New York City has the largest public school system in the country. More than a million students, and tens of thousands of teachers, administrators, and support staff.  If you read the papers, the biggest issue is how to organize teaching. The debate is over on-line learning versus in-person learning and everything in between.  But, as the city works to reopen schools, last-minute changes and concerns for inadequate infection prevention measures are adding further uncertainty in these COVID times.

Reopening dates have been pushed back twice, with the Department of Education ultimately settling on a new plan for staggered reopenings that began last week.  Despite extensive preparation, there are still serious deficiencies in the pandemic response, which could be a set-up for a resurgence of COVID-19.  The biggest shortfall: deficiencies in testing capacity.

Frequent schedule changes and confusing communication have caused many parents to lose confidence in the Department of Education.  Shirley Wu, a high school English teacher, and mother of a 6-year-old daughter from Queens, struggled with her own decision not to send her daughter to an in-person class.  “We pulled her out because they had so much conflicting information, and we couldn’t feel confident,” she said.  “The more they said, the less confident we felt.”

For parents deciding whether to send their children back to school, the stakes are high.  School districts in other states that have reopened without an effective testing and infection prevention plan have faced severe consequences.  Georgia’s Cherokee County School District reopened on August third, and within two weeks, there were 120 cases of COVID-19, and over 2,200 students were quarantined.

Concerned about possible similar outbreaks in New York, the public school teachers’ union, the United Federation of Teachers, has made testing a primary focus of their requirements for returning to school.  The union initially demanded that all students and staff be tested before returning to school, unless they have evidence of testing positive for COVID antibodies.  But the mayor’s office and Department of Education have refused to require testing prior to the start of school.  Instead, they are planning for monthly surveillance testing of 10 to 20 percent of the public school population.

On September 8th, teachers returned to school to begin preparations for the academic year.  Within a week, 56 public school staff across 56 different schools had tested positive for the coronavirus.  Two public schools – P.S. 811X The Academy for Career and Living Skill and P.S. 139 –  were closed for 24 hours due to two separate suspected cases of  COVID-19 in the school building.

On top of this, despite their own union’s stance that all returning teachers be tested, only about 25 percent of the city’s public school teachers opted to be tested before returning to class. Moreover, according to the UFT, many of these tests were performed on September 2nd. Results were not available until after teachers had already reported to schools on September 8th.

For students that returned to school in recent weeks, the NYC Health + Hospitals recommended, but did not require, testing prior to the start of school.  Dr. Andrew Wallach, chief of ambulatory care, said, “For the kids, we are offering and encouraging testing.  We are making available new capacity to do that.”

However, experts like Dr. Jeffrey Shaman, an infectious disease specialist at Columbia University, feels the city laboratories are not up to the task.  He says the city is “Struggling to get up to 50,000 [tests] a day … They’re nowhere near where they need to be.”  He feels the New York City public health system is not prepared or even capable of testing every public school student.

With 1.1 million children in the New York City school system and 73,000 teachers, as well as thousands of additional staff, the UFT estimates an additional 750,000 tests would need to be done as schools reopen.  “The City doesn’t have the capacity to do this,” said Dr. Shaman.

According to the New York State Department of Health, the average number of COVID-19 tests in New York City for the week ending 9/14/20 was 33,783, the highest daily average in the city to date.  That would make a total of only 236,481 tests performed that entire week, the largest number of tests performed in a single week since the pandemic hit.  Still, this is less than a third of what would be required to test the majority of those currently entering schools.

Testing of symptomatic students and staff has also been controversial.  CDC guidelines recommend that all symptomatic individuals in schools be referred to a healthcare provider for possible testing.  They also recommend testing of exposed individuals “because of the potential for asymptomatic and pre-symptomatic transmission of the virus,” as well as contact tracing – notifying local health officials, staff, family, and those who have had close contact with those who test positive for COVID-19 – which hinges on adequate testing.

Medical professionals, like Dr. Shaman, agree on the importance of testing to confirm COVID cases.  “Symptomatic people need to be tested,” he said.

But on-site COVID testing for symptomatic students and teachers is not being offered.  Instead, schools will only be able to recommend testing, and students and staff will need to travel to an off-site testing location. The New York City Department of Education guidelines mandate that “If a student or teacher is feeling sick … and, if their symptoms are consistent with COVID-19, [they] are asked to get tested.”

Currently, there are 50 free testing sites across New York, as well as circulating mobile testing units.  That’s likely not enough.  Furthermore, COVID testing results at public testing sites are so delayed that many are useless.  New York City School Chancellor Carranza promised two months ago at a July 30 press conference “24-hour turnaround time results at any of the 34 city-run testing locations.”  However, this has not happened.

While city officials say tests will be back within 48 hours, and some sites are meeting that deadline, the median turnaround time is two days, and 75 percent come back within 4 days.  But, many testing sites report even longer turnaround times.

In Brownsville, one of the areas hit hardest by COVID, 9 out of 10 testing centers that were contacted last week estimated a waiting period of 3 to 7 days (most at 5 to 7 days) for testing results to come back.  Only one center – AdvantageCare of East New York – offered point of care testing with same-day results.

By the time test results come back, and appropriate contact tracing is done, exposed, and infected individuals may have infected countless others.

Students with limited access to healthcare and limited family support may also be less likely to get tested, especially if they have to travel to testing sites.

“A lot of the students I have – they don’t have the support at home,” says the director of one transfer school in Brownsville.  “I could totally see parents opting not to do it.”  Without adequate testing, and appropriate isolation and quarantine, transfer schools are particularly at risk.  Keeping school open will be much more difficult, and they will need to rely more heavily on distance learning options.

New York City school teachers like Mark Rentflejs, a sign language teacher and United Federation of Teachers representative, experienced the challenges of remote learning firsthand during the COVID-19 surge this spring.

“Attendance was awful.  Many chapter leaders said they never saw a student all week … Many students are taking care of kids or working another job,” says Rentflejs.

New York City Department of Education remote learning attendance data from April 6 through April 14 showed that 84 percent of students logged into their remote learning system, down from 91.5 percent last year attendance for the same time period, which was 91.5 percent, and a statement from DOE spokeswoman Miranda Barbot acknowledged that this data “cannot be considered attendance in the traditional sense.”

Gareth Chase, a mathematics teacher in Brooklyn, is concerned that at-risk students could be devastated by frequent school closures and bouncebacks.  “Our students really need a consistent structure – they’re coming from a lot of chaos.  School is supposed to be a unifying factor – I think a consistent educational platform is critical,” said Chase.

Without adequate on-site COVID testing, teachers like Wu and Chase are expecting more coronavirus, and more chaos, as schools reopen.  “I’m a teacher and a mother,” says Wu.  “I wanted to support this, but I just can’t.”

Susannah Hills is an otolaryngologist.

Image credit: Shutterstock.com