Susan Brooks, the school nurse at Lawrence Middle School, greets students at the school door and lobby daily at 7:15 a.m. until the first bell rings at 7:48 a.m. Her role has changed during the COVID-19 pandemic. Credit: Newsday / Alejandra Villa Loarca/Alejandra Villa Loarca

Long Island school districts in "hot spots" — areas with outbreaks of COVID-19 — are having to tackle another unprecedented state requirement to keep their schools open: testing 20% to 30% of the people in those buildings.

Several districts across Nassau and Suffolk counties, including Lawrence, Great Neck, Massapequa, Hampton Bays, Riverhead and Copiague, have had to comply with testing requirements in recent weeks. But fulfilling the requirements differs by county and district, making it difficult to estimate the potential costs school systems might incur — even while getting free test kits from the state.

District leaders say they will comply with the mandate so students can continue attending in-person or hybrid instruction, but some feel the burden of testing shouldn’t be on education institutions. They also worry about unknown expenditures that might come from the mandate, coupled with potential state aid cuts and other costs related to the coronavirus pandemic.

"Schools are not public testing systems, rather systems of education," said Melissa Burak, superintendent of Lynbrook schools in Nassau County. "The biggest concern is that schools should not be asked to act as testing agencies. This is a matter of public health and should be conducted by public health entities."

To help reduce the spread of the coronavirus, Gov. Andrew M. Cuomo implemented a "cluster action initiative" in October that categorizes areas with outbreaks into three zones — yellow, orange and red — each one with successively higher restrictions.

Districts must test 20% of in-person students, faculty and staff over a two-week period following a "yellow zone" designation, according to the state's latest guidance. If the results of testing show the positivity rate is lower than the zone’s seven-day positivity rate, testing at the school can stop, the guidance states.

Meanwhile, schools in orange zones must test 20% of people in the building on a rolling basis each month, and schools in red zones must do the same for 30% of those people, the guidance states.

Initially, the state required schools in orange and red zones to close immediately upon receiving those designations. Guidance updated on Dec. 4 states that schools can remain open so long as they follow the testing requirements. If random sampling in any school reaches a positivity rate of 2% or higher in New York City or 3% or higher outside of New York City, then the school will be required to close.

The Lawrence, Great Neck, Massapequa, Hampton Bays, Riverhead and Copiague districts have been in the yellow zone in recent weeks.

Statistics displayed Friday by Cuomo showed that students in grades K-12 are responsible for about 1.1% of new confirmed COVID-19 cases. Elementary school students are responsible for .49%, middle school students are responsible for .19%, and high school students for .46%.

To help alleviate potential costs to the districts, the state Department of Health sent about 219,000 free test kits to health departments statewide. Local health departments are encouraged to distribute the kits at no charge to districts and community testing sites.

Around 19,080 test kits have been supplied to Nassau County, and 3,840 were provided to Suffolk County last week, according to the state.

But the process isn’t so straightforward and simple when it comes to who conducts the testing in schools.

Some counties, such as Suffolk, have a local health department with in-house clinical operations and enough licensed medical employees to staff multiple testing sites at schools. Others, like Nassau, don’t have clinical capabilities, leaving districts to either partner with private labs or hospitals to come to the schools and do testing, or to seek out licenses for their own employees to handle the testing process and test in school.

Districts also can fulfill the requirement by asking families to visit free testing sites in the community and ask that they send the results to district officials.

"It’s a misunderstanding that there’s a one-set procedure that has to happen for all schools," Dr. Lawrence E. Eisenstein, Nassau's health commissioner and an infectious disease specialist, said in an interview. "There really is not a one-size-fits-all, which makes sense because our districts have unique features, geography and circumstances that would call for differing needs."

Testing cost: ‘Tough to calculate’

The Suffolk County School Superintendents Association saw its members alarmed when the testing requirement was announced and supplied them with a 10-step guidance to break down the process of testing in their schools.

"Every district is going to handle this the way that’s most appropriate for them," said Ronald M. Masera, president of the association’s board of directors. "The cost for districts is tough to calculate because every district is going to handle it differently. The reality is that the cost should ultimately be free for the kids in your school."

Center Moriches schools Superintendent Ronald M. Masera.

Center Moriches schools Superintendent Ronald M. Masera. Credit: Randee Daddona

Masera said most schools in Suffolk have decided to partner with the county Department of Health Services. In that case, the county sends employees to operate testing sites at the schools, but if the county runs low on staff, then districts have to use their own workers.

"They may just need to shift resources and repurpose some staff for a limited duration," Masera said.

Among the steps the guidance recommends is to hold an informational webinar for families about testing and to develop a "testing site plan." The site plan must have eight stations to serve different functions like checking in, pretest screenings, waiting areas and testing, to name several. The testing can take place at the school nurse's office or somewhere in the school building that can accommodate the various stations, Masera said.

"The process is not as difficult and daunting as people might have believed it to be," said Masera, superintendent of the 1,600-student Center Moriches district. "I think we have an obligation to prove that our schools are safe and that the infection is not spreading within our schools."

Suffolk school-based testing data provided by the association shows there were 2,722 total tests administered from Nov. 19 through Dec. 11 across schools in Hampton Bays, Riverhead, East Hampton, Copiague and East Islip. The total positive test count was 40, and the overall positive rate was 1.47%, the data shows.

New York State received the test kits — Abbott BinaxNOW rapid antigen tests — through the U.S. Department of Health and Human Services and distributed them to local health departments for free, said Grace Kelly-McGovern, spokeswoman for the Suffolk Department of Health Services.

The tests require a sample collected from the anterior nostrils by health care personnel, she said. The sample is then inserted into the test card after some drops of a reagent are applied, and it provides a result in 15 minutes, she said. There are no lab processing costs, as a lab isn’t required, she said.

In Nassau, districts can partner with a private lab or hospital to conduct testing, or request for school employees to get licensed by the state to become testers and administer tests at school.

All districts also can let students and staff go to a free testing site in the community or to their own doctors to get tested and send the district their results.

"Initially, there was a concern that there would be a great cost to the school districts, but that doesn’t appear to be the case," said Bill Heidenreich, president of the Nassau County Council of School Superintendents executive board.

Valley Stream schools Superintendent Bill Heidenreich.

Valley Stream schools Superintendent Bill Heidenreich. Credit: Newsday/J. Conrad Williams Jr.

Among the companies that Nassau districts plan to partner with are Garden City-based Baseline Health, Ronkonkoma-based House M.D., Stony Brook-based Applied DNA Sciences, and ATC Around the Clock Healthcare Services, which has locations in Huntington and Lake Success.

Some charge an upfront cost, others take insurance with no out-of-pocket costs for students, faculty or the schools, Heidenreich said.

Burak, the Lynbrook superintendent, said she plans to work with an agency that will allow families to use their own insurance.

"This is all new to us," said Heidenreich, who also serves as superintendent of the Valley Stream Central High School District, which has about 4,500 students. "We’re doing our best to work through a rapidly evolving situation. If we are required to administer tests to stay open, then that’s what we’ll do."

The DIY approach

Another way to fulfill the requirement would be for the district to apply for its own "limited services laboratory" license, which would allow school nurses to do the testing at schools using the free kits from the state, Eisenstein said.

Nassau County Executive Laura Curran, in a news briefing Wednesday, said the county is working with districts "to help them get a license directly from the state Department of Health so that they can become testers themselves. They have the school nurses. They have the medical directors. It makes a lot of sense."

Susan Brooks, the school nurse at Lawrence Middle School, takes...

Susan Brooks, the school nurse at Lawrence Middle School, takes students' temperatures as part of the COVID-19 safety protocols. Credit: Newsday/Alejandra Villa Loarca

But school nurses have had to take on new duties amid the pandemic, and some school leaders say it would be a burden on them to also manage testing.

"We do have nurses, but our nurses are monitoring signs and symptoms of students in school and making sure everything is fine. To add the testing would really decrease their capacity to do their daily work," said Ann Pedersen, superintendent of Lawrence schools.

Lawrence Middle School nurse Susan Brooks, wearing a medical gown, gloves, a mask and face shield, said she greets about 100 kids every morning, taking their temperatures and making sure they filled out their daily health screenings, in addition to her usual duties such as checking for immunization records.

"They think that we just sit down all day twiddling our thumbs waiting for kids to come down for a Band-Aid," Brooks said. "A lot of times I’m part-mom, part-psychologist, part-nurse, part-social worker."

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