Study examines testing impacts

Illustration of an adult performing a nasal swab coronavirus test on a school-aged child. There is a drawing of a clock on the topmost layer of the image.
Health Promotion Practice published the study in December after a year of research from the USC’s Department of Population and Public Health Sciences. (Shriya Jayanthi | Daily Trojan)

For two months beginning in December 2020, researchers from the USC Department of Population and Public Health Sciences conducted focus groups and interviews with Los Angeles high school administrators, teachers, parents and students to examine each group’s attitudes toward in-school coronavirus testing. The study, published last December in peer-reviewed journal “Health Promotion Practice,” was funded by the Rockefeller Foundation in an effort to understand the feasibility and efficacy of implementing testing in schools.

High levels of coronavirus transmissions led to school closures in Los Angeles County and across the country. In March 2020, shortly after the World Health Organization declared the coronavirus a pandemic, Los Angeles Unified School District, composed of 900 campuses serving more than 670,000 students, joined other major California school districts and at least 12 other states in announcing a shutdown of its schools. As the pandemic evolved, schools discussed strategies for safe reopenings, including physical distancing measures, mask mandates, improved cleaning protocols and in-school coronavirus testing.

According to the study, many states provided coronavirus test kits to schools, but anecdotal evidence indicated in-school testing did not factor into several Southern California schools’ plans. The study discovered a few significant barriers to the implementation of in-school testing, including financial and logistical challenges.

“For the schools and school districts to properly implement mitigation strategies, there needs to be proper support for the schools,” Project Director Daniel Soto said. “That could be financial support; it could be helping reduce barriers in terms of access to tests.”

The study’s focus groups and interviews took place over Zoom and followed a structured guide. After transcribing interviews and collecting qualitative data, researchers analyzed the quotes to extract significant themes. The study found that although perspectives differed between stakeholders as a whole, all four groups — administrators, teachers, parents and students — supported testing. 

“Everyone was in favor of kids being tested. It was just a matter of the logistics of doing it,” ​​said Jennifer B. Unger, professor of population and public health sciences in the Keck School of Medicine.

Among school administrators, concerns centered around the financial, logistical and staffing demands of frequent in-school testing, as well as the possible stigma students who test positive might be subjected to. Teachers expressed some discomfort about returning, but thought in-school testing would increase school safety by reducing the number of parents who sent their sick children onto campus. 

Parents agreed with school administrators in their concern about the stigma of testing positive, and shared some of the teachers’ distrust that other parents would keep their sick children at home, a problem they also believed in-school testing would help alleviate. Parents also mentioned the physical discomfort of rapid antigen tests, an inconvenience most students accepted if it would enable them to attend classes in-person. 

One of the greatest challenges to in-school testing illuminated by the study was the difficulty of navigating the logistics of such programs. 

“The biggest take-home message from the study was that schools really need technical assistance to implement a testing program,” Unger said. “You can’t take people who are educators and expect them to suddenly become medical professionals … It’s new for them, and they need some help setting it up.”

According to the study, successful school-based coronavirus testing could not only bring students and faculty safely back on campus faster, but also provide the communities around the schools with better protection and resources to combat the coronavirus.

“There were some neighborhoods in L.A. County that were disproportionately impacted by morbidity and mortality from COVID-19,” Soto said. “The need was really great at the time, not only for how to implement tests, but coming up with a program and design that would work for schools that wouldn’t necessarily impact learning of students.”

Study participants came from nine urban L.A. County school districts, consisting of public, private and charter schools. L.A.County comprises a high proportion of Latinx residents relative to the United States. The research article noted that, given that Latinx individuals are more likely to work as essential workers required to interact with the public and that the rates of vaccination and coronavirus testing among the Latinx population have lagged behind those of non-Hispanic whites, implementing coronavirus testing in schools could help contain the spread of the coronavirus within these communities. 

Although researchers conducted the study last year, Unger said the challenges it highlights remain pertinent during the rapid spread of the omicron variant over recent months. 

“We’re right in the middle of the omicron outbreak, and schools are trying to keep their kids and their staff healthy,” Unger said. “They’re trying to keep sick kids out of school and healthy kids in school, and they really don’t know how to go about doing that.”

While the published article focused on qualitative research, the study also consisted of other components, such as pilot testing programs. Partnering with the Los Angeles Department of Recreation and Parks, University researchers delivered rapid antigen tests to the learning centers of the department’s “Safer at Parks” program, which launched to offer parents alternatives to at-home remote learning for their children during the pandemic. Researchers also worked to implement rapid antigen testing programs for high school athletes in some L.A. schools. 

“[The study] is like the tip of the iceberg. It is the beginning of us doing a lot more work in the community,” Soto said. “The first step, really, to do proper work in the community is to assess the needs of the community and learn more about barriers and facilitators.”

According to project director Ryan Lee, the understanding of stakeholder concerns, developed through the initial qualitative study, helped University researchers continue their work and research projects with coronavirus testing. Graduate students from the Masters of Public Health, Masters of Social Work and Masters of Education in School Counseling programs currently visit schools to assist with testing as needed, provide training, set up test sites and fill in for personnel shortages.

“Testing can be a really important tool to help keep students safe and it’s actually something that can be done fairly easily,” Lee said. We’re seeing schools take on these massive testing efforts … We’re really excited to be able to continue to help support these schools and help keep students and communities safe.”