MCCPTA has two primary goals in the approach to COVID-19 prevention and mitigation that we hope MCPS administrators and the Board of Education share:
- Preventing outbreaks in schools, and
- Minimizing disruptions to in-person instruction.
A strong in-school infection prevention program includes a high participation testing program, increased vaccination, true universal masking, physical distancing, hand hygiene, increased ventilation (including being outdoors), clear communication to affected communities, and effective surveillance. Given the current trajectory of COVID and the time-sensitive nature of these issues, we provide the following key concerns and recommendations which, with rapid implementation, will greatly improve our ability to achieve both goals.
These recommendations are drafted by medical and scientific experts working directly with COVID in their day-to-day professions who also are parents of MCPS students. These experts offer the recommendations based on their personal credentials and expertise, not through their professional affiliations with the hope MCPS and the Board of Education will consider these in the future planning and implementation of COVID-19 protocols and mitigation strategies.
1. MCPS does not currently have anyone in leadership with decision-making authority holding appropriate health credentials as the system navigates a pandemic.
Other school systems have appointed a Public Health Officer and/or established a Medical Advisory Board for this purpose.
→ We recommend that the Interim Superintendent and/or the Board of Education appoint a medical professional qualified in infectious diseases, public health, or working directly in COVID management day to day, with strong knowledge in current COVID infection prevention approaches.
2. There is no plan for symptomatic diagnostic testing in schools, which could also contribute to outbreaks and to unnecessary disruptions to in-person instruction.
PCR tests are widely considered the most effective screening tool for COVID-19 because they are highly effective at identifying infection during the pre-symptomatic period. However, rapid antigen tests, which are less expensive and easier to administer than PCR tests, are effective diagnostic tools that have comparable sensitivity to PCR tests among symptomatic individuals.
Having rapid antigen tests available in school nurses’ offices for symptomatic students would enable MCPS to be more targeted about quarantines. If a student’s rapid antigen test were negative, per the current symptomatic protocol, the student should still be sent home and instructed to seek a confirmatory PCR test before returning to school. However, close contacts of that symptomatic student would only need to quarantine and test if the symptomatic student’s subsequent PCR test came back positive. Alternatively, if a symptomatic student’s rapid antigen test were positive, school officials could minimize transmission because they could immediately inform close contacts to quarantine and seek PCR testing rather than waiting 24-48 hours for symptomatic student’s PCR results.
→ We recommend MCPS provide rapid antigen tests to students and staff who present with symptoms of COVID-19. These tests should be made available and administered in ALL school health rooms (elementary, middle, and high schools).
3. The current approach has been lacking in community-engagement, which could lead to decreased participation in testing.
Maximizing participation in the asymptomatic testing program is critical to achieving our goals of minimizing outbreaks and disruptions to in-person instruction. There was little engagement with parents/guardians and community members while the COVID-19 testing and mitigation strategies were being developed, which runs counter to decades of research on best practices in public health. Not involving community members in the design, implementation, and evaluation of interventions can lead to unanticipated barriers and missed opportunities. Parents have noted their children were fearful of nasal swabs and refused to assent to those tests but would likely be comfortable with non-invasive saliva-based tests.
→ We recommend that MCPS officials and administrators partner with a parent/guardian COVID-19 advisory board in the design, implementation, and evaluation of our COVID-19 response. This advisory board should reflect our diverse community and include both community advocates and subject matter experts to increase participation rates.
4. The current opt-in model for consent to asymptomatic screening tests will miss cases and is likely to lead to outbreaks.
The current approach of opt-in testing is inadequate to capture COVID cases and may lead to spread of COVID in classrooms and schools. Children opted-in are a selected (non-random) sample of MCPS students that is likely to be biased toward families who are more likely to
be vaccinated and using COVID precautions in their homes and personal interactions outside of school. An opt-out approach will capture a greater percentage of students for testing and keep our communities safer. While some selection bias will remain with an opt-out approach, the magnitude will be smaller.
→ We recommend that MCPS switch to a mandatory selection model similar to the one adopted in Baltimore City schools in which each family must sign a consent form indicating whether they choose to opt in or opt out of the school-based asymptomatic and diagnostic testing programs. Families who do not have an approved medical or religious exemption and choose to opt-out of the school-based programs will be required to have their child(ren) tested through an outside organization within 24 hours of when the child(ren) would have been tested in MCPS and then promptly deliver those results to the school system. A mandatory selection model for parental/guardian consent balances the rights of families and students to make choices about their personal health with their responsibilities to contribute to the health, safety, and functioning of our school communities during a global pandemic.
→ We further recommend that the school-based asymptomatic PCR testing program provide an option to choose non-invasive saliva-based samples for children or families who would prefer saliva tests over nasal swabs.
5. The random sampling method MCPS plans to utilize has not been clarified, nor has the 10% sample size been scientifically justified.
The sample size and sampling method will have a major impact on how effective screening is at identifying cases and therefore of meeting our goals. Risk for SARS CoV-2 infection is not evenly distributed among students across the county; rather, it varies by zip code and age. Yet currently we do not know the scientific justification for or effectiveness of sampling only 10% of children each week, nor do we know whether MCPS plans on sampling 10% of children across the county, within each school, or within each grade or classroom within each school. If we do not sample in every school every week, our testing protocol will not account for differential vaccination and incidence rates across the county. If we do not sample within each grade in each school, our testing protocol will not account for the increasing risk by age. Such a small sample is likely inadequate to capture the true COVID rate among children and will miss new cases, which could lead to further outbreaks and missed school. The optimal testing frequency is WEEKLY for PCR tests or BI-WEEKLY for rapid antigen tests.
→ We recommend that MCPS conduct weekly PCR testing of all students not opted-out. This is the optimal approach to identify cases. Alternative approaches would be pooled weekly PCR testing (by classroom) or a stratified random sampling design in which MCPS students are stratified by school and then grade or classroom to account for variation in incidence rates by zip code and age. If a random sample is used, MCPS must consult with a biostatistician to determine the sample size required to ensure the screening program will catch enough cases that it will help to reduce outbreaks and disruptions to in-person learning.
6. The approach/plans for analyzing the data has not been put forward.
There has been no discussion on MCPS plans to analyze data on the number of students who have opted-in to be screened (under current system), number of cases, and number of people quarantined, etc. As we head into cold/flu/allergy season, the policy of quarantine based on only one symptom (for example cough or report of sore throat) may be overly aggressive resulting in too much disruption. On-site rapid antigen testing as stated above would mitigate this, but another consideration would be to move to quarantine in the case that two symptoms are present rather than one. An exception would of course be fever, and parents should not be sending their children to school with fever in any case.
→ We recommend the data be made available and/or analyzed by a qualified public health scientist or medical expert to inform real-time changes in policies to address glaring issues or obvious failures of the strategy.