon)? It doesn’t make sense.”
In part, the divergent views reflect differences of opinion about the risks COVID-19 poses for children.
Under the age of 10, kids are less likely to spread the disease or get very ill. But there is ongoing evidence that teenagers can and do get the disease and spread it. And Oregon’s latest surge in cases is occurring while children under 16 remain unvaccinated. (Approval of the vaccine for kids 12 and up is expected as soon as next week.)
Screening testing (also called COVID-19 surveillance) does not come cheap. But the federal government has provided funding to get the program going: $127 million for Oregon for now through next school year.
For this school year, the Oregon Health Authority has opted to begin using that money to offer an optional program to test unvaccinated teachers and staff, because the CDC has prioritized testing for adults.
Weekly testing of all students and staff reduces COVID-19 by 50%, one study by the research groups Mathematica and the RAND Corporation found. Testing of just staff was less effective.
But the money OHA is spending to surveil teachers has other obstacles to being effective: Results by mail are promised within “days.” If the idea is to contain the virus, faster results are better.
“I think that approach is ridiculous,” says Multnomah County Commissioner Sharon Meieran, an emergency room doctor, adding she’s supportive of screening tests at schools but that OHA’s initial efforts aren’t going to work. “I don’t know what they would be trying to discern with that kind of approach.”
Says the CDC: “When considering which tests to use for screening testing, schools or their testing partners should choose tests that can be reliably supplied and that provide results within 24 hours.”
That has advocates for screenings all the more concerned.
“SARS-CoV-2′s advantage is that it’s a stealthy virus,” says Kindra Crick, a PPS parent with a degree in molecular biology. “To keep schools open and reduce disruptive classroom shutdowns, we need to be using rapid-turnaround asymptomatic screenings to keep infectious COVID cases out of school buildings and after-school activities. Arming people with a way to quickly find out when they are infectious is a powerful way to keep both schools and the economy open—one we should be using for unvaccinated and undervaccinated [communities].”
Crick makes a key point: Given the uncertainty surrounding how many Americans will get vaccinated, the pandemic may not dissipate soon. That adds to the need for school districts to detect outbreaks quickly.
Retired virologist Maureen Hoatlin, a former OHSU associate professor of biochemistry, says she favors following the CDC suggestion to broadly screen students: “You’ll be able to limit the spread of the disease.”