Opinion: How to get the remaining 50% onto campus — persistent testing

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Many COVID-19 rapid antigen tests can deliver results is 15 minutes or less — in stark contrast to the two-three day turnaround time of polymerase chain reaction tests which are the most commonly used test for COVID-19. While Palo Alto Unified School District has recently struck a deal to buy PCR tests for students and staff, PCR testing does not allow for students to fully return to in-person learning. With rapid antigen tests, however, this possibility can become a reality. Photo: Daniel Garepis-Holland

Ryan Lee, Staff Writer

A sparsely populated lunchtime Quad normally bustling with activity pre-pandemic reflects student hesitancy to return to in-person learning. While Palo Alto Unified School District has recently struck a deal to buy polymerase chain reaction tests for students and staff, PCR testing does not allow for students to fully return to in-person learning. With rapid antigen tests, however, this possibility can become a reality. Photo: Daniel Garepis-Holland

Despite the opportunity to return to campus, students at Palo Alto High School continue to face the harsh realities of distance and online learning: The loss of education, mental health issues, obesity and hunger are just a few. The exacerbation of the achievement gap also grows each day as a significant proportion of Paly students remain in distance learning.

While many — students and staff alike — herald secondary school reopening as a crucial step forward, it is important that we not forget the remaining half of students choosing not to return. Some students say that Zooming from a classroom is not worth the hassle while others say that they are not willing to put themselves or their families at greater risk for contracting COVID-19 without more stringent safety measures.

As few schools plan to fully return to in-person learning in the coming months, many doctors such as Danielle Dooley — a medical director at Children’s National Hospital in Washington, D.C. — worry that we are ignoring many of the taken-for-granted benefits of in-person school. And for most school-aged children, vaccines are unlikely to arrive in the coming months, according to Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. So what can we do to address the urgent needs of students and bring back the rest of the student body? Constant and continuous testing.

A Growing Body of Evidence
In many other parts of the world, students — especially elementary through high school students — have already returned to in-person education. In these situations, mask wearing, proper ventilation and social distancing have been universally implemented. Backed by studies from around the world, a recent data analysis study published in Pediatrics arrived at the same conclusion as its international peers: Children are less likely to become infected with the novel coronavirus and are not the main drivers of virus transmission.

For many — including the American Academy of Pediatrics — this evidence is sufficient to re-open schools. If students can wear masks, maintain social distancing and work in well-ventilated areas, the risk to students and staff is minimal. If Palo Alto Unified School District can further implement testing — once every two days — into its safety protocols, there is little reason for students to refuse an inevitable return to in-person education.

The Solution: Rapid Antigen Detection Tests
The magic wand to make constant testing a reality is a thin strip of paper that functions similarly to a pregnancy test. A rapid antigen detection test requires only a simple nasal swab and 15 minutes or less to work its magic. A low cost and scalable product, it is perfect for the high volume of tests required to ensure that on-campus teaching is safe.

“It [rapid antigen tests] will make a world of difference if we can do it today,” said Amesh Adalja, a senior scholar at Johns Hopkins Center for Health Security.

While the Board of Education recently proposed a plan to conduct mandatory staff testing every other week with the option for students to be tested, the devil is in the details. The current plan proposes using polymerase chain reaction tests which — for the district’s purposes — is inferior to rapid antigen tests.

A traditional PCR test costs between $50 to $100 per test. In the memorandum of understanding between Predicine — a biomedical company producing COVID-19 PCR tests — and the district, the cost per test is listed as $65. With rapid antigen tests, the cost per unit can be as low as $5  — a 90% to 95% decrease in cost.

To see how they match up, the Voice calculated the costs and tests administered with a student body of 2,124 students and 128 full-time teachers.

According to the board’s proposed plan, the PCR tests will be administered every other week and will cost $329,355 to cover the rest of the second semester, totaling 5,067 tests administered. For rapid antigen tests, it would cost $253,350 for the rest of the second semester, accounting for 50,670 total tests. The PCR cost calculations were also done with only 50% of the student body to better represent predicted school attendance. (calculations can be found here)

Using rapid antigen tests, the district can save around $76,000 while administering close to 10 times more tests.

Rapid Antigen Detection Test Concerns
A common concern about antigen tests is their sensitivity — the ability of the test to correctly identify a positive case — which is not as high as PCR tests. A recently published study in Science Advances, however, found that effective screening is dependent upon frequency of testing and speed of reporting compared to test sensitivity, according to lead author Daniel Larremore. To better understand this, antigen tests can be thought of a contagiousness test.

While positive COVID-19 patients may be missed due to low sensitivity, the negative result demonstrates the person has a low level of contagiousness. In fact, the only times a COVID-19 positive patient can falsely test negative occurs between day two and day three since infection, hence testing every other day.

With a traditional PCR test, a patient’s test result is more dependent on the progression of their COVID-19 case, meaning that you can test negative while actively shedding viral particles, or test positive while not contagious, according to the CDC.

Current studies point in one direction — schools can safely operate in person. With only about 44% of surveyed Paly students choosing to immediately return and only 10% showing up, a substantial number of students are being left behind, with critical educational and health resources being severed from those who need it most, a recent Columbia University study suggests.

With the resources to invest in cutting-edge COVID-19 testing, PAUSD must choose both a safe and economic approach to in-person learning by committing to a rigorous testing protocol using rapid antigen tests. This option will allow all students to confidently return to campus as cases in Santa Clara County continue to drop, erasing the need to teach through a computer which negates many of the benefits of in-person education.

As vaccination rates ramp up and COVID-19 cases continue to trend downwards, there is no reason for the district not to return all students back to full-time in-person learning.

“Children absolutely need to return to in-school learning for their healthy development and well-being,” AAP President Lee Savio Beers said. “And so safety in schools and in the community must be a priority.”

The Voice reached out to Yolanda Conaway, Assistant Superintendent of Equity and Student Affairs, for comment regarding the particular testing option presented in this story but received no response. Conaway is responsible for coordinating potential COVID-19 testing for the district, and recommended in the March 9 board meeting that the Board approve the Memorandum of Understanding with Predicine.