More than 75 doctors from several major hospitals across Massachusetts, including BIDMC, are urging Governor Baker to dedicate funding and resources to expand surveillance testing of COVID-19 as school districts prepare to reopen this fall.

Boston Globe – July 24, 2020

Doctors to Governor Baker: Expanded COVID-19 surveillance testing ‘essential’ to reopening schools safely

More than 75 doctors across Massachusetts are urging Governor Charlie Baker to dedicate funding and resources to expand surveillance testing of COVID-19 as school districts prepare to reopen this fall.

In a letter submitted to the governor’s office Thursday, the multidisciplinary group of medical professionals say the state’s current testing strategy, which relies on diagnostic tests administered through a patchwork of providers, with turnaround times as long as 6 to 10 days, “hinders our ability to understand in real-time what is happening in any given district.” Widespread, rapid testing, they argue, is “essential” to ensuring schools can reopen safely.

“We are very much in favor of trying to open schools in person right now because community prevalence is low in Massachusetts,” said Dr. Elissa Perkins, an emergency medicine physician at Boston Medical Center, who wrote the letter, along with Dr. Westyn Branch-Elliman, an assistant professor and infectious disease specialist at Harvard Medical School.

But it will be “impossible to implement” the state’s school reopening guidelines, Perkins said, without widely accessible coronavirus tests that can quickly produce results.

“You’re left with a situation in which you start quarantining entire classrooms whenever anybody has a sore throat or a cough, which will keep children out of school pretty much all year, or you only start these protocols when you have a positive test result,” she continued. “But that doesn’t work when we’re relying on pediatricians and community testing sites [and]… it takes 8 to 10 days for the test result to come back.”

In the latter scenario, a child suspected of having COVID-19 would wait for her test results in quarantine at home. But the students she may have exposed would continue attending class, potentially spreading the disease elsewhere, Perkins explained.

If the child’s test results come back positive, “you’d have to start the process all over again for each of those children,” she said. “It just doesn’t work.”

The coalition that signed the letter includes emergency department physicians, critical care doctors, infectious diseases pharmacists, and pediatricians from several major hospitals, health care systems, and universities across the state, such as Boston Children’s Hospital, Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital, and the University of Massachusetts Medical School.

A spokesman for Baker noted that the Massachusetts chapter of the American Academy of Pediatrics has endorsed the state’s school reopening guidelines.

Ideally, the signatories recommend recurrent testing, at weekly or biweekly intervals, of all students and staff, which “would allow a school to stay ahead of a potential outbreak.” The tests, they note, must be “easily accessible, cheap, atraumatic for the child, and with a rapid turnaround time that is fast enough to identify cases in time to appropriately institute quarantines, and also fast enough to get children who do not have COVID back into the classroom.”

The letter cites at least two tests that meet these criteria, including rapid antigen tests. Although these tests are not as sensitive as the gold-standard polymerase chain reaction, or PCR, tests used by governments and hospitals to confirm coronavirus diagnoses, they can detect COVID-19 during periods of infectivity, which would allow school districts to “immediately begin testing close contacts, with rapid answers.”

“The only way for these strategies to work is if the epidemiologic work is transferred from physician offices to the towns, or to the nursing programs already embedded within the schools,” the letter says. Otherwise, “even the most efficient pediatricians” will quickly become overwhelmed testing both symptomatic and asymptomatic students.

“Decentralized systems are inherently susceptible to losing data and disorganization,” Branch-Elliman told the Globe. “I think it’s important that as we are looking for ways to screen and then follow up on test results, we have a centralized way of doing so to make sure none of the test results fall through the cracks.”

Branch-Elliman, who works with Perkins on Milton Public Schools’ reopening committee, said states and districts must consider “outside the box” strategies in order to reopen schools as safely as possible, such as finding larger classroom spaces or holding classes outdoors.

“One thing that’s sort of lost in all of these discussions is we don’t know how long this pandemic is going to last. If we’re lucky, we get a vaccine or we get a post-exposure prophylactic strategy. If we’re not lucky, we could be dealing with trying to control this for years,” she said. “Closing schools was a reasonable thing to do upfront. However, we need to think about whether or not it’s a reasonable strategy to ask kids to be doing remote learning for potentially years.”

Thomas Scott, executive director of the Massachusetts Association of School Superintendents, said he is not aware of any school districts that are planning to regularly test students and staff for coronavirus as part of their reopening plans.

“I think it would be advantageous for some districts who may have some difficulty convincing some parts of the community, whether it’s teachers or parents,” Scott said. “I think it’s an option people would love.”

MerrieNajimy, president of the Massachusetts Teachers Association, which has criticized the state’s guidelines as inadequate, agreed that increased testing and tracing is necessary to safely reopen schools. But the state also must ensure school buildings are in compliance with health and safety standards, and fully supply personal protective equipment, she said, “rather than leaving the districts to their own devices.”

“And none this can actually be done without school funding,” Najimy said. “We have been saying from the beginning the state has the ability to raise progressive revenues on wealthy individuals and corporations in Massachusetts, so they can fund the public good.”