We Need to Stop Indiscriminately Testing for COVID. It's Harming our Kids | Opinion

There is a pervasive notion in the United States that doing more to fight any disease is always better. It's a sentiment that's only grown during the pandemic. In truth, we live in a world of tradeoffs with downsides to most medical interventions—which means that the ability to test is not always a reason to test.

We do not, for example, regularly test everyone for HIV; it's clear in that case that the burdens can quickly outweigh the benefits. And yet, while most intuitively understand that we can't regularly test everyone for every disease, acknowledging that there are tradeoffs is something many seem to be struggling with when it comes to COVID-19.

Screening school children for COVID-19 is an obvious example of intervention where the harms appear to clearly outweigh the benefits. Screening asymptomatic children for COVID-19 whether they have been in contact with someone with COVID or not has not been shown to reduce viral spread or improve child or community health. What is has been shown to do is result in unnecessary school days lost and excessive burdens on school districts and working families. And it diverts resources from pressing educational and public health needs, things like the pandemic-related educational achievement gap and the growing mental health crisis among children.

And yet, too many schools insist on regularly testing children, despite these clear harms and the clear absence of real benefits. Senate Bill 1479 in California, for example, would require COVID-19 testing plans to be developed for students for the indefinite future, a project which is anticipated to cost at least $1.5 billion in the first year alone.

It's misguided at best and deeply harmful at worst. As governments and districts look toward the 2022-23 school year, they must acknowledge that it's no longer appropriate for schools to take on an outsized role in health care. Schools have not previously served as testing sites for respiratory illnesses—certainly not for asymptomatic children.

California's bill and others like it are simply out-of-step with our society's evolving relationship with COVID-19.

SARS-CoV-2 was new to our immune systems in early 2020. But as of April 2022, at least 97 percent of Americans have some protective immunity, from either vaccination or infection. COVID vaccines likely saved many lives by priming immune systems before exposure, yet it is clear that neither vaccination nor mass testing will stop transmission or infection.

Indeed, the vaccine's transmission reduction was never studied, as Dr. Patrick Moore of the University of Pittsburgh Cancer Institute pointed out in an open FDA meeting. As with influenza, cases of COVID-19 will continue to appear, but the number and severity of those infections will be significantly reduced.

Indeed, countries known for carefully weighing harms and benefits in public health such as Denmark, Norway and the UK have not only completely moved testing out of schools but are targeting resources very specifically now and testing only at-risk patients whose outcomes may improve through early detection.

Denmark established a practice of testing only those who have symptoms and are over 65 or at particularly high risk. The UK stopped all school-based testing, and as of April 1 will only offer free testing to a small group of at-risk adults with symptoms. And Norway recommends not testing any children for COVID-19, even if they have symptoms.

With the high number of U.S. adults at risk due to poor access to care and/or obesity, we should be directing our public health efforts where they are needed most. Schools, filled with children at the lowest risk for severe COVID-19 and working-age adults with access to vaccines and boosters, are therefore the last setting where mass testing should be deployed.

testing kids
NEW YORK, NY - APRIL 29: A girl is testing for Covic-19 at the Transformé Md Medical Center on April 29, 2020 in White Plains, NY. One possible option in the treatment of COVID-19 is to give patients the plasma of those who have already recovered from the disease, in the hope that the blood will have the antibodies. Pablo Monsalve/VIEWpress via Getty Images

Moreover, asymptomatic testing with rapid tests can also yield a high number of false positive tests, resulting in inappropriate work and school days missed despite the child not actually having COVID. This is a particular problem when case rates are low; a recent study of asymptomatic workplace testing found that 62 percent of positive rapid tests in a batch of 179,000 tests were false positives, while the true test positivity rate was 0.35 percent. That an imperfect screening test becomes less reliable as the prevalence of the disease in the population decreases is a basic tenet of public health screening and Bayes' theorem.

And there is real harm to these false positives. The high rate of false positives among students without symptoms will result in days or weeks of missed school for children, missed work and lost income for working families, and time pursuing additional testing—all for a child that does not even have COVID-19.

In fact, the community positivity rate would have to be 3 to 7 percent for true positives to outweigh false positives. That means for the last 52 weeks in California, a positive COVID-19 test would have been more likely to be inaccurate than accurate, for anywhere from 38 to 45 of those weeks.

Despite adopting a large scale school testing program, California students missed more days of school in January 2022 than students in Arizona, Florida and Texas, for no established benefit to student or community health. From the CDC, through April 2022, California's 23,000 cases per 100,000 people compares to Florida's 27,000 per 100,000 where no such universal school testing program was adopted. California and Florida have also had comparable age-adjusted COVID mortality rates.

Furthermore, school staff will be burdened with yet another responsibility at a time when many districts are facing unprecedented staffing shortages. Multiple states abandoned school test-and-trace programs during Omicron due to overwhelmed staff and massive student absentee rates. The resources needed to perform this testing could be better directed at programs to improve mental health, facilities and educational resources to end the chronic absenteeism related to ineffective COVID-19 testing and quarantine procedures, which exacerbate learning loss from the extended closures.

No amount of testing will eliminate COVID-19 or halt transmission. Many nations with aggressive testing previously lauded for their "COVID success"—Iceland, Denmark, Norway, Australia, New Zealand and South Korea—have since experienced population adjusted surges larger than any experienced in the USA.

Lastly, some parties have strong financial interests in continued mass testing whether or not it is in the best interest of public health. In California, a testing and genomics company and COVID-19 testing software provider strongly advocated for the continued COVID testing in schools.

The tradeoffs of required asymptomatic COVID-19 testing must be considered whether it's inside or outside schools. The harms from not acknowledging the epidemiologic realities of 2022 will disproportionately impact children, working families, and public-school districts, all of which deserve, now more than ever, an evidence-based and measured approach to public health.

Unbiased data-driven physician-scientists and public health experts need to speak up about the harms of over-medicalization, especially as it pertains to childhood, public education, and even the average non-healthcare work setting.

Dr. Tracy Beth Hoeg is a physician-scientist affiliated with the University of California-Davis and Sierra Nevada Memorial Hospital. She is also an epidemiologist with the Florida Department of Health. Her research focus of late has been on COVID transmission in schools and risk benefit analysis of COVID vaccination in adolescents and she has had research published on these topics in multiple peer-reviewed journals. She is the mother of 4 children.

Dr. Ram Duriseti is a physician-scientist who practices Emergency Medicine with a focus in Pediatric Emergency Medicine at Stanford Health and General Emergency Medicine in Sutter Health. His doctoral background is in statistical computing and computational modeling of complex decisions. He is the father of 3 children.

The views in this article are the writers' own.