Marta Kalas talks about adapting a health testing programme that works.
For any school, adapting to Covid-19 is challenging. How will you know when your risks increase and you need to take different steps? Will you be able to notice a new source of infection quickly enough? This is where a programme for regular and methodical testing can be beneficial. It is important to understand that testing can only help if it is effective, and that means being part of a concerted effort with a systematic plan.
The topic is a confusing one and good advice is difficult to find. Specific advice from the government has not yet been forthcoming, so for now you need to do the best you can. Let’s look at some practical steps can you take in designing and managing health testing in your educational setting for staff, children and visitors:
First of all, the best advice is still to ask staff to monitor symptoms and be aware of what additional risks each staff member may be exposed to. For example, are they living in a communal environment like a house-share, are they part of a large family with most members working and using public transport, do they use public transport themselves to come to work? All of these will increase their risk. This doesn’t mean they shouldn’t come to work – it’s simply something to be aware of and bear in mind when working out your testing plan.
There are a number of issues to consider when setting up a testing programme and you need to be very careful about some of the hidden implications. It is not simply a medical or clinical question, the personal privacy aspects are just as important.
When designing a testing programme ensure it is:
- Planned and documented
- Systematic (even if you are doing random checks, you need to make it clear who is tested, when and how)
- Actionable: you need to know what specific action you will take if certain results are found
- Follows Public Health England (PHE) guidelines and if possible is carried out under clinical supervision. The latter may not be possible, although many occupational health physicians can provide this as a service.
There are some pitfalls that schools should look out for. The testing programme must also avoid the following:
- Improvising/introducing the latest test available without considering the implications
- Testing must not lead to discrimination or the perception of discrimination
- Once data is no longer needed, it needs to be destroyed and the process documented
- Using tests that are not approved by the Medicines and Healthcare products Regulatory Agency (MHRA)
- Interpreting results to one’s own purposes
- Using a system where security of data cannot be guaranteed (e.g. Excel)
Things to consider
In addition, there are number of questions you need to ask when putting together a testing programme in order for it to be safe and secure.
- What type of information will you be collecting and what action will you follow if you find it? For example: Will it lead to more testing of a specific group? How will PPE use need to change? Will who works when or where need to change?
- What other information will you need to record in order to give context to the testing? For example, this could be linked to risk factors like sharing a household with a person at higher risk.
Example questions, with possible answers, might be:
Why are you in isolation or being tested?
- I have symptoms (go to symptoms checker)
- I have tested positive but have no symptoms
- Someone else in my household has symptoms
- Some in my household tested positive but has no symptoms
If you have symptoms, did they start:
- Less than 7 days ago
- Between 7 and 14 days ago
- What type of test needs to be carried out in relation to any symptoms? Will tests need to be repeated and, if so, at what intervals?
- How will you manage repeated testing? How long is the information valid?
The timing of these questions and answers as well as the related test result is really important; each test is only effective for a very precise period. Test at the wrong time, and the results will lose their meaning.
Unfortunately, it is unlikely that your current system for recording HR data is ready for the challenge, so a new secure computer-based system of Covid-19 testing is the way to go.
If you can use a dedicated testing platform to manage the process, it will be much easier to track the results, know what actions to take, and ensure that everyone who needs to be tested is tested. People who have a high-contact job, bigger families or at-risk family members should be tested more regularly. There is some evidence that people with a BAME background may be at higher risk. This may mean that they need to be treated differently (for example, testing more regularly, or shorter intervals between tests), however it is essential that you avoid any form of discrimination.
Be open and transparent about why and how you want to manage the testing, and, if necessary, get some advice/training about sensitive communication with employees at risk. You will also need to talk to parents about a) testing their children; b) the reporting procedure if a child or member of staff is found to have Covid-19; and c) what actions will be taken if a test is positive. All these elements need to be considered and decided in advance of the testing programme commencing.
By getting specific advice on the legal and clinical aspects of your plan and taking clear and transparent action-steps you can make testing programme work efficiently in your school.