As the school鈥檚 COVID liaison 鈥� one of 76 based at each of the San Bernardino City district鈥檚 schools 鈥� Kaur sometimes handles 20 tests a day, but she鈥檚 expecting to get a lot busier. California鈥檚 mandate that all school employees be vaccinated or get tested weekly went into effect Oct. 15. San Bernardino County includes the zip code in Southern California, and its overall is lower than that of many counties in the state. Kaur said some residents think 鈥淐OVID isn鈥檛 real.鈥�

Fearing that testing and contact tracing would take staff members鈥� time away from instruction, the district is spending $12.6 million in federal funds on a contract with a public health staffing agency, AM LLC, to place a liaison in each school.

鈥淲e鈥檙e trying to stay in the business of education and not dabble in the business of public health,鈥� said Eric Verete, the district鈥檚 safety and emergency manager. He frequently hears from administrators in other districts who are struggling to manage the process on their own. 鈥淲e were well ahead of the game,鈥� he said.

But many districts across the country are behind. As the Biden administration to increase testing in schools 鈥� and take advantage of $10 billion in federal funding earmarked for that purpose 鈥� and the Centers for Disease Control and Prevention promotes programs as a way for students exposed to COVID-19 to avoid quarantine, schools are under pressure to ramp up testing. Some have reassigned staff members and specifically to manage the testing process, while others are pushing back against the additional burden. And though a vaccine for elementary school students is expected soon, some experts say the need for testing won鈥檛 disappear.

鈥淪ome sort of testing will be part of our lexicon going forward,鈥� said Mara Aspinall, a professor at Arizona State University. Especially in districts without mask mandates, she added, weekly surveillance testing 鈥� swabbing a random sample of a school鈥檚 population 鈥� could be an effective way to minimize outbreaks.

鈥楥aught flat-footed鈥�

Districts that started testing programs last school year, such as Baltimore, Los Angeles and San Antonio, were able to resume or expand them this fall.

Shari Camhi, superintendent of the 4,500-student Baldwin Union Free School District, near New York City, decided to implement testing because of her own frustration in December, when there was an uptick in positive cases.

She found herself 鈥済oing to five different places 鈥� and couldn鈥檛 get tested anywhere,鈥� she said. 鈥淲e just needed to make it easier for people.鈥�

Mastery Schools, a network of charters in Philadelphia and Camden, New Jersey, began offering surveillance testing in February, through a federal program that preceded the $10 billion allocation. That鈥檚 what local private schools were doing, said Laura Clancy, Mastery鈥檚 senior adviser of health and safety. Adding that it鈥檚 hard to find free testing in the community, she called the program 鈥渁n additional layer of assurance for staff and parents.鈥�

But districts that didn鈥檛 test last school year 鈥� and maybe thought the virus was going to be mostly under control this fall 鈥� were 鈥渃aught flat-footed, with no time to prepare鈥� when school reopened, said Leah Perkinson, pandemics manager at the Rockefeller Foundation. She described testing in school for the first time as 鈥渢aking your entire school on a field trip to a place that no one has ever been to before.鈥�

The foundation launched a program this year to match schools with testing vendors. But Aspinall, who advises Rockefeller, said obstacles remained in many communities despite the availability of federal funds. And now, increased demand is straining both districts and vendors.

Some resistant officials had a change of heart after it became clear the Delta variant would continue to interfere with in-person learning. Idaho lawmakers turned down the state鈥檚 portion of the $10 billion in the spring, but Gov. Brad Little later made to school districts. In New Hampshire, the Conway School District initially opted out of the state鈥檚 Safer at School Screening program, but this month after several student athletes tested positive.

In Massachusetts, Gov. Charlie Baker has asked for the National Guard鈥檚 help because the state’s testing vendor is short-staffed and schools were using their own employees to test and contact-trace.

鈥淣urses were becoming overwhelmed because of the demands on their time,鈥� said Thomas Scott, executive director of the Massachusetts Association of School Superintendents. The state considered bringing in more vendors, he added, but said other companies were having the same challenges. 

In New Mexico, Joshua Landry, a nurse at Chaparral Middle School in Alamogordo, said COVID testing and tracing now 鈥渃onsumes the majority of my day.鈥� He has less time to work on individualized education plans for students with disabilities or to follow up with children who have asthma, diabetes or other health conditions that require medication and monitoring.

He鈥檚 had to call an ambulance three times this school year for emergencies, such as a student with asthma who didn’t have an inhaler at school.

In other states and districts, leaders have decided they can鈥檛 spare staff members for testing-related responsibilities when they鈥檙e still adjusting to having all students back at school. In Pennsylvania, less than 400 of the state鈥檚 5,000 public and private schools have opted into the testing program. And in Colorado鈥檚 Poudre School District, Superintendent Brian Kingsley said this month that participating in the state鈥檚 program would divert staff members鈥� time away from their “鈥� of educating students. 

While the state health department 鈥減rovides a lot of resources to stand up these programs in public schools across the state of Colorado, it鈥檚 not enough to do it without having a significant impact on schools, on staffing,鈥� he said at a board meeting. 鈥淪tudents don鈥檛 walk themselves to a testing center.鈥�

In the Mastery network, Clancy said parents with younger students are more comfortable participating if they already know the school nurses and health aides conducting the testing. Older students swab their own nostrils in class, overseen by their teachers, because it wasn鈥檛 feasible to test students at lunch or as they entered school in the morning.

But getting permission is a challenge for schools serving populations where 鈥渉uge chunks of our parents don鈥檛 have an email address,鈥� Clancy said, adding that lack of internet access is especially problematic when a child has symptoms. 鈥淚f you can’t get that person on the phone, you’re not going to be able to get consent.鈥�

Lingering misconceptions about the role of testing are another ongoing challenge, she said. Some parents think that if they consent to their child being tested, they鈥檙e also agreeing to a vaccine. Older students have said they feel they can put off vaccination until college because they鈥檙e participating in their school鈥檚 testing program.

鈥楬ighly complex environment鈥�

Balancing the interests of parents, school board members, children and school staff has been a challenge for vendors as well, Aspinall said, calling a school a 鈥渉ighly complex environment.鈥� 

鈥淲orking with schools is not the same as working with businesses or retail pharmacies,鈥� she said. 鈥淵ou have to have a lot of patience because you’re dealing with an institution that was not built to be a health care provider.鈥�

David Savitsky, CEO of ATC Healthcare Services, which provides testing in the Baldwin district and hundreds across the country, said his teams try to set up outside, weather permitting, to minimize the impact on schools. Currently, his sites are testing more unvaccinated employees than students, but he expects that to change with the Thanksgiving and winter holidays approaching, because students could be exposed to more people.

He added that the availability of vaccines for younger students, expected within days, could prompt more districts to add surveillance testing for families who choose not to get their children inoculated.

鈥淲e鈥檙e not going to be part of that discussion, but hopefully we鈥檙e part of the solution,鈥� he said.

In San Bernardino, Verete said he wasn鈥檛 even sure what he needed when he first reached out to AM LLC. He just knew contract tracing was going to eat up a lot of time. At the high school, it can take Kaur at least an hour to confer with a student鈥檚 teachers, advisers and 鈥� if the student is an athlete 鈥� coaches. Then she has to reach the students鈥� families. 

Kaur, who works for AM LLC, earned her undergraduate degree in public health and, as a former intern at the Los Angeles County Department of Health, learned to stand up to vaccine opponents.

鈥淚鈥檝e had my fair share of people fighting back,鈥� she said. 

Opposed to vaccines or not, parents were concerned about sending their children back to school this fall, and she was bombarded with questions about active cases on campus until the district launched its COVID-19 .

She handles required testing for student athletes and unvaccinated employees, but also sees walk-ins wondering whether their sore throat or headache is COVID-related. 

The district鈥檚 original contract with AM LLC was for six months. But Verete extended it for the rest of the school year. 

鈥淚t鈥檚 beneficial to have someone there, knowing their job is to deal with COVID,鈥� he said. 鈥�It鈥檚 not going away like we wanted it to.鈥�