Practice Title: Reopening Schools During COVID-19 Pandemic through Community Engagement and In-school Testing
Department: Houston Health Department
Size: Large (Population of 500,000+ people)
State: Texas
Summary of Practice:
· A brief description of your local health department, including location and the demographics of the population served in your community.
Houston Health Department (HHD) is a full-service health department located at 8000 North Stadium Drive Houston, Texas. The department services benefit all Houston residents especially those most in need, such as low-income families, the elderly, and minority populations. It serves over 2.2 million residents in the City of Houston (CoH).
· A description of the public health issue.
With the emergence of COVID-19 and attendant global chaos, in-person learning was stopped in schools within the United States during the spring of 2020. After a year of virtual school learning, attendant adverse psycho-social effects of isolation alongside other mental health challenges, need for students to return to safe in-person learning was echoed across various groups and communities. Public health interventions such as screening testing for COVID-19 and vaccination were activated for early detection of cases and prevention of spread. To keep the over 400,000 students and faculties in schools (K-12) within the CoH safe, a comprehensive in-school COVID-19 testing was implemented by the HHD through fundings received from the Centers for Diseases Control and Prevention (CDC) Reopening Schools grant.
· A description of the goals and objectives of the proposed practice.
Goal: To safely reopening schools and keeping them safely opened for in-person learning through COVID-19 Pandemic
Objectives:
1. To provide free and accessible COVID-19 testing to schools
2. To promptly detect cases of COVID-19 in schools especially among the vulnerable
3. To rapidly respond to COVID-19 outbreaks in schools
· The activities that were implemented for your practice.
A) Planning phase:
i) Stakeholders’ engagement - school district management, schoolteachers, nurses, parents’ community, social media influencers, student community, CDC Foundation
ii) Laboratory assessment and selection
iii) School assessment for existing COVID-19 infection prevention and control strategies
iv) In-school testing frequency determination
v) Parental consent – consent letter content and deployment strategy development
B) Implementation phase: The program implementation phase includes the following -
i. Obtaining a one-time parental consent for each participating student to cover for all COVID-19 testing conducted on each student for the school year.
ii. Consent is also obtained from faculty members (both teaching and non-teaching staff)
iii. School nurses and field staff training on testing coordination
iv. Development and distribution information, education and communication (IEC) tools
v. Routine school visits (field staff deployment) for nasal sample collection, kit shipping, PCR testing and result sharing
vi. Case investigation and contact tracing – 24-hour open epi hot lines
vii. Field outbreak investigation and implementation of control strategies
viii. Technical support provided to schools for infection prevention with deployment of epidemiologists to schools to support nurses in implementing mitigation strategies.
C) Results/Outcomes:
i) HHD developed a multi-agency partnership
ii) A private laboratory with lab site located within the CoH was engaged.
iii) Surveillance screening testing and outbreak response testing
iv) Antigen testing and Polymerase chain reaction (PCR) testing.
v) A total of 471 schools (443 public and 28 private schools) were enrolled for testing
vi) Over 107,000 PCR tests were conducted, and 62,636 antigen tests kits supplied
vii) Sixteen emergency drive-through clinics were set up in response to school outbreaks
viii) 1.5% COVID-19 cumulative positivity rate was observed
ix) No school closure due COVID-19 outbreak from start of 2021/2022 school year till report writing.
D) Project objectives, and if they were met.
Objectives:
1. To provide free and accessible COVID-19 testing to schools - Over 400,000 students and 17,000 staff had access to free COVID-19 testing at their various schools through the HHD/Private lab PCR testing, HHD/DSHS/TEA antigen test kit supply programs.
2. To promptly detect cases of COVID-19 in schools especially among the vulnerable population – HHD developed COVID-19 Vulnerability Indices which determined frequency of testing for each school, and through the surveillance screening was able to quickly detect surges in cases
3. To rapidly respond to COVID-19 outbreak in schools: 16 rapid response drive-through testing sites were activated. Epidemiologists were deployed to provide technical support to schools with outbreaks; develop line lists of cases, review existing IPC measures and guide the implementation of control measures.
E) The specific factors that led to the success of this practice.
a. Stakeholders mapping
b. Stakeholders engagement .
c. Obtaining parental consent
d. CDC funding for program activities
e. Health department workforce development
F) The public health impact of this practice
1) No COVID-19 pandemic-related school closure throughout the 2021/2022 school year.
2) Low community transmission of COVID-19 due to on-going school testing/surveillance
3) Improved school health program – linkage to other school-healthcare services such as dental health support, eye tests, vaccinations, and other social support.
G) The level or type of community engagement included in your practice
The Program engaged both government and non-governmental agencies to ensure an effective and successful school COVID-19 testing/surveillance. The program utilized various levels of community engagement from individuals to groups, in-person and virtual engagement platforms such as social media.
All these stakeholders were engaged through all the program phases – planning and design, implementation, and evaluation
· The steps taken to address and reduce health inequities.
1) Use of a model of vulnerability indices that assisted the identification of schools located within underserved communities/ZIP Codes
2) In-school surveillance testing frequency was higher and prioritized in schools located within ZIP Codes with high COVID-19 transmission and low vaccine coverage – these were mainly schools located within communities of color, African American communities, Hispanic communities and other minority population.
3) Priority was also given to schools caring for children with physical or mental impairment – e.g. Avondale House (school caring for individuals with autism)
4) Activation of emergency drive-through testing clinics in locations with sudden surge in cases enabling the testing of not only the students and faculty within the affected schools but also their household members.
H) Program and/or local health department website.
HHD School Testing Program
HHD School Testing News Release
Reopening Schools During COVID-19 Pandemic through Community Engagement and In-school Testing
Category
Infectious Disease Prevention and Control
Description