Navigating the Ins and Outs of In-School Testing

Insights from the Rockefeller Foundation’s Testing Playbook

March 17, 2021

As more schools start reopening, it’s in everyone’s best interest to make sure that reopening happens responsibly. Regular testing, layered with other COVID-19 mitigation measures, can help students and teachers return to in-person learning with peace of mind. But providing regular testing for hundreds or even thousands of people is anything but simple.

The Rockefeller Foundation recently released a playbook to help schools navigate the complexities of in-school testing. Called COVID-19 Testing in K-12 Settings: A Playbook for Educators and Leaders, it provides useful insights into how schools can set up testing programs so that they can bring back students with confidence.

The Benefits of In-School Testing

Routine testing can help control outbreaks and keep schools open.

Researchers estimate that at least 50% of new COVID-19 infections come from those who are infected but not showing symptoms. Routine testing can allow schools to move as quickly as possible to contain outbreaks.

Acting quickly to prevent out-of-control spread helps schools keep the doors open and helps to protect the surrounding community.

Providing COVID-19 tests in schools makes it easier for families to access testing.

“If people don’t have cars, they are not going to go to the site to get tested. They need it to come to them,” said the Testing Lead for New Orleans Public Schools.

As many of us have experienced, COVID-19 tests can be hard to come by. Even if there’s free or low-cost testing in the area, families may face long wait times or difficulties getting to the testing site.

When testing is offered in schools, it allows families to easily access testing for their children—in a familiar and trusted environment.

Testing boosts confidence in the school’s safety plan.

There is widespread concern about students and teachers getting or spreading COVID-19. Without knowing the school’s true risk level, it’s understandable that people might be afraid. 

Routine testing both provides schools with the information they need and allows them to share that information with their community, alleviating the fear of the unknown. One superintendent who participated in our free pilot program, whose district had been open at full capacity without testing, told us “it lifted the fear” and “people’s morale was the highest it’s been since March 13.”

Choosing a Testing Strategy

The first step of setting up a testing program is picking which strategy—diagnostic, screening, or surveillance—is the best match with your goals.

Diagnostic testing focuses on those who have COVID-19 symptoms or have been in close contact with someone who has tested positive. The priority is to identify people who have COVID-19 as quickly as possible, allowing for prompt treatment, isolation, and contact tracing.

Screening is routine testing of people who don’t have symptoms or a known exposure. The goal is to identify people with COVID-19 regardless of whether they’re currently showing symptoms. Identifying those cases as quickly as possible can help prevent spread.

According to the Rockefeller Foundation, when screening, frequency of testing and quick turnaround time are more important than accuracy. They recommend testing at least once each week. If using a quick, less accurate test, it may be necessary for individuals who test positive to follow up with a second, more accurate type of test.

Surveillance means testing to figure out the percentage of people who have the virus within a community. In this case, results are used for making public health decisions, but are not returned to individuals.

When to Consider Pooled Testing

Many schools choose pooled testing as a way to simplify their testing program and reduce costs. Pooling means that the samples from many students are combined and tested as one unit.

The big benefit of pooling is that if the classroom pool is negative, you can assume everyone in the pool is negative, all for the cost of one test rather than dozens. For schools that struggle to find funding for testing, this can be a godsend. If a pooled test is positive, the school can follow up with just that class, concentrating resources on those who really need it and allowing everyone else to continue learning undisturbed.

Deciding Between Different Types of Tests

There are two main types of tests: rapid antigen tests, which detect the outer shell of the virus, and PCR, which detects the virus’s genetic code. PCR tests are generally highly accurate but can take a few days to process. Rapid tests tend to be less accurate, but give results in just a few minutes. Both can be used for individual testing, but pooled tests only use PCR.

While the first generation of COVID-19 tests often used samples from deep in the nasal cavity, luckily, there are more comfortable options currently available. There are now both PCR and rapid tests that use saliva samples or a swab that’s taken just a half-inch inside the nostril.

Cost-wise, individual PCR tests tend to be the most expensive at around $25 to $100 per person, plus additional fees for administering the test. According to the Rockefeller Foundation, pooling can lower costs to around $10-25 per person, plus $15-20 per person for test administration. Concentric’s pooled test actually comes in well below that estimate, costing as little as $6 per person. And, since our tests are self-administered, there are no additional fees.

Finally, rapid tests can cost around $5-25 per person, plus additional fees for administering the test. Note that some experts recommend following up positive rapid tests with a PCR test to confirm the result.

For more information on in-school testing, types of testing strategies, or potential sources of funding, contact us! You can attend an online info session, get a cost estimate, or schedule a call with a representative today.