Local collaboration makes COVID-19 saliva testing available at the school-level

If you're seeking an example of a rigorous school testing program in West Michigan, look no further than Godfrey-Lee in Wyoming — the smallest geographic school district in the state (only 1.44 square miles).

In October of this year, Superintendent Kevin Polston partnered with Kent County Director of Community Wellness Joann Hoganson, RN, MSN to launch a COVID-19 rapid saliva testing pilot program at the school district as part of the county's ongoing COVID-19 relief and recovery efforts and the spending of federal CARES dollars. Together, the district and the county are able to offer drive-up and drop-off saliva testing for students via a local lab offering the rapid testing solution.

"The last 8 months have been challenging ... there's no question about it," says Polston, who oversaw the district's temporary closure in the spring due to the governor's Stay Home, Stay Safe order that sent all Michigan students home for the remainder of the 2019-2020 school year. As a cornerstone of a small yet diverse neighborhood that refers to itself by the name of the school district, Polston takes the schools' central role in the community seriously.Kevin Polston, Superintendent of Godfrey Lee Schools. Image courtesy Godfrey Lee School District.

"We see ourselves as an essential service to our community," he says. Of course, the schools' core mission is educating children, but they also offer essential services like meals for those struggling with food insecurity. During the schools' closure in the spring, says Polston, they served 200,000 meals — twice as many as they would have if they remained open.

It's this core of community service that bolstered Godfrey-Lee's close partnership with Kent County since the pandemic hit in March.

Polston himself served on the Governor's Return to School Advisory Council, during which he worked with other professionals around the country in developing safe plans for students and community members. So when he was approached with the opportunity for launch a testing pilot at Godfrey-Lee in partnership with the county, he didn't hesitate. To Polston, this partnership was "delivering health and a health equity mindset" to his small community.

Hoganson, a nurse by profession, headed up the effort. Before COVID-19, she served as the Director of Nursing for Kent County. As numbers began to rise and schools were forced to close, Hoganson was asked to serve as the liaison between the Kent County Health Department and all Kent County schools. Her chief initiatives included developing a toolkit that offers school administrators the information and strategies they need to keep kids and community members healthy, and the schools open and running.

"We really focus on prevention," says Hoganson. "We recognize that educating children and having them in a safe location ... is part of public health as well."

When it came to distributing federal CARES dollars, Hoganson identified racial and economic disparities among key populations as a defining factor in launching new programs. "We really wanted to use our CARES money to address some of the disparities we were seeing in testing results," she says.

Hoganson is referring to school districts in which a high percentage of the student population are on Medicaid, come from non-English speaking families, or whose households fall below the poverty level. These are the students and families that would be disproportionately impacted by a COVID-19 diagnosis in the household.

Taking into account this racial and socioeconomic diversity of the school district (among the six schools, 92% of enrollment are racial and ethnic minorities) says Hoganson, "That's where Godfrey-Lee stood out to us."

The schools' began testing in October, after having already implemented the county-wide online symptom screening program for all students when the school year began. Starting in October, if a student reported that they were experiencing symptoms of COVID-19, they would then be referred for an immediate rapid saliva test through local Arctic Medical Laboratory. According to Hoganson, Arctic is one of only a handful of labs in the county currently offering rapid saliva tests that provides results within 24 hours.

Staff collect a saliva sample curbside at a Godfrey Lee school. Image courtesy School News Network.

"They're getting us really quick turnaround, which allows us to act more quickly," says Hoganson.

The saliva test is much less invasive than the traditional COVID-19 screening, which requires a deep swab of the nasal cavity, and has been described as uncomfortable or even painful. "Kids don't like it," says Hoganson.

To complete their less invasive saliva test, parents can then drive the student to their school site for curbside testing, and the campus healthcare para pro, KSSN coordinator, or school nurse will provide the testing kit. Parents then assist their child in providing a saliva sample in a sealed bag, which is then placed in another clean bag and held with all other samples until 2 p.m. each day when Arctic picks up all samples for testing.

If students are unable to travel to the school, personnel can also deliver kits to their homes, and collect completed samples from an outdoor location.

Tests are free to students and families. "For the most part, we can bill to Medicaid," says Hoganson. For families without Medicaid or the inability to pay with health insurance, the county uses CARES funds to cover the cost.

Godfrey-Lee has conducted approximately 300 tests at time of publication. The quick turnaround of test results at no cost to families has enabled the district to advise quarantine for those who test positive, and allow back to school those who don't. "We want to get those kids who can be in school, back into school," says Hoganson, who doesn't think kids should be waiting days for test results while they miss out on their education.Joann Hoganson. Image courtesy Kent County Health Department.

"If we can speed that process up, we think we are doing a great service to the educational community by getting safe kids back into school."

For Polston and his students, household spread is a high priority issue, because a high percentage of reported exposures were from a household member or relative. "We know that household spread is very contagious," says Polston. However, "Every close contact of a positive case that we've had at school has come back negative."

As Godfrey-Lee and other school districts in the state shift their high schools to all-virtual learning amid the Kent County Health Department's epidemic order, Polston notes that testing will still be available.

"We will still have testing available to all students, virtual and in-person," he says. All schools will still be test sites.

Having completed a successful pilot launch of school-based saliva testing with a local lab, Hoganson hopes to increase the number of tests available to schoolchildren in Kent County, both at Godfrey-Lee and at other districts. She and her team are currently considering three yet-to-be-announced school districts that meet the same criteria of underserved student population.

"We have to have the medical community support the decisions we're making...and we want to make sure that safety remains our top priority," says Polston.

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