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Op-Ed: Schools, take a lesson from hospitals about rapid testing

Rebecca Slotkin
The Hartford Courant
A young boy gives a fist bump after being tested in Phoenix's western neighborhood of Maryvale Saturday, June 27, 2020, for a free COVID-19 test organized by Equality Health Foundation, which focuses on care in underserved communities. Public health experts say wider testing helps people in underserved neighborhoods and is key to controlling a pandemic. (AP Photo/Matt York)

No one likes to wait, but the current public COVID-19 test turnaround times make reopening our school systems unimaginable.

Like many Americans, my friend and I are both waiting for a CVS "MinuteClinic" COVID test result.

I am a doctor; she is a teacher. I live in Connecticut; she lives in Washington, D.C. The projected wait time for both of us is six to 10 days, maybe more. Someone in Arizona waited more than 22 days.

Staffing a school is much different than staffing hospital services, but what we share in common is a vulnerable workforce with specialized skills.

I was one of Yale's internal medicine chief residents, responsible for the staffing and education of our residents this past academic year. By late March, our internal medicine program had over 20 residents out sick or waiting for their COVID-19 tests to return, meaning that roughly 10% to 15% of our resident body was out of work.

When our hospital was able to provide its own rapid COVID-19 test for its front-line workers, our staffing crisis significantly improved.

CVS and other public testing sites are doing a tremendous service to the nation by offering these tests regardless of ability to pay, but due to resource limitations, most people wait for their results for at least six to 10 days.

As schools discuss reopening across the country and we face rising numbers of COVID-19 cases, the importance of easy access to rapid testing early and often cannot be overemphasized.

Teachers, like doctors, are frequently exposed to colds and other viral illnesses. Adults get about 2-3 colds per year, and children get more. COVID-19 has a wide range of symptoms and presentations, so it is difficult to distinguish from other viral illnesses without a test.

Some people may infect others without any symptoms. The only way to stop the spread of a disease through a community is to immediately isolate and test any symptomatic individual as well as any asymptomatic individuals they have been in contact with.

Epidemiologists believe that frequent testing is how we can quell our current crisis. With the current testing wait times, we need far more lab capacity, testing solution, swabs, contact tracers and other trained personnel to help interpret the results to meet this country's needs.

The Trump administration is pushing for cutting funds for testing at possibly the worst time. Let's imagine that school systems experience even a fraction of the number of absences that we did early in the pandemic and rapid testing isn't available.

Are schools prepared to replace a large portion of their teachers with substitutes? What happens when the substitutes get sick? What happens to the kids who are home and sick or home and waiting for test results? Will whole classrooms of students be out waiting for testing when one student falls ill? Do those kids lose at least two weeks whenever they get any kind of virus?

In addition to monitoring COVID-19 cases, masking, cleaning procedures and social distancing, local testing limitations and wait times must become a driving factor in school reopening discussions.

There are clear benefits of children going back to school as soon as possible, which were formally recognized by pediatricians, educators and superintendents. But in that same statement, they also urged that "a one-size-fits-all approach is not appropriate for return to school decisions."

There will be a time when schools can safely reopen. The University of Massachusetts medical school has succeeded through frequent and rapid testing. Now is the time to fund testing and CDC resources. Now is the time to build the testing infrastructure we need to reopen safely.

Ultimately, if rapid testing protocols cannot be enacted for teachers or facilities staff, a school is better off remaining virtual. Schools should learn from hospitals' experiences when it comes to workforce planning in the COVID-19 era.

Our nation's children and educators should not be sacrificed for the sake of political posturing. Doctors and teachers are finite resources. They should be valued as such.

Rebecca Slotkin is an internal medicine hospitalist physician at Yale New Haven Hospital.