NEW YORK — While the $10 billion in school COVID-19 screening funds provided by the American Rescue Plan Act reached state health departments in early April, little of it has yet made its way to individual schools and school districts.
Many states are still working out their plans for using and distributing the funding, suggesting that large-scale COVID-19 screening will likely not roll out until the start of the next school year in the fall.
This raises questions around what demand for school COVID-19 screening will ultimately be, as vaccines will likely be available for many teenage students by the fall and infections have fallen in recent months even as many schools have opened for in-person instruction without extensive COVID-19 screening programs in place.
Passed in March, ARPA provided $10 billion in funding for K-12 school COVID-19 screening. Those funds were distributed through the US Centers for Disease Control and Prevention to state departments of health, which received the money in early April. A flurry of activity around school testing followed ARPA's passage as laboratories and vendors positioned themselves to fulfill what they anticipated would be rising demand for school SARS-CoV-2 testing services.
Opentrons Labworks, for instance, announced that it was launching labs in New York, Washington, D.C., Los Angeles, and Seattle focused on K-12 testing through its SARS-CoV-2 testing business, Pandemic Response Lab. Meanwhile, Thermo Fisher Scientific and Color Health announced that they were partnering to launch a school SARS-CoV-2 testing program. Gingko Bioworks, likewise, announced agreements with Dascena Labs, Olive Labs and CQuentia to provide testing to K-12 schools, and Opko Health subsidiary BioReference Laboratories, which had been providing testing for New York City schools since October, announced that it was expanding its SARS-CoV-2 testing program to reach schools across the country.
This month, 360Dx contacted the departments of health for all 50 states, asking where they stood in implementing COVID-19 screening with the ARPA funds and distributing those funds to schools and districts. Of the 16 states that replied with details about their use of the ARPA money, nearly all said that they were still developing their plans for the funds and none had begun broadly distributing them to individual schools or school districts.
One state, Idaho, noted that the state's legislature did not approve use of the ARPA funds and that the department of health would therefore not be able to use them during the next fiscal year. More typically, states were still in the process of identifying vendors and or piloting programs that they hoped to expand throughout the summer and fall. A few states gave dates for when they would begin providing the CDC funds to participating schools — Oklahoma will start on July 15 and Missouri is starting July 1 — but most did not. While the states' plans differed in their specifics, the most commonly cited approach among respondents was to use the summer for piloting testing programs and gauging school interest with a more comprehensive rollout planned for the fall.
Perhaps unsurprisingly, as they approach the school testing market, vendors are seeing a wide range of interest levels and organizational strategies and, at the level of individual schools and districts, differing levels of awareness around whether or not COVID-19 screening funds are available and how their schools can access them.
"I would say in working with our commercial team and the conversations that they are having with the school districts, I do think there is an opportunity to improve some communication because the school districts are still confused as to their access to the funding," said Stacia Rivello, senior director of marketing at Quest Diagnostics and lead for the company's school-aged testing programs.
Matthew McKnight, chief commercial officer of Ginkgo Bioworks, noted in an email that, as is to be expected with any nationwide program, his company is seeing "meaningful variability" in program implementation. He cited Maine and Massachusetts as examples of states that have made efforts "to get testing into schools as fast as possible."
Massachusetts has been a leader in K-12 testing throughout the pandemic. Since January, the state has offered weekly testing of students using pooled PCR with antigen testing to follow up positive results. Around half the state's school districts have participated in the program.
Maine this month launched a K-12 COVID-19 screening program run by Ginkgo that provides weekly testing of K-12 students and staff to all interested public and private schools using pooled PCR and antigen testing with Abbott's BinaxNow test to follow up positive results.
These states are something of outliers, though, with "many other states … designing statewide programs through RFP processes that they plan to launch in the summer to prepare for the fall," McKnight wrote. He cited as examples North Carolina and Colorado.
In its reply to 360Dx, the North Carolina Department of Health and Human Services said that it "anticipates working closely with districts and schools to implement a testing program that fits their needs," but did not provide additional details.
The Colorado Department of Public Health and Environment noted that it has begun using some of the ARPA funding for a pilot program at three schools in the Durango area where it was testing students twice a week.
The department said it also anticipated awarding funding for a summer school screening pilot in the near future. It said that for the 2021-2022 school year it plans to use the ARPA funds to "provide a variety of testing options to schools through state contracts," including "pooled PCR testing in K-12 schools across the state."
McKnight also noted that Ginkgo has encountered "a number of municipalities that have not been able to access [the ARPA] funds through their states."
"Milwaukee, for example, has been successfully running pooled testing to support [school] reopening, but has been unable to access funds from the state of Wisconsin to continue this program," he wrote.
The Wisconsin Department of Health Services said that it is "still developing our plan for use of the funds."
David Berlin, head of launch of COVID-19 testing for Cambridge, Massachusetts-based CIC Health, which handles testing for around 600 schools in Massachusetts' K-12 screening program, said that the state has served as a model of sorts for other states developing school screening programs.
"What we've seen is pretty much everyone watching Massachusetts as the program rolls out," he said. "We're now four months into the program and we're learning a lot about what is an effective strategy, what transmission looks like in schools, what is your likelihood of having a positive case in your school at a given time."
He added that CIC has recently begun to see more requests for proposals from states and school districts looking to put the CDC funds to use.
"I think we've seen probably 14 come out in the last two weeks specifically focused on school testing," he said, though he noted that many of these were for relatively small-scale projects, such as a Colorado RFP for testing 1,500 individuals a week participating in summer programs.
"Everyone is very much testing the waters," he said.
Berlin said that in CIC's experience, district superintendents and school principals have proved key figures in implementing screening programs.
"What we're seeing is that the superintendents need to get very involved, and then the principals are actually the ones to operationalize it — they need to come up with the program to motivate everyone, to make sure consent is at a certain level," he said.
Streamlining the process for teachers is also key, he said. "Five minutes a week is the maximum amount of time teachers want to spend doing testing."
Upon announcing in March the $10 billion in CDC funding for K-12 screening, the US Department of Health and Human Services said that the funding would "be able to be deployed quickly as part of a strategy to help get schools open in the remaining months of this school year."
In retrospect, that timeline appears overly optimistic, as few states have begun using the testing funds at all, let alone in support of large-scale screening.
Mara Aspinall, professor of practice at Arizona State University and an adviser to the Rockefeller Foundation, which has been a key provider of guidance around school COVID-19 testing, said, though, that she believed that the federal government's school screening effort had made rapid progress for a program of its scope.
"The administration took office in January. They got [ARPA] completed in March, they announced [the CDC funding] one week later, and the money got into state bank accounts 10 days after that," said Aspinall, former president and CEO of Roche's Ventana Medical Systems. "That's pretty phenomenally fast."
What demand for testing will look like at the start of the next school year remains to be seen.
Projections vary, said Ellen Beausang, senior VP of advanced diagnostics at BioReference, noting that schools the company is currently serving and/or in discussions with around screening have said they may move to scaled-back programs in the fall depending on conditions.
"What we do know and what they are saying is that there will be some school-based testing programs," she said.
Kevan Savage, vice president of marketing at Brooklyn-based Opentrons, likewise noted that schools' attitudes toward their testing needs in the fall are "pretty variable" but said that he believed there would still be a need for surveillance testing in students not old enough for vaccination and for monitoring the emergence of new virus variants.
"The volume of COVID incidents may go down, but there is still going to be a need for that variant tracking," he said.
"I think no matter what, people need a plan for testing," Berlin said. "Whatever vendor they use doesn't matter, but they need a plan, and they need a plan that they can operationalize quickly and not have to go through months of a bidding process and get funding from the state."