Why some SC districts are saying ‘no’ to COVID-19 testing in schools
At least 11 South Carolina school districts, including the state’s largest, will not participate in a rapid COVID-19 testing initiative the governor announced last month, and many others remain undecided about their participation.
The voluntary testing plan, which Gov. Henry McMaster and the state Department of Education have promoted as a means of accelerating the reopening of schools for in-person instruction, would further strain schools already short on personnel, could encourage parents to send their sick children into school buildings for testing and may create additional legal liability for districts, according to officials from two districts that opted out of the program.
Given those concerns and the widespread availability of COVID-19 testing in their local communities, officials from Greenville and Lancaster County schools said they didn’t see a pressing need for in-school testing at this time.
Abbeville, Calhoun, Edgefield, Greenwood 50 and 52, Horry, Marlboro, Newberry and Saluda school districts also have opted out of the rapid testing protocol, according to the state Department of Education.
Another 22 districts, including Lexington 1 and Lexington-Richland 5, were still deciding whether to participate as of Wednesday afternoon. Lexington 2, 3 and 4, as well as Richland 1 and 2 have opted in.
“Each district right now is having to go through and weigh the pros and cons for their district because it is more than just being given a free test kit and doing it,” said Dawn MacAdams, Richland 2’s head nurse and a past president of the South Carolina Association of School Nurses. “When you start looking at all of the logistics of what it’s going to take to do it by law and best practice, a lot of districts have concerns about how they’re going to accomplish this.”
Districts surprised by rapid testing rollout
Local districts and state education officials were caught off guard when McMaster rolled out the schools testing plan in a surprise announcement one week before Thanksgiving.
Education Department spokesman Ryan Brown said the announcement “blindsided” districts, which knew COVID-19 testing in schools had been under discussion, but weren’t aware of the specific plan before it was announced.
At least one local schools chief, whose district will not participate in the testing program, questioned whether educators had even been involved in crafting the plan.
“It’s just a little frustrating because I feel like decisions are being made for schools to offer things, but I don’t know if there’s any educators at the table when these decisions are being made,” Lancaster County schools superintendent Jonathan Phipps said.
Districts that plan to offer the rapid testing — 48 have opted in so far — are now scrambling to work out the training, logistics and safe disposal protocols necessary to get it up and running.
The Department of Health and Environmental Control last week began distributing rapid antigen test kits to participating districts in an amount equivalent to 10% of their student and staff populations.
The tests, which involve a nasal swab and are considered easy to administer, return results in about 15 minutes. They’re reliable at detecting the coronavirus in people who are at or near the peak of their infection, but are not recommended for use with asymptomatic individuals.
The vast majority of participating districts have received an initial shipment of rapid antigen test kits from DHEC, but few are prepared to start testing students and staff immediately.
The only district Brown said he knew had announced its intention to begin testing this week is Laurens 55, an Upstate district with about 5,700 students.
Charleston, which already offers its roughly 56,000 students and staff COVID-19 saliva tests through a partnership with the Medical University of South Carolina, is hoping to introduce rapid antigen testing by the end of this week or early next week to be used in conjunction with the more accurate saliva tests, district spokesman Andrew Pruitt said.
Other districts, like Richland 2, are unlikely to begin testing before January, MacAdams said.
“With less than three weeks until winter break starts, that’s just not enough time to get it all together,” she said last week.
Apprehension over rapid testing’s effects
Four of the 11 districts that have opted out of testing so far already offer five-day face-to-face instruction at some or all of their schools.
Officials from Greenville and Lancaster County schools, which both offer hybrid instruction models, cited as their chief concern the possibility that more symptomatic children would come to school if rapid testing was available there.
“We think this is driving people to send their children to school when we’ve asked them not to send someone who might be infectious to school,” Greenville County schools spokeswoman Teri Brinkman said.
Phipps, the Lancaster schools chief, agreed and said he thought offering in-school rapid testing, even if well intended, sends the wrong message.
He said he initially thought rapid testing in schools could prove useful for identifying infected but asymptomatic students and staff who may be spreading the virus undetected, but soured on the state’s plan after learning the tests would be administered only to people with symptoms.
“When I heard that, that’s when I began thinking, if they’re showing symptoms they shouldn’t be at school,” Phipps said.
DHEC has clarified that the tests are intended only for students and staff who develop symptoms during the course of the school day and have advised against symptomatic individuals reporting to school to seek testing, but it’s no guarantee parents and students abide by those instructions.
“We’ve spent nine months trying to really hone in on the message of ‘Don’t come to school if you have symptoms,’ ” Brinkman said. “A lot of parents follow that really, really well and some are less great. We think this opens up a gray area to where they think they’ll send (their mildly sick kids) and if they feel worse we’ll test them.”
McMaster, who for months has steadfastly called on schools to resume five-day, in-person instruction, said Wednesday that he didn’t understand why districts would opt not to test students for fear of more sick kids coming to class.
“They ought to do it,” he said during an afternoon press conference held to address the state’s recent surge in COVID-19 cases. “We need to get the children back in the school or we’re going to be paying the price for that for decades.”
State superintendent of education Molly Spearman said she knew many local officials feared in-school testing could bring more symptomatic students into their buildings, but shared at Tuesday’s state Board of Education meeting that several innovative districts had worked out ways around that potential problem.
“Some of them are not doing (testing) at school, they may be doing it at another site,” she said. “It may be by appointment. If you feel like you need a test you can go, so that you don’t have to come into the school to get the test.”
Spearman said she suspects some districts that aren’t currently planning to participate in the testing initiative may reverse course after they see other districts implement it successfully.
Another concern districts have about testing in schools is the added burden it places on nurses, who are already overextended tending to hundreds, if not thousands, of students at one or more schools.
Between caring for sick and injured students and conducting extensive COVID-19 contact tracing, squeezing in COVID-19 testing on top of everything else will be a challenge, MacAdams said.
“Nurses are working hard,” she said, noting that many work evenings, weekends and over holiday breaks. “They’re tired and stressed, just as much as teachers are, and I have several of my own nurses who are thinking about leaving school nursing due to what they’re having to do during the pandemic.”
State education officials have encouraged short-staffed districts to use federal coronavirus relief aid to bring on more nursing help, but good candidates are hard to find.
Many districts, like Greenville and Richland 2, struggled to fill vacancies even before COVID-19 heaped more responsibilities on nurse’s plates.
“We just don’t have people interested in school nursing to fill the vacancies that we have because the pay is so much lower than what they can make in a physician’s office or a hospital, and there’s more burden on them in a school setting,” MacAdams said.
Supplementing nurses with school athletic trainers, whom the state has identified as potential COVID-19 testers, is an imperfect solution, said Patrick Kelly, a Richland 2 teacher who serves as director of governmental affairs for the Palmetto State Teachers Association.
With districts already confronting a teacher shortage that’s been exacerbated this year by coronavirus-related quarantines, relying on athletic trainers to pick up the slack in addition to teaching classes and treating injured athletes is not ideal, he said.
“To pull them out of an instructional role to do a COVID-19 test, someone must be responsible for their class,” Kelly said. “And schools don’t have that staffing right now.”
While districts could benefit from hiring additional administrative staff to lend nurses a hand with non-technical work, as state education officials have suggested, many of their responsibilities require specialized knowledge and training, MacAdams said.
“In nursing, we want to get it right the first time,” she said. “And some things we just can’t delegate.”
Legal liability also poses a consideration for districts, local school officials said.
If a contagious student tests negative for COVID-19 — as can happen on occasion with the less-sensitive rapid tests — and goes on to infect others, either at school or at home, who is ultimately responsible? Phipps asked.
“We’re liable for enough,” he said. “I’m not sure we need to take that on.”
Brown, the state Education Department spokesman, acknowledged some districts have expressed concerns about implementing rapid testing, but said his agency had been working with DHEC to address district’s questions and ease their anxieties.
“I think a lot of them were under the assumption that they had to begin this immediately, and that’s not the case,” Brown said. “We don’t want them to start until they’re ready and have systems in place.”
He said the Education Department is encouraging districts to participate in the rapid testing initiative, but not forcing them to, and that despite their concerns, most of the feedback the agency has received from district officials has been positive.
While rapid COVID-19 testing in schools will undoubtedly allow districts to identify and isolate contagious students more quickly, its greatest impact might be in curbing staff shortages, Brown has said.
A symptomatic teacher whose rapid test comes back negative would be able to return to the classroom on a faster timeline than one quarantining with a presumed case of COVID-19.
The instructional benefit to students and the personal benefit to employees who can avoid using personal days or taking a leave of absence while quarantining are significant, he said.
Is rapid testing a silver bullet?
Both Kelly and MacAdams said they believe there’s great value in getting both students and teachers back into classrooms as soon as possible, but aren’t sure offering on-site testing is the best means to reach that end.
“If the governor is serious about wanting to get students back into face-to-face instruction as quickly as possible statewide, he needs to lead on the things we already know can prevent the spread and transmission of this disease,” Kelly said, citing mask use.
McMaster has encouraged mask use, but has declined to institute a statewide mask mandate.
“The governor has said several times and continues to say that such a mandate is not just impractical, but also unenforceable,” spokesman Brian Symmes said Tuesday in response to U.S. Rep. Joe Cunningham’s recent call that McMaster impose a temporary statewide mask mandate due to South Carolina’s skyrocketing daily COVID-19 case counts.
Symmes said the governor is supportive of any local official who believes a mask mandate makes sense in their community, but rejects a “one size fits all” approach to the issue.
MacAdams said she thinks state officials should continue to stress the need for better compliance with mask use, social distancing and hand-washing, and drive home the message that the novel coronavirus is not a hoax.
“If we could control community spread, we could get kids back into buildings safely,” she said.
Symmes agreed about the need for better community compliance with COVID-19 mitigation methods, but also highlighted what he sees as the value that rapid testing provides school leaders.
“We think this gives them another tool in their toolkit to be able to facilitate the reopening of our school districts,” he said.
As of Tuesday, there had been nearly 5,000 cumulative COVID-19 cases associated with South Carolina schools since the beginning of the school year, representing about 5.5% of all coronavirus cases statewide over that span, according to DHEC.
This story was originally published December 9, 2020 at 9:00 AM with the headline "Why some SC districts are saying ‘no’ to COVID-19 testing in schools."