Child Care Providers Find Ways to Get More Coronavirus Testing

Originally Appeared on WBUR Edify
By: Kathleen McNerney

November 30, 2020

As more people get COVID-19 across the state, it's inevitable that cases will pop up in preschools and child care, despite health precautions such as wearing masks and rigorous cleaning.

That's what happened at Nurtury, which operates six centers and supports 130 family child care providers in Greater Boston. Since they reopened their facilities in July, they have had a few isolated cases of the coronavirus. The daily health screenings usually caught any potential cases before a child or caregiver came through the doors.

But in late October, that changed.

“It was two days back to back. It was a tough two days,” Nurtury CEO Laura Perille said.

A teacher at one location had tested positive. At a different location, a parent had COVID-19. A third site: another positive teacher.

Laura Perille, former Boston school superintendent and now CEO of Nutury, receives a COVID test at the Greater Roslindale Health and Dental Center in November. (Jesse Costa/WBUR)

“I had some level of exposure in three different centers, in three different neighborhoods, in three different towns and no cross pollination of staff,” Perille said.

After consulting with public health officials in Boston and Cambridge, Perille closed three classrooms at one location for a week. She completely shut down another center for nearly three weeks, affecting 18 staff members and 50 families. She encouraged all staff and families to get tested.

At the location that closed, four teachers and two children ultimately tested positive. Perille said contact tracers had trouble determining which cases were contracted in the center, and which ones were from elsewhere in the community. It appeared to be a mix.

The state continued to pay Nurtury the enrollment fees for the subsidized families during the closures, softening what would have been a $54,000 financial hit to roughly $14,000. But there were other losses: four families and a staff member who had health concerns decided not to return to that location.

“That’s really when we felt that this was a sign of things to come and we needed more testing support and a better testing solution,” she said.

If families and staff were able to get test results more quickly, Perille thinks she could have reopened three days sooner.

According to the latest state data, Nurtury isn't alone. The coronavirus cases reported in child care settings have been increasing recently. At the beginning of the month, the state reported roughly 190 children and 240 staff across the state had tested positive for COVID-19 at some point since late August. By Nov. 22, those totals had more than doubled.

As community spread increases, child care providers believe they need access to on-site coronavirus testing with rapid results in order to remain open.

Child care doesn't have any systematic testing right now in Massachusetts. In K-12, the Baker administration is rolling out rapid antigen tests -- called BinaxNOW — at 134 districts as part of its strategy to keep schools open.

Some care providers are finding their own solutions -- creating partnerships and pilot programs to add to their prevention toolkit. One partnership came about almost randomly: a cold call from a doctor who struggled to get a test for her own child to return to preschool.

"As a parent, I didn't know where to go," said Dr. Jennifer Trieu, medical director at Greater Roslindale Medical and Dental Center. It wasn't immediately clear to her which of the free sites would test children. “The last thing a parent wants to do is bring a child to a testing site expecting a test, and then they say, 'Oh, I can't test you because you're under a certain age.' "

Her medical center is a free coronavirus testing site, but she said she likes to navigate testing as a regular parent instead of leveraging resources she has because of her position. It also helps her get a sense of what her community needs.

If it was a problem for her to find a testing site, she thought others may be having similar challenges. She started Googling child care in Roslindale to find out, leaving messages at several businesses.

"I wasn't sure what Nurtury or who Nurtury was, but I found it on Google and I got a call back from Laura [Perille],” Trieu said.

They launched a simple partnership: any Nurtury employee or family who calls for an appointment will be prioritized. It didn’t cost anything extra. It’s prioritizing public resources.

Perille, who was the interim superintendent of Boston Public Schools before leading Nurtury, thinks this partnership can be replicated across the city for child care and K-12 schools.

"It would be amazing if any child care worker could go to any testing site in the state and say, 'hey, I work in child care' and have their results expedited," Perille said.

But providers said they need more.

Doris Yepez is a family child care coordinator with Nurtury. When one of the providers has a possible exposure to the coronavirus, she said they are often in "panic mode." Yepez calmly explains what they need to do, and that they or any assistant or family they enroll can get tested at the Roslindale clinic.

“I have found myself booking appointments for like 2 o'clock, which is right away, and the parents [say], 'No, I'm still at work. I can't leave my work and go get my kid tested,' ” she said. "[They find it] upsetting that their employer is waiting for them to go back to work, but they can't."

What caregivers and families really want, according to Yepez, is something they can get on-site, which is exactly what a new pilot program by the nonprofit Neighborhood Villages is aiming to do.

“We are hemorrhaging women from our workforce, largely related to child care breakdowns," cofounder Lauren Kennedy said. "Many women [are] leaving their jobs or losing their jobs because they don't have the care solutions that we need.”

Over the next 12 weeks, nearly 500 staff across seven early childhood and after-school programs will get tested for coronavirus once a week with a method called pooled testing. It uses the gold-standard PCR tests, which are much more sensitive than rapid antigen tests.

Here's how it works: saliva samples are taken from staff, then tested in one batch. If that batch comes back negative, it's unlikely anyone in that group has the coronavirus. If it comes back positive, those same samples are retested in pairs. The pairs that test positive will have to get tested individually.

“The name of the game is basically finding potential asymptomatic spreaders and moving them out before they can transmit it to anyone else,” said Jonathan Kolstad, a health economist at UC Berkeley who works on pooled testing.

Colleges, as well as private and more resourced K-12 schools — like Wellesley Public Schools — are using pooled testing. There are similar pilots in some public schools. Kolstad said other municipalities and businesses are interested, too.

“It's not lost on them that if everyone I know has been tested this week, I'm a lot safer,” Kolstad said.

It's a complement to health measures such as cleaning, wearing masks, social distancing when possible and grouping kids and staff in cohorts.

Perille said it's important for her staff, who are almost entirely women who have been at the "front lines" of the pandemic.

“They are at higher risk than those of us who work virtually," Perille said. "They're showing up and they're in the classrooms every day. And if it gives them greater confidence to know that they and all their peers tested negative that week, then that seems to me to be the kinds of things we do to keep child care open.”

Many public health experts believe pooled testing could — and should — be scaled up across child care and K-12 schools, particularly in places with low transmission.

"The return on investment from a federal or state government is off the charts," Kolstad said. "Even if you simply value the lost productivity of parents who are unable to work at all or work completely, that alone would pay for the testing many times over.”

He estimates that to be $50 million to $100 million a month in family incomes in Massachusetts.