McMaster order clears way for rapid COVID-19 testing in SC schools. Here’s what’s next
South Carolina school districts are scrambling to work out training, logistics and safety protocols in response to Gov. Henry McMaster’s announcement last week that state health officials would soon begin distributing rapid COVID-19 test kits to schools.
McMaster, who has repeatedly called for schools to return to in-person learning five days a week, signed an executive order Wednesday authorizing the state’s Department of Health and Environmental Control to provide all public schools with rapid antigen tests supplied by the federal government for use by students and school staff.
”School districts throughout our state have shown that we can safely educate our children in the classroom, and these tests will give students, teachers, and faculty members another layer of defense against the COVID-19 virus,” McMaster said in a statement.
While state education department officials have been in talks with DHEC about bringing rapid COVID-19 testing to schools for some time, they were caught off guard last week when the governor announced the plan and the accelerated timeline for its rollout.
“Districts were blindsided more or less by it, because they hadn’t received anything besides us telling them we were working towards it,” said Ryan Brown, spokesman for the S.C. Department of Education. “Ideally, they would have had the guidance and been prepared to review it and answer questions from their school communities prior to any type of public announcement.”
DHEC is in the process of finalizing its distribution plans, but anticipates that an initial allotment of Abbott BinaxNow test kits, which return results in 15 minutes, will reach districts next week in an amount equivalent to 10% of their student and staff populations, said agency spokeswoman Laura Renwick.
Subsequent test kit allocations, which could be adjusted based on need, will be provided monthly as long as supplies last.
South Carolina is scheduled to receive more than 1.5 million of the kits by the end of the year, although only 220,200 of those are currently allocated to schools, Renwick said. The rest are slated for nursing homes, assisted living facilities, home health/hospice operations and historically Black colleges and universities.
School districts are not required to implement a rapid COVID-19 testing system in their schools, Brown said, but as of Monday none had said they planned to opt out.
They may start testing students immediately under a federal waiver secured by the state, but have been told to obtain their own waivers as soon as possible, because until that happens a violation by an individual school could jeopardize the ability of all schools to test students, Brown said.
Whether testing actually starts right away will depend largely on districts’ ability to quickly coordinate and administer a rapid testing program that Brown said they hadn’t known was forthcoming until the governor announced it last week.
McMaster’s spokesman Brian Symmes said the governor made the announcement when he did because he thought it was important for parents and school officials to know rapid testing was on the horizon.
Are districts ready?
While DHEC is readying to deliver the rapid test kits shortly after the Thanksgiving break, many districts will need additional time to train staff, obtain parental consent and hammer out the logistics of testing, reporting and disposing of test samples.
“There may be some districts that can implement testing immediately, but for the majority I don’t think that’s going to be likely,” said Debbie Elmore, a spokeswoman for the S.C. School Boards Association.
Richland 2 spokeswoman Libby Roof said Tuesday that her district received guidance about testing late Friday afternoon and had yet to thoroughly review it. She said administrators would not have a chance to assess DHEC’s rapid testing guidance this week due to the holiday, but planned to convene early next week to talk it over and begin formulating the district’s plan.
“We do plan to take advantage of the testing, but we just want to make sure we’ve got our procedures in place and our nurses are trained and we have all the proper approvals before we move forward,” Roof said.
Richland 1 and Lexington 2 officials also said they would need to wade through a series of logistical issues before they’ll have a better idea when testing students is actually feasible.
“We have not announced a definitive date for the start, as we are still evaluating key areas, including training nurses on proper kit use, evaluating PPE needs for those administering tests, testing locations, communicating with families, and more,” said Lexington 2 spokeswoman Dawn Kujawa. “Once we have established the protocols, in accordance with state health and safety guidance, we will begin using the kits. We hope to begin using the kits some time during the month of December, and we will continue to evaluate and make adjustments as needed.”
Rapid diagnosis won’t catch all cases
Unlike the saliva tests used by the University of South Carolina as a screening tool for asymptomatic college students and faculty, K-12 rapid testing will be reserved for students and staff who develop symptoms during the school day on campus, DHEC’S Renwick said.
Children and adult staff who develop symptoms at home should not report to school, although some districts may choose to test such students and employees in school parking lots, she said.
Rapid antigen tests like the BinaxNow are considered reliable at detecting the virus in people who are at or near the peak of their infection, but are not recommended for use with asymptomatic individuals because they’re not as sensitive as the “gold standard” viral tests that are processed in a laboratory.
The ability to rapidly determine whether a student or staff member with COVID-19 symptoms actually has the virus will help mitigate spread of the disease by allowing schools to quickly identify and isolate those infected individuals, but it will not root out all cases.
Studies have shown that a large percentage of children and young adults — perhaps as many as 50% — are asymptomatic when infected with COVID-19. Since the rapid testing will only be administered to students and staff with symptoms, there are likely to be a significant number of individuals on school campuses whose coronavirus infections still go undetected.
As a result, DHEC and SCDE continue to stress that rapid testing is not a panacea, but just another tool schools have at their disposal to mitigate the spread of COVID-19.
“Symptom identification and testing can’t identify every case and is intended to be an additional layer of protection to the other actions the schools take to protect students including mask wearing and appropriate distancing,” Renwick said. “These actions help prevent spread within the school including from those that may be infected but not showing symptoms.”
The tests cannot be administered without parental consent and should be reserved for students and staff with COVID-19 symptoms such as shortness of breath, cough, fever or loss of taste or smell, according to DHEC. They may also be used when someone presents with two or more other symptoms, such as headache, fatigue, sore throat, nausea and vomiting, among others.
“Because COVID-19 symptoms are similar to symptoms of other diseases, the BinaxNOW tests can be used to diagnose or potentially rule out COVID-19 as a cause of symptoms and do so quickly,” Renwick said. “This can be a helpful mitigation tool by allowing faster diagnosis of COVID-positive individuals, thereby allowing for isolation to begin quickly and for identifying potential close contacts to begin quarantine quickly.”
School nurses and athletic trainers have been designated to administer the tests, which are done using a nasal swab, or to supervise the collection of tests by staff or older students who may self-administer them.
Nurses equipped with personal protective equipment who have been trained in the process can collect specimens from younger children or those with disabilities, although DHEC advises that parents or guardians may also need to assist.
Students and staff who test positive will be treated as probable COVID-19 cases and required to isolate, while those who test negative will be permitted to return to class.
“This is ideal especially in the event of a positive case, as isolation and contact tracing and quarantine are able to be performed much sooner, decreasing the risk of further spread,” Renwick said. “In addition, a negative test result may allow the child to remain in school, decreasing the amount of in-person school time lost.”
If a parent or staff member does not consent, they will be sent home to isolate and advised to seek follow-up medical care, public health officials said.
Students and staff with COVID-19 symptoms who can’t immediately be tested are instructed to isolate at home for at least 10 days from the time their symptoms began and until they’ve been fever-free for 24 hours without the use of fever-reducing medication; or until they obtain a negative viral test result or provide a doctor’s note clearing them to return to school, Renwick said.
Education spokesman Brown said Monday that he wasn’t sure whether parental consent would need to be established in advance of testing or at the time of testing, but that districts generally prefer parental consent to be in writing rather than given verbally.
Will rapid tests in school mean a return to in-person learning?
McMaster said when announcing the school testing initiative last week that his ultimate goal was for schools to reopen, but the impact on districts that have been cautious about returning to in-person instruction remains to be seen.
It’s not clear just how many students and staff will actually take advantage of the testing, or even qualify for it, since symptomatic individuals have been asked to stay home and should not be going into schools to begin with.
Brown said there are children and staff who report to schools while symptomatic, and some who may develop symptoms during the course of the school day, but that it’s not common or widespread across the state.
He said he thought the school testing initiative might actually be most beneficial in dealing with staff shortages, which have occurred when large numbers of teachers have been forced to quarantine after developing symptoms and don’t immediately know if they have COVID-19 or something else.
“Probably the biggest benefit will be knowing which staff are sitting out from school because they’ve exhibited symptoms or because they’re actually positive,” he said. “The ability to find that out rapidly will be very important to continue a school’s operations as normally as possible.”
A staff member whose rapid test comes back negative would be able to return to the classroom more quickly and avoid using personal days or having to take leave, Brown said.
“The ability to test and determine if an illness is COVID-19 or not is important, because obviously with a cold or the flu, the timelines are very different,” he said.
Symmes, the governor’s spokesman, said the limitations of rapid testing should not detract from the positive news that public school parents will soon be able to have their children tested for COVID-19 at school.
“You can’t let perfection get in the way of good,” he said. “There are very few perfect solutions, as we have all seen over the past eight months. What we know is that this gives us an added ability to quickly identify positive tests in the school atmosphere, which should give parents, teachers and students a greater sense of comfort being in the classroom where we all know students learn most effectively.”
This story was originally published November 25, 2020 at 3:46 PM.