COVID-19 Testing Program for K-12 Schools Program One-Pager K-12 COVID-19 Testing Program Guidance Information for Parents COVID-19 screening testing can help protect our school communities and help keep students in the classroom. Between December 2020 and June 2021, 58 school districts, charter schools, and private schools participated in NCDHHS’s COVID-19 School Testing program, receiving over 70,000 rapid tests to perform diagnostic and routine screening testing. Schools reported that testing: increased confidence from families that in-person learning was safe, and allowed schools to rapidly identify and quickly quarantine suspected cases of COVID-19, which helped get students and staff back into the classroom faster. NCDHHS encourages schools to implement a COVID-19 screening testing program for the upcoming school year. Testing will remain a crucial mitigation measure to prevent the spread of COVID-19 in schools. State-Funded Testing Program Options As announced in June, NCDHHS is offering two testing program options for school districts, charter schools, and private schools to select from for the 2021-2022 school year: Option 1: State-Contracted Vendor Testing Schools may choose to use a state-contracted vendor that is available to all schools performing testing of students and staff. A vendor will be provided at no cost to schools that elect to participate in this program option. Option 2: Independent Testing Schools may choose to perform testing on their own or in partnership with a non-state sponsored vendor. NCDHHS will provide tests at no cost to all schools who elect to perform testing independently. Funding for Temporary School Health Staff Additionally, public schools participating in either option are eligible to receive funding for temporary school health staff. NCDHHS will provide schools that choose this additional support, and meet the requirements of this program, with funds to hire: a registered nurse (RN), licensed practical nurse (LPN), and/or unlicensed assisted personnel (UAP). NCDHHS encourages all schools and districts to opt-in to a COVID-19 testing program by September 13, 2021. More detailed information, guidance, and an opt-in registration form was sent to all school and district superintendents and school health administrators in mid-July. Frequently Asked Questions These FAQs will be updated regularly as new information is available. Last updated on 8/25/2021. For questions about the process, contact K12covidtesting@dhhs.nc.gov. Testing Program Overview How can my district or school opt-in to the program? Who will be notified? NCDHHS sent an opt-in form to district and school leaders on or about July 15, 2021, via the North Carolina Department of Public Instruction and organizations that serve independent schools. We also notified school health nurses and staff, as well as Local Health Departments (LHD), when the opt-in form went live in mid-July. If needed, the opt-in form can be requested by contacting K12covidtesting@dhhs.nc.gov. Schools are encouraged to opt-in to the testing program by Sept. 13. I submitted the opt-in form. When should I expect to hear from you about next steps? Please allow six business days from your form submission date to hear from our team. If you have not received a response within six business days, please contact K12covidtesting@dhhs.nc.gov. Will entire districts opt-in for the program or will it be individual schools in a district? School districts will opt-in and make decisions about which schools that they want to include. Who is eligible for COVID-19 testing? School students and staff are eligible for both diagnostic and screening testing. Staff should include teachers, substitute teachers, bus drivers, food service, and custodial staff. Family members will not be eligible for routine screening testing or diagnostic testing by the state-contracted vendors or by school staff when using state-supplied test kits. However, districts and schools may include family members in testing for special event screening, such as before athletic events, using tests received from the state. What if my district or school already has a testing program for COVID-19? Please continue with your existing program if it is working for your school or district. If you will be requesting tests from the state you must still complete the COVID-19 testing program opt-in registration form choosing the Independent testing option. A link to the opt-in form may be requested from K12covidtesting@dhhs.nc.gov. The opt-in form helps us better understand the approach all schools are taking to COVID-19 testing, and the form will let us know if your school or district: already has a testing program; or would like to request additional support resources or make changes to your testing program. What if we do not want to test for COVID-19? NCDHHS strongly encourages schools and districts to implement a COVID-19 screening testing program for the 2021-22 school year. Testing remains a crucial mitigation measure to prevent the spread of COVID-19 and schools are being asked to opt-in to the voluntary StrongSchoolsNC K-12 COVID-19 Testing program. We encourage schools who do not conduct testing to provide their community with a list of free COVID-19 testing locations near them. How long will funds last? Funding will run through July 31, 2022. After opting in to the testing program, can we later change our selected program option? Can we later opt out of the testing program? If your district or school has already submitted the opt-in form and would like to change your program option selection, please email K12covidtesting@dhhs.nc.gov for assistance. Flexibility is a key part of the testing program – both when opting in and as the school year progresses. When schools or districts opt in to the testing program, they identify a testing option that meets their needs at the present time and, if applicable, discuss a testing plan with the assigned vendor. Testing needs may change over the school year as community and state levels of COVID-19 spread change, as discussed in NCDHHS K-12 Testing Program Guidance. Having a testing plan in place allows you to access state resources and be prepared as conditions evolve in the upcoming school year. Since testing programs are able to respond to current conditions there is no opt-out protocol required. Will supplies (such as gowns, face shields, and gloves) be provided to schools for the next school year? NCDHHS does not currently have plans to provide these supplies directly to schools for the upcoming school year in the manner used last year during the PPE shortages. If working with a state-contracted testing vendor (Option 1), PPE is included in the end-to-end services for testing purposes. If a school is doing Independent Testing (Option 2), all staff should follow standard precautions when running each test and handling clinical specimens. The state does provide a mechanism for schools to order PPE supplies available upon request. How have schools communicated with parents about COVID-19 testing? NCDHHS will provide additional communications resources (e.g. updated communications toolkit and printed materials) to support participating schools in communicating with families in early September. Districts and schools may elect to receive these materials when completing the program opt-in form. Schools partnering with the state-contracted vendors (“Option 1”) will also have communications materials support, provided by the vendor, to further explain how testing works and how a parent or guardian can give consent for their child to participate in their school’s testing program. Some schools have found it helpful to conduct town hall discussions in which school leaders talk about pressing issues with members of the community. These discussions are often recorded to ensure that as many people as possible are able to listen in. An example town hall discussion provided by Cumberland County Schools last spring can be viewed at: "Coffee Conversations" Plan A Update. Will all students in a participating school be tested? Each school or district will make decisions regarding how to implement their testing program and who will be asked to participate. Can pre-K students be tested as part of the program? Funds are intended to support K-12 student testing. NC Pre-K program students on LEA campuses may be included. Is parental consent required for a child to be tested? Schools should provide parents/guardians direction on consent procedures in order for their student at to participate in testing. There is no single statewide consent form or process. If using one of the state-contracted vendors for testing, they are available to collaborate on a consent form and process with your school/district. NCDHHS advises districts and schools who are not utilizing one of the state-contracted vendors to use current consent protocols in school districts and/or to work with their legal teams to develop a form and define a process for obtaining required consent. Is consent required each time a test is done? Consent processes will be determined by the school or district. State-contracted vendors recommend getting consent from parents/guardians for students to participate in the school’s testing program, so consent is only needed one time. However, schools may choose the consent frequency best suited to their needs. Are consent forms available in both digital and paper forms? State-contracted vendors are able to supply consent forms in both digital and paper formats. Is a specific type of COVID-19 testing required for participation in the program? No, program participation does not require a specific type of COVID-19 testing. The program is designed to support local flexibility in building a testing plan that meets local testing needs and CDC guidance. Does a student need to be tested at their own school? Or can student testing supported through this funding program be done at a location that is not necessarily on a school campus? CDC funding requirements and NCDHHS testing program implementation include a strong focus on ease of access, equity, and keeping students in school. To meet these programmatic values, routine K-12 screening and diagnostic testing provided through the StrongSchoolsNC K-12 COVID-19 Testing program must be provided on the school campus that a student being tested attends. A positive feature of K-12 testing programs for parents is the ability to access a COVID-19 test without needing to take their student elsewhere, which helps minimize disruption for both the parent’s work day and the child’s school day. School-based testing can be critical for families who may experience transportation and other challenges that limit access to COVID-19 testing. A program that is not accessible on campus may then create a situation of inequity among students. It is expected that NC K-12 testing programs funded through the DHHS program will be equitably accessible to all students on the school campus and seek to minimize school day disruptions. Off-campus COVID-19 testing options currently exist in most counties supported through other resources. For more information on non-school-based testing options, visit ncdhhs.gov/GetTested. General Testing Guidance What are the advantages of pooled screening testing? Pooled screening testing is designed to be quick, accurate and easy when larger numbers of students are being tested. It limits loss of class time and catches unknown cases that are in the school before they can spread to many others. When those cases are identified through screening testing early there is much less need for diagnostic COVID testing in the school. Pooled screening testing has been successfully used in other NC settings and in K-12 schools in other states. By pooling tests into groups (e.g. classrooms, athletic teams, clubs, etc.) vendors can reduce the amount of time required to individually collect, label, and analyze COVID-19 tests – and that minimizes school day disruptions. Based on experience, pooled tests generally come back negative for COVID-19, but if there is a positive case, then follow-up testing within the positive group will be necessary. Members of a positive pool are not required to be excluded from school during the follow up testing. How do you identify a positive student in the pool? If a pooled test comes back positive, each individual in the pool will be retested with a rapid antigen test to identify the positive case(s). Only the positive person in the pool will then be advised on isolation. Where should symptomatic students stay while they wait to take a COVID-19 test, get their results, and/or wait for their parents to pick them up? Schools should use an isolation space for students needing a diagnostic test, as discussed in the StrongSchoolsNC Toolkit and guidance. Who is responsible for following up with the student or staff member after test results, and contact tracing (if applicable for a positive test)? Case investigation and contact tracing should be done as a collaboration between K-12 schools and local health departments. For those participating in the state vendor program, vendors will report test results to both local and state public health, as well as the district/school, to help facilitate this process. Guidance for coordinating contact tracing efforts with schools and local health departments is available on the NCDHHS website. It is imperative that schools and districts collaborate with the local health department in providing contact information for, or notifying close contacts of, a suspected or confirmed COVID-19 case among staff, students, and families while maintaining confidentiality. Additionally, schools and districts should appropriately exclude students and faculty/staff from school during isolation and quarantine, and advise staff, students, and parents to be aware of the possibility of calls from contact tracers from the local health department. Steps that schools and districts can take to enhance current practices to increase the speed and efficiency of contact tracing in collaboration with the health department, including developing a contact tracing plan, is found in the Guidance linked above. How can my school plan for safe isolation and quarantine? Some students, parents and staff may be disproportionately impacted by quarantine and isolation requirements after testing. As districts and schools have throughout the COVID-19 response, we advise sites to continue to consider the financial, emotional, and educational tolls incurred by the populations that they serve and have a toolkit ready to support these individuals. NCDHHS has put together guidance and resources for schools and parents related to remote learning, food assistance, internet access, child care, and other support services that we encourage sites to leverage in developing their plans. State Vendor Testing (“Option 1”) What services can the vendors provide? In partnership with local schools, the state-contracted vendors are available to provide end-to-end testing services, including: acquiring testing supplies, receiving parent or guardian consent for a student to be tested, administering COVID-19 tests, interpreting test results, and communicating results to individuals, parents and guardians, and, as applicable, local and state health departments. What types of COVID-19 tests are available from the state-contracted vendors? Standards for COVID-19 testing often determine the test types that should be used in different testing situations. Vendors offer a variety of test types, dependent on those standards and the testing program options selected by the district or school. Specific test types will be discussed with schools during the onboarding process. Will the state-contracted vendors manage any confirmatory testing needed for positive results? Yes, vendors do support confirmatory testing if needed for positive results. Do the state-contracted vendors or NCDHHS offer antibody testing? No, antibody tests are not in scope for the program. What would screening testing look like for an athletics team, band, staff, students, etc.? Your district and school will work directly with the testing vendor and NCDHHS to design a testing plan that works best for your school’s needs. These logistics can be discussed on a case by case basis since factors such as group types, size, and frequency of testing are important in plan development. Independent Testing (“Option 2”) If my school district or school would like to use our own testing vendor, rather than the state vendors, are there labs that we can work with? If the state-contracted vendors do not meet a district or school’s needs, the district/school may independently partner with another entity to performing testing. A district/school may want to contact the local health department to see if they have any testing vendor partners that can be recommended or consider universities or medical centers in the area that may be interested in partnering for a school’s testing program. NCDHHS will not be able to reimburse schools for the cost of independently contracted vendors. If we already have a CLIA certificate of waiver for schools to conduct other testing, do we need another CLIA certificate of waiver for COVID-19 testing? Schools do not need a new CLIA certificate of waiver; however, schools do need to modify their existing certificate of waiver to include the state-supplied test type (currently, the Abbott BinaxNOW COVID-19 Ag Card), or any other test that they may be using. The CMS form 116 should be used to report any change of information on the current CLIA certificate. If you have any questions, please contact DHSR at DHSR.CLIA@dhhs.nc.gov or via phone at (919) 815-4620. How can a site obtain a CLIA certificate of waiver? Any site that performs laboratory testing, including antigen testing, must follow applicable regulatory requirements including federal, state, and local mandates for testing, as well as requirements for the safety and confidentiality of personal information, as mandated by CLIA regulations. Some tests, such as COVID-19 antigen tests, may be performed under fewer CLIA regulations for labs and are classified as “waived” tests. However, sites performing these tests must apply for a CLIA Certificate of Waiver. A district or school may choose to apply for or utilize its own CLIA Certificate of Waiver or partner with an entity that has a CLIA certificate that can be extended to include the district or school if the entity has oversight for the testing. More information may be found at CLIA Information for Schools. Get the application for a CLIA Certificate (CMS Form 116) of Waiver here. If applicable, an LEA/charter school may apply for one CLIA Certificate of Waiver that would include all schools in the district. For your convenience, we are sharing information that may help you fill out your CLIA application if your facility does not already have one. The below language uses the state-supplied Abbott BinaxNOW test as an example, but this language may be replaced with the name of the waived test your district or school has elected to use. In section I, select “Other Changes (Specify)” and fill in “COVID 19” to alert our program that your application is a part of this distribution effort. In section II, select “Certificate of Waiver”. In section III, select “26-School/Student Health Service”. In section V, select “Yes” if you are applying as a school district and have more than one school in your district. In #1 in section V, select “No” as each school may act as a temporary testing location should there be a need to test students, teachers, or staff. In #2 – “Yes,” and #3, “No” In section V, select “No. If no, go to section V1” if you are applying as a school at a single site. In section VI, enter “BinaxNOW COVID-19 Ag Card” or name of other test if used Completely fill out the other sections, as applicable. Please also include information about other medical tests, including any other COVID-19 tests, you may be performing at this location and provide specifics on these test systems. Please send the completed application to NCDHHS Division of Health Service Regulation/CLIA Certification at DHSR.CLIA@dhhs.nc.gov or via fax to (919) 733-0176. If you have any questions, please contact DHSR at (919) 815-4620. What training is required to administer the state-supplied antigen tests? Do the tests require a medical professional to administer them? The current state-supplied tests are the Abbott BinaxNOW COVID-19 Ag Card. Individuals performing these tests do not need to be medical professionals. The Emergency Use Authorization (EUA) received by the Abbott BinaxNOW rapid antigen test allows it to be performed by a person who receives a specific training, described below. However, unlicensed staff performing tests MUST be under direct supervision of a licensed medical professional, such as an RN school nurse. Please note that if your district or school is using a test other than the state-supplied BinaxNOW, training and personnel requirements may differ. Always check with the manufacturer and FDA to confirm these requirements before you begin testing. All staff administering Abbott BinaxNOW test kits at a site must complete all Abbott BinaxNOW training modules. The Abbott BinaxNOW training modules can be found here and are listed below: Module 1: Getting Started Module 2: Quality Control Module 3: Specimen Collection and Handling Module 4: Patient (Individual) Test Module 5: Navica Admin App These modules provide a detailed step-by-step guide to the test process. All the modules should be completed in their entirety prior to staff performing test on individuals. Further information about the proper use of the Abbott BinaxNOW test kits can be found on the package insert and in this document. This includes information regarding specimen collection, handling, transportation, and storage. It is the responsibility of the entity holding the CLIA certificate of waiver (i.e., district, school, or CLIA-certified partner) to ensure that all the staff administering tests have completed the necessary training requirements and are competent in performing the test. Documentation or records of satisfactory completion of training should be maintained by the school, district or partner organization performing tests. Staff who have questions or concerns about the administration of the test can always utilize these direct links to Abbott support: 800-257-9525 8:00 am – 8:00 pm Monday through Friday or email@example.com. What are the requirements around the storage or disposal of the state-supplied test kits? All staff administering the tests must follow the instructions provided on the test package insert regarding specimen collection, handling, transport and storage as is detailed here. All components of the Abbott BinaxNOW test kit, as well as gloves used by personnel administering the tests and any grossly contaminated PPE, should be discarded as biohazard waste according to federal, state, and local regulatory requirements. Sites administering tests must have a means to appropriately package, transport, and dispose of medical waste. Expired tests should also be exposed of as medical waste. Please pay close attention to the expiration dates listed on test packaging. If your district or schools do not already have medical waste disposal processes in place, many sites participating in the pilot partnered with vendors such as SteriCycle to provide this service. Though testing outdoors may be ideal for social distancing and ventilation purposes, it also poses a number of challenges, temperature being one. All test components should be at room temperature before use, defined as 15-30◦C (59 - 86◦F). We therefore recommend indoor testing if temperatures fall outside of that range. We recognize that indoor testing may not be feasible or safe in all settings; in those circumstances, assure testing supplies are maintained within the defined range and consider use of temperature control equipment outside. What are the requirements around PPE for state-supplied tests? All staff should follow standard precautions when running each test and handling clinical specimens. For personnel collecting specimens or within 6 feet of individuals suspected to have COVID-19, the following PPE is required: A surgical or procedural mask (a fit-tested N95 or higher-level respirator can be used if available) Eye protection Gloves Gown, when collecting specimens Staff administering tests must change gloves between handling of specimens suspected of COVID-19. Additionally, when using patient swabs, minimize contamination of the swab stick and wrapper by widely opening the wrapper prior to placing the swab back into the wrapper. Visit the CDC website for PPE guidance or contact your school nurse or local health department for further information regarding the proper use of PPE. Schools and districts must be able to maintain an adequate supply of PPE as is required to administer tests as needed. Funding for Additional School Health Staff How are the funds for staffing received after opting in? When opting into the testing program, public schools should indicate their desire to access funds for staffing as an add-on option. Staffing funds will be distributed through the agency that is reported each year as the major employer of school nursing staff (LEA, Local Health Department, Hospital, Health Alliance) for the public district or school. Local health department administered programs will receive funds via the agreement addendum process (AA362). Other school nurse employers, including LEAs, will receive funds via contract between DHHS/DPH and the employing agency All nurse employer recipients are required to submit a draft budget via the link here. A template and additional information are available at this location to assist in the budget development. This budget action must be taken prior to execution of the contract/agreement process. Access to funds is anticipated in September. Schools that indicated a desire for staffing funds will receive an email confirmation with their estimated amount of funding included in order for them to begin recruiting additional health staff. When will funds for health care staffing be released? Access to funds is anticipated in September. How are additional staffing dollar amounts for districts and charter schools determined? Staffing dollars amounts are calculated based on the district or school’s actual Month 1 2021 Average Daily Membership (ADM) as provided by the NC Department of Public Instruction. LEAs are allocated one amount for all schools and have flexibility to make decisions about the needs of the district and individual district schools for staffing support. An LEA or charter will not receive less than $200,000, regardless of size. What types of activities may be completed by an RN, LPN, or UAP? School health staff hired with testing program funds must support COVID-19 testing programs, other COVID-19 mitigation and prevention activities as needed (such as oversight for the school’s contact tracing plan), and other school health program activities that support student health and may have been delayed during the pandemic. Activities performed must always be within the scope of practice for the staff person’s license level. How will we report on use of the funds for staffing? Numbers and types of staff hired, as well as certain activities preformed, will be reported via the North Carolina Annual School Health Services Report surveys in December and June. Test Reporting What are the school testing reporting requirements? For districts and schools using the state-contracted vendor program option, the vendor will be responsible for reporting test results. For districts and schools opting to conduct independent testing, all positive and negative test results must be reported daily as part of required reporting of COVID-19 diagnostic tests. The most current reporting requirements and methods of reporting of COVID-19 diagnostic tests are described in the NC Administrative Code Emergency Rule and the associated NCDHHS guidance for reporting results. NCDHHS offers regular training on its user-friendly COVID-19 testing reporting platform, called eCATR PTR. Please email firstname.lastname@example.org to be added to an upcoming training. How do I report school testing results? NCDHHS provides four options for facilities to automate reporting results: Patient Test Result Portal (eCATR PTR), COVID-19 Laboratory Automation (CLDA), HL7-based Electronic Lab Reporting (ELR) and COVID-19 Centralized ELR Reporters. The information provided here will help facilities select an approach to automation that fits their needs and capabilities. For most districts and schools performing independent testing and reporting, eCATR PTR will be the best tool. eCATR PTR is a secure web-based tool with a user-friendly interface to input positive and negative COVID-19 test results and associated data. The online overview linked above provides more information about the eCATR PTR reporting tool. To be added to an eCATR PTR training session, please email email@example.com. What is the best way to have multiple users report test results in the eCATR PTR system? Data entry in the eCATR PTR system can be through one person or multiple users on one account. Many of testing program pilot schools chose to use one centralized school account that all nurses and delegated staff had access to in order to enter test results. To be added to an eCATR PTR training session, please email firstname.lastname@example.org. Is there a way to provide eCATR results to other stakeholders (i.e. child’s sports team)? NCDHHS can authorize an account in eCATR to have a Print Test Result capability. If you need this function, please contact email@example.com. Does NCDHHS require or recommend a COVID-19 case dashboard on the school website, so stakeholders are aware? NCDHHS is not requiring that schools publish a COVID-19 case dashboard. Dashboards can provide helpful information to families and the public and be effective in managing incoming emails and calls to the school; however, regular dashboards do require maintenance and consistent updating. For example, one pilot district indicated that their dashboard worked in unison with contact tracing and increased transparency but required significant effort to keep up-to-date.