Alabama schools are re-opening without the financial and logistical capacity for universal COVID-19 testing of students, and experts are divided on the risk that presents.
“There would be a lot of obstacles to reach a point where we could achieve that goal (of universal testing),” said Professor of Pediatrics at USA Health Children’s and Women’s Hospital, Dr. David Gremse.
Schools began reopening across Alabama this week, but many experts believe testing Alabama’s students on a regular basis is not financially or logistically feasible, given staffing limitations and the delay in getting results from testing labs.
The CDC does not require schools to test students in order to re-open, and Dr. Brian Gannon, professor of pediatrics at the University of Alabama, thinks widespread testing could even backfire.
“(Universal testing) gives you false sense of security that these people are safe to come to school,” he said, noting that someone could get a test, go to the grocery store, and pick up COVID-19 later that day.
But Dr. Ashish Jha, professor of global public health at Harvard University, sees broad testing as essential to opening schools.
“Going without (universal testing) in a place like Alabama, strikes me as extremely high risk,” he said, adding that he would not send his own child to school in Alabama given the rate of COVID-19 spread, and certainly not without universal testing.
“We’re building in layers of safety, and if you want to build in a strong layer of safety with testing, you want to be testing everybody twice a week.”
Tests too pricey
The state’s school reopening plan includes no statewide K-12 testing initiative, which some state Senators and members of the Alabama School Nursing Association had called for. Instead the plan distributes funds to K-12 districts to spend at their discretion.
At the university level, Operation GuideSafe is requiring students to get tested for the beginning of the year before they arrive on campus.
Dr. Michael Saag, infectious disease professor at the University of Alabama at Birmingham, says the aim is to get a snapshot of COVID-19 among the student population.
“It’s simply a way of saying, ‘we’re starting with a known entity and we’re going to follow what happens over time.’”
Saag says Alabama is prioritizing testing college students over younger children because they tend to cohabitate in dorms, increasing the likelihood of spread.
He believes universal testing in all schools would be impossibly expensive for Alabama at $50 a test. Hundreds of thousands of tests would be needed.
“You start doing the math and it becomes pretty overwhelming in terms of the lift that has to be made,” he said, adding that right now, there is a shortage of tests for patients in clinical settings which needs to be the priority.
A new approach to testing
Meanwhile, nationwide, the conversation about COVID-19 testing is moving in a new direction.
Jha and other researchers are calling for a shift towards less expensive, less accurate tests, called antigen tests. The tests could be so cheap to produce, they argue, that every American could test themselves once a day, dramatically improving the rate of testing nationwide.
“You overcome the sensitivity issues by testing more frequently,” said Saag, at UAB, who is hopeful about antigen testing but not convinced it can be done as cheaply as some experts propose.
Seven states, including Louisiana, are banding together to pursue the development of antigen testing capacity to use in schools and other settings, and Arkansas is investing in hundreds of antigen testing machines as it reopens schools.
Yet a move toward cheaper tests is not taking off in Alabama so far.
Dr. Gremse, for one, is concerned about using a less accurate test.
“There is not enough testing data available yet to verify whether antigen testing is accurate for screening purposes,” he said.
For Dr. Saag, sentinel testing, taking a random sampling of a population to track the disease’s spread, is the best solution, on balance.
He says districts should be prepared that COVID-19 will sooner or later spread through schools.
“To me it’s inevitable,” he said. “The question is to what degree they’ll see this, and the timing of when they’ll see it.”