It is now widely appreciated that the social, economic, and mental health impact of San Francisco schools staying closed is devastating. Allowing some schools to open while others remain shuttered is a moral failing. The equity gap is widening by the day and families are suffering.
A major sticking point of the reopening debate between city administration and teacher’s unions is the lack of preventative (often called surveillance) testing. A high frequency testing program - weekly or biweekly - provides significant risk reduction, and more importantly, a clear sign of commitment to protecting the community. The current third-party testing solution under agreement is a start but is woefully inadequate in terms of population coverage, frequency and turnaround time.
There is a belief that deploying frequent preventative testing at the scale of the entire school system is an insurmountable challenge. The successful initial deployments in other much larger cities should dispel this myth. While it requires some heavy logistical lifting, it is very achievable according to our modeling.
In New York City, 190,000 children are back in school with a weekly randomized preventative testing program, while in San Francisco the current proposal for SFUSD has only roughly 1,200 children returning to school at the end of January with no preventative testing of the children. We find it appalling that our small city, the acknowledged global center of innovation, is far behind New York City and many other cities around the globe. Meanwhile, private schools and community hubs that have opened here this fall report a less than 1% positivity rate. This is crucial evidence that reopening can be done safely.
In San Francisco, testing is an issue of logistics and will, not a matter of technology or science. Teachers and staff should be afforded the assurance of frequent preventative testing, as well as rapid turnaround testing for those who have symptoms. Lost time for symptomatic teachers and students is a looming, serious issue already faced by opened schools. Staffing is stretched thin to accommodate smaller class sizes; thus, substitutes are harder to come by. It typically takes 3-4 days to obtain PCR testing and results through healthcare providers. Rapid tests should be made available on-site at schools, along with specific community sites for PCR testing of teachers, staff and students in order to expedite return to school after symptoms, quarantine, or possible exposures.
COVID-19 has spread widely due to a person being infectious before showing symptoms. Particularly for the adult and teen populations in schools, rapid turnaround preventative testing can keep spread at bay when paired with safety measures such as universal masking, small cohorts, and symptom screening. There are a number of rapid testing solutions now available from established commercial providers and data collected here in San Francisco shows they provide effective levels of pre-symptomatic detection. Preventative testing of teens might be our only chance at getting them back into the classroom this school year.
Testing should not be an issue of funding. Effective rapid tests cost $5. We estimate that it would cost less than $30M to deploy a city-wide preventative testing system in schools using a combination of on-site and mobile testing for the next year. Given the huge socioeconomic loss due to kids staying at home, this is a tiny investment that will pay huge dividends. Private sources must step up now. Our city claims 75 billionaires as residents and just as many billion-dollar-plus market cap “unicorn” companies and recent blockbuster IPOs.
The bottom line is that trust and peace of mind for teachers, staff, administrators, parents and students is invaluable. Testing is not a panacea but it is an effective component in reducing risk. Based on current data, it might not be strictly needed for safe elementary school openings, but we must deploy testing resources in the short term to build confidence. We propose a testing rollout that is progressive, adaptive to conditions, and supported by evidence along the way. But it must start now.
The entire city stands to benefit tremendously if we move quickly together. Testing need not be mandatory because the benefits of preventative testing do not depend on 100% participation. More testing leads to better data, which leads to more targeted responses and allocation of resources, and results in protection from outbreaks for the community at large. We will learn and adapt as we go, and share our experience and best practices. If we make testing in schools a partnership between academia, the community and the City we can combat the virus more effectively and slow the ever-widening equity gap.
We are far from out of the woods in this pandemic; vaccines will not be widely deployed in the adult and teenage population until the fall of 2021 at the absolute earliest. We have an opportunity: our city can provide a service to our nation by sharing detailed data on school transmission and proving out practical logistical solutions. Our model could then inform and extend to other cities in need in the Bay Area and beyond.
We are all in this together, and we can be safer together.