Drool for school: Colorado schools add saliva testing to slow spread of coronavirus in the classroom

Elementary school students in Cherry Creek School District are getting a bonus lesson this year: While studying reading, math and science, they’re also learning the best way to drool into a test tube.

It’s not a typical part of the curriculum, but collecting students’ saliva has become another critical step in keeping schools open safely as the coronavirus continues to threaten with infections and outbreaks. And the lesson involves Cherry Creek school nurses coaching young learners to think about something sour they might eat or something that would make their mouth water, said Michelle Weinraub, the district’s health services director.

Cherry Creek School District and some of Colorado’s other metro and suburban school districts have expanded COVID-19 testing to students, who may not show symptoms of the virus when infected but can transmit it to those around them. 

With help from COVIDCheck Colorado — a testing network developed by Gary Community Investment Company and The Piton Foundation — Cherry Creek School District, Denver Public Schools and the Academy of Charter Schools are regularly testing students whose parents and guardians give their consent. Aurora Public Schools is also making saliva testing accessible to student-athletes. For districts, that means loading up on at least hundreds more nasal swab sticks and tubes to hold saliva each week.

Many districts across Colorado have been regularly testing teachers and staff throughout the school year, with COVIDCheck Colorado continually adding to its testing network. To date, it’s completed more than 127,700 tests for K-12 educators and about 900 tests for early childhood educators — out of about 365,000 tests administered altogether, said Chyrise Harris, vice president of communications for GCI. COVIDCheck Colorado serves four early childhood education centers; 73 school districts, independent schools and charter schools; and 19 higher education institutions.

In school circles, the testing system has largely focused on monitoring the health of adults. But in September, COVIDCheck Colorado branched out to begin testing some of Colorado’s youngest residents from some of the most vulnerable families: students at Clayton Early Learning in Denver.

Now, as Gov. Jared Polis and many districts prioritize in-person learning this semester, opening up testing to K-12 students has become yet another tool to help districts track the spread of the virus in school communities and hopefully get ahead of any outbreaks that would warrant quarantines or closures.

It’s part of the solution for keeping schools open and keeping students and staff safe.

“I think it’s one ingredient to be used in combination with other strategies,” said Dr. Glen Mays, chairman of the Department of Health Systems, Management and Policy in the Colorado School of Public Health. “It certainly could be helpful in helping to keep rates of transmission low overall.”

Children are much less likely to develop severe health complications if they contract the coronavirus and are less likely to transmit the virus to each other or to adults, Mays said, though it’s not clear why.

Still, he supports testing elementary school students. In general, he said, the testing will offer districts more insight into how they’re faring with positive cases.

“I think it makes good sense,” he said. “It’s likely to give more information to schools and school districts about where the risks are and how schools are performing with reducing transmission.”

Mays added that even as a COVID-19 vaccine is being distributed to adults across Colorado, it’s a good idea to test kids for the virus in schools. Not everyone will be able to get vaccinated — for some, because of health reasons — and it’s still unclear if the vaccine prevents people from transmitting the virus to others.

“All we know is the vaccine dramatically reduces the likelihood of developing a severe health issue if you’ve been infected,” he said.

A mission to catch asymptomatic cases 

Each week, Cherry Creek School District aims to test 5-10% of kids whose families have agreed to the protocol. The district has elementary schools with as few as about 300 students and others with student populations above 800. 

The district will limit in-school testing to elementary students, in part because younger kids are more likely to have a positive case but be asymptomatic, Weinraub said.

That’s one of the reasons that COVIDCheck Colorado has extended its testing pool to students. At least 40-50% of people who test positive for the coronavirus exhibit no symptoms, according to UCHealth. Schools need to conduct regular asymptomatic testing of all students to make sure they’re catching kids who may have the virus but not any symptoms, said GCI president and CEO Mike Johnston. He added that testing fits into a wider matrix of health and safety protocols that includes wearing masks, social distancing, washing hands and keeping students cohorted.

“In addition to that, to be able to regularly monitor students and staff who could be asymptomatic for the virus helps us make sure that we’re identifying any outbreaks early and that we’re preventing any broader school spread,” said Johnston, a former state senator, teacher and principal.

Schools have helped keep their communities safe by following all the usual safety measures, Johnston said. Last semester, COVIDCheck Colorado determined that schools were some of the safest places as the prevalence rate on tests for most of the fall was below 1%. 

However, community spread of the coronavirus at the turn of the year caused some schools to question whether it would be safe to reopen for the second semester. Johnston said that adding the capacity for regular student testing along with staff testing would offer additional protections.

COVIDCheck Colorado has quickly scaled up to be able to deliver thousands of tests to Colorado educators, students, families and community members since it launched in July. 

Johnston said the initiative has accelerated testing as it has expanded its drive-through and mobile testing capacity, with tests funded by the Colorado Department of Public Health and Environment and Polis’ office. Introducing COVID-19 testing through saliva has also helped with growing the network’s footprint, as it’s a more efficient way to collect samples from kids than the nasal swab technique. 

Johnston said that instead of having to take 500 children through a drive-through site to be tested, 500 tubes can be dropped off at a school, where a school nurse or other qualified staff member supervises the tests. Then they’re picked up at the end of the day and sent off to a lab.

The saliva method, known as Saliva Direct, is authorized by the U.S. Food and Drug Administration through Yale University and has been used by the National Basketball Association, Johnston said.

The process behind the saliva collection is simple. Weinraub, of Cherry Creek School District, said school nurses and health technicians first identify each student and ensure their parent or guardian has signed off on their participation. After making sure that the student has not consumed food or drink in the previous half hour, the nurses and health technicians give them a plastic tube that Weinraub compares to a test tube. The student then must drool 0.5 milliliters — one-tenth of a teaspoon — of saliva into the tube. The tubes are sealed, labeled and sent to a lab.

The nurses and health technicians overseeing the testing do not touch the saliva.

Cherry Creek School District plans to test random groups of students so that the testing is equitable among all students whose families allow them to participate, she said. Middle and high school students can access COVID-19 testing through the district’s drive-through sites. With much larger student populations at middle and high schools, nurses would face logistical challenges, racing the clock to test groups of students while also tending to students visiting their offices for other health concerns.

Weinraub said identifying asymptomatic students and staff who test positive, and removing them from the school setting, is just one more strategy for keeping the rest of its students and staff safe and in the classroom.

“We want to live in the science,” she said. “We do live in the science. We’re working at this from an evidence-based lens.”

Meanwhile, DPS has also expanded COVID-19 testing to students through its partnership with COVIDCheck Colorado. Students can get tested for free at any one of the district’s couple dozen drive-through sites, many of which are located at schools, DPS spokeswoman Winna MacLaren said.

DPS is encouraging students to get tested every two weeks, in line with what local health experts are recommending, beginning before they return to in-person learning. The district’s elementary school students returned to classrooms last week, and middle and high school students will go back at various dates starting Tuesday.

Testing students enables the district to stay on pace with positive cases and minimize the chances of an outbreak, MacLaren said.

“It really does help us keep track of what’s going on with the health conditions in our community and allows us to very quickly respond,” she said.

That’s exactly what Clayton Early Learning in Denver has been able to accomplish since it began regularly testing students, their families and staff in September through a partnership with COVIDCheck Colorado.

The early childhood learning center has tested 100-200 people every other week and earlier this month began offering free testing to the surrounding community, with testing available every week on Monday, Wednesday and Friday mornings.

The center has had to quarantine individual classrooms over the past several months but has been able to keep its school open consistently. Testing children has helped make that possible, President and CEO Becky Crowe said.

Identifying positive cases and then supporting children, family and staff members to quarantine and get the health care they need without transmitting the virus on campus has been critical to the center’s success, she said.

Plus, the free testing has eased nerves across campus.

“It really has addressed some of the anxiety that our educators and families were feeling with respect to in-person schooling,” Crowe said.