A federally funded Covid-19 screening program that is open to all schools in Hawaii has seen inconsistent implementation, with staffing shortages and lack of logistical coordination at the school level among the main barriers to a successful launch.

Already delayed in Hawaii, the so-called Operation Expanded Testing — a partnership between the Department of Education and state Department of Health — offers PCR testing to students and staff, with nasal swabs shipped off to a mainland lab and results delivered in about three days. Testing is touted by the Centers for Disease Control and Prevention as a way to mitigate the potential spread of Covid-19, particularly when an infected individual may be asymptomatic.

With the Covid-19 vaccine still only available to those 12 and up, and vaccines not mandatory in Hawaii for eligible students, schools can be potential settings for transmission. Since the start of the school year in early August, the DOE, which serves 159,500 students in grades pre-K-12, has experienced 3,280 cumulative positive cases and many students have had to quarantine as a result.

Self COVID-19 swab testing held at the Kalakaua District Gym. This latest testing system involves the patient swabbing the nostrils. August 27, 2020
The DOE has said 165 of 257 schools have registered for Operation Expanded Testing but only 67 schools have launched the program as of Sept. 23. Cory Lum/Civil Beat

While a new screening program is another protective layer on campus, not all schools are able to offer it yet, including Maui High, home to about 2,000 students. It has had 27 reported cases since the start of school.

Asked whether the school is offering expanding testing, vice principal Joanne Higa replied, “Not at this time, no. One of the main issues is staffing, resources. If we had more staffing, yes, or a place or a time to set it up or mail out (the samples).”

There is no count of how many of DOE’s 87,000 vaccine-eligible students have received the vaccine, although statewide health data indicates 60% of 12 to 17 year olds in Hawaii are fully vaccinated while 74% have received at least one shot. Among the roughly 22,000 DOE staff members, 89% were partially or fully vaccinated, as of late August.

The testing at schools is voluntary. For children under 18, parental consent is required.

At Ke Kula Kaiapuni O Anuenue, a K-12 Hawaiian immersion school in Palolo, test kits have arrived but the school is still not able to administer them because staff needs to be trained, according to teacher Leimomi Ka‘aihili Leong. While she said her school has very good safety protocols, Leong is anxiously waiting for the screening to start.

“Being able to test, for me, I can guarantee I can provide a safe learning environment for the kids,” she said.

Other schools in Hawaii have already implemented the program. At Leilelua High in Wahiawa, free Covid-19 testing is offered to students from 7 a.m. to 9 a.m. every Monday and Thursday near the athletic stadium ticket booth. Aliamanu Middle in Salt Lake has been offering free Covid testing every Thursday before school, during recess or at lunch in the health room, since Sept. 9.

It’s come as welcome relief to some parents, even those whose children are already vaccinated.

“I’m very happy and grateful, but at the same time, I really wish it started in the spring” to help stem the spread of cases, said Melissa Bolton, whose 12-year-old son attends Aliamanu Middle. “I hope a lot of parents sign up their children, so we can at least keep our kids safe, our teachers safe, our state of Hawaii safe.”

Who’s Responsible for Coordinating?

A Sept. 1 memo sent by DOE deputy superintendent Phyllis Unebasami to school principals and complex area superintendents extended training support and even the help of the Hawaii National Guard to launch Operation Expanded Testing on school campuses.

But Jeff Hickman, a spokesman for the Hawaii National Guard, said there is still no formal agreement in place.

“A request came from DOE, but there were not enough details in it that would tell us how we would support it,” Hickman said. “There wasn’t enough information for us to assist,” including exactly how many individuals the DOE needed, or what was needed of them.

“Right now, the Guard doesn’t have anything set,” he said, adding he expects a request for assistance to come eventually, but that it might still take a couple of weeks to staff.

Holomua Elementary School students walk back to their classrooms after recess.
The free screening is voluntary and parental consent must be provided for kids under 18. Cory Lum/Civil Beat/2021

At a Sept. 16 Board of Education meeting, Unebasami acknowledged the effort each school must make to set up the testing program, particularly those with leaner staff, no available nurses or simply no space on campus to set up a pop-up clinic.

She said schools have been relying on volunteers, school nurses, temporary hires, or if certain schools are located close to each other, “centralizing testing operations to access one facility.” In the Campbell-Kapolei complex area, which has had among the highest Covid-19 case counts since early August, Kapolei High is designated as a testing site for the entire Kapolei complex while Ewa Makai Middle is hosting the testing site for the Campbell complex, according to Sean Tajima, the complex area superintendent.

“It is a real challenge for us to institute school-based testing,” Unebasami said. “However, there is a commitment to do so.”

But, the assurance isn’t enough for some parents, including George White, who in recent written BOE testimony excoriated the department for making the testing kits optional to schools and placing the onus on school principals to implement “such a crucial initiative with very limited support and resources.”

He also cited a need for DOE to “flood the schools with hundreds of thousands of rapid antigen tests.”

“It is perplexing to understand why they haven’t, but even more disconcerting that this does not appear to be the public health and safety priority that it clearly is,” he wrote.

According to state Department of Health spokesman Brooks Baehr, health officials are working to bring such a program to the state, offered through the CDC, known as the “ELC Reopening Schools” program that will rely upon rapid antigen tests. The National Kidney Foundation has the contract to administer the tests on the neighbor islands, while the state is still negotiating with a vendor to offer the tests on Oahu, he said.

The expanded Covid screening program, which is available to public, private and charter schools, is part of a $42 million federal allocation to Hawaii under President Biden’s American Rescue Plan.

“Screening testing gives us a sense of transmission within various communities. It also gives parents peace of mind,” Baehr said. “Schools are critical infrastructure and we really want to keep them open.”

DOE Dept of Education adminstrators during joint house/senate hearing at the Capitol.
DOE Deputy Superintendent Phyllis Unebasami, second from left, said it’s a challenge for schools to implement the program. Cory Lum/Civil Beat

According to DOE spokeswoman Nanea Kalani, 165 of 257 schools have signed up for the program, 67 schools are actively testing and 4,600 total test results have been returned so far.

At a Sept. 15 briefing to state lawmakers, acting state epidemiologist Sarah Kemble said anyone from coaches to staff members could be trained to administer Operation Expanded Testing.

“It’s not incredibly complex but it does take people on the ground to implement. It is one of the easiest programs to set up in that regard,” she said at the briefing.

Right now, students who test positive for Covid-19 or are deemed “close contacts,” and are unvaccinated, must quarantine for 10 days, according to a DOE health and safety guide.

This isn’t the only screening that schools are relying upon. At some private schools in Hawaii, testing has long been integrated into campus life. Iolani School has been doing rapid pool testing since the beginning of the school year in which 25% of the school community is selected and tested each week, according to spokeswoman Michelle Hee.

The school also has a high vaccination rate: 99% among faculty and staff and above 95% among those in grades 7 to 12, she added.

Kamaile Academy, a charter school, is part of a community testing pilot offered through The Pacific Alliance Against Covid-19. The Waianae school is testing 50% of its staff each week and is aiming to soon start testing students on a voluntary basis by training staff to administer tests out of a nearby trailer on campus, according to principal Paul Kepka.

Setting up school-based screening “is something that has to be well-coordinated,” said Bob Davis, the complex area superintendent for the Leilehua-Mililani-Waialua complex area. Testing “is a very strong mitigation strategy to ensure we do not have transmission on the school campus.”

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