Why we need equity in Covid-19 testing

This post is written by Jorge Fanjul at the Centre for Public Impact and Diana Bruce at Diana Bruce & Associates LLC.

• The problem: The approach by many schools to require unvaccinated students exposed to Covid-19 to quarantine at home is inequitable and an avoidable barrier to learning, when better approaches exist.
• Why it matters: Approaches to testing, layered with a multitude of equity issues, can disproportionately harm marginalised students.
• The solution: Implementing a “Test-to-Stay” approach allows schools to keep close contacts of infected students in the classroom while minimising the risk of continued spread.

Throughout the pandemic, we’ve seen remarkable achievements, countless protests, a re-examination of nearly every aspect of education, and a massive system of Covid-19 testing set up in schools. The logistics and strategies for mass student testing have been a tremendous undertaking that required educators and health care workers to consistently go beyond their job descriptions. Despite the challenges, schools have made notable strides in implementing testing and mitigation strategies to protect students and staff. However, many of these advancements exacerbated equity issues that must be addressed in subsequent Covid-19 prevention efforts.

Testing is not the issue. In fact, consistent and widespread testing built the community trust that allowed schools to reopen. However, it also created a layered equity issue that, particularly in communities of colour, keeps students out of school as a result of contact tracing and vaccination status. Further exacerbating inequities, the legacy of racism in our health care system and the onslaught of pandemic misinformation disproportionately harm communities of colour, and has led to lower rates of vaccination among Black students in Washington DC. We will continue to promote the vaccine in all communities, but it is imperative that we fight against this imbalance now. Through our work with the DC Covid-19 Response Collaborative (DCRC), we believe “Test-to-Stay” is one of the most equitable and effective Covid-19 mitigation strategies.

What is it?

Broadly, Test-to-Stay is an approach that allows unvaccinated students who are close contacts of those who test positive for Covid-19 to continue learning in person while they undergo a series of rapid Covid-19 tests over several days – instead of quarantining at home (as long as their tests stay negative). If a child tests positive while participating in Test-To-Stay, the student goes home to isolate. But if the tests are negative, the child continues to attend school.

Further exacerbating inequities, the legacy of racism in our health care system and the onslaught of pandemic misinformation disproportionately harm communities of colour.

Without Test-To-Stay, unvaccinated students are sent home for several days if they are exposed to someone who has tested positive for Covid-19, missing critical socialising and academic time with peers and teachers in person. This revolving door for unvaccinated students is socially isolating and disruptive to learning, on top of the mental health crisis so many children are experiencing during the pandemic. And, given the lower vaccination rates among children of colour, the collateral damage of our pandemic response in schools is being felt more acutely by these communities. Test-To-Stay lends itself to more time in school and more time focused on learning.

DCRC schools are beginning to implement this approach and believe that Test-To-Stay shows promise for reducing the spread of Covid-19 in schools, minimising disruption to the educational process, and producing the fewest lost learning days. Alternative approaches, like quarantining exposed students at home, can inequitably send marginalised students home, further setting back the most vulnerable students.

What’s needed?

Test-To-Stay, however, requires schools to run a testing site. To do so, they must secure a Certificate of Clinical Laboratory Improvement Amendments (CLIA) Waiver that allows schools to administer and analyse rapid antigen Covid-19 tests at school if their health department didn’t secure one on their behalf. The logistical and financial requirements associated with CLIA waivers, like securing a lab director responsible for the program and training staff to administer the tests, can be prohibitive for some schools.

If securing a CLIA waiver is not feasible, the second-best, equity-centred approach is parent-administered, at-home rapid testing of students participating in Test-To-Stay. In this model, schools could secure rapid tests with ESSER funds to provide for at-home use. However, this kind of at-home testing puts an increased burden on parents and caregivers, particularly those who do not speak English at home as their primary language, work multiple jobs, lack access to reliable internet to upload results, or are people with disabilities.

The logistical and financial requirements associated with CLIA waivers, like securing a lab director responsible for the program and training staff to administer the tests, can be prohibitive for some schools.

If schools are unable to provide tests, they can direct families to community testing sites where they can acquire tests to administer themselves. However, there are greater equity issues with this approach as taking a child off-site can mean lost hours at work, placing families under greater economic strain. We need to do all that we can so that protecting our school communities doesn’t also create greater instability for our families. As such, schools should implement the above alternatives if feasible.

No one wants to see children sick. The pandemic has pushed the entire education system and those who work with it, to our limits. Yet as time passes, we have learned that the initial systems set up to quash infections by quarantining all possible exposures resulted in disproportionate harm to marginalised students, assaulting largely Black and Brown communities. It is time to use all the tools we have in our Covid-19 testing systems to minimize lost learning days, maximise in-person instruction, and bring about a more equitable and fair education system for all.

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