Johnston, the DESE official, told me he stands by the rapid test and its performance. He noted that if everyone in a positive pool gets a negative BinaxNOW result, each person then has to take a third test: a non-pooled PCR.
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But that points to a different drawback of the program—it threatens to be a Pandora’s box of logistical decisions. With so much of the testing process thrust upon districts, school nurses are now working more than ever. Every time samples need to be collected, a trained health-care worker has to don a set of pricey personal protective equipment; each follow-up test increases the risk of an infected person exposing others. Colleen Nigzus, a nurse leader in Harvard, told me that, along with testing coordination, contact tracing, and community education, these new duties have increased her workload by at least 50 percent, bleeding into nights and weekends, without overtime pay. The larger the district, the more unwieldy the system gets. (Most Massachusetts nurses I talked to have at least gotten their vaccines.)
Resampling people with a different test on a different day also raises the risk that an infection will be missed. People afraid to test positive might not return for the retest. And there would be no way to tell if the BinaxNOW caught one infection, but missed two others in the same pool.
“On a shoestring budget, you have to make some compromises,” Pride told me. “But I don’t think these are compromises many of us would recommend to make.”
Pires, the Medway superintendent, admitted that some of the data on the BinaxNOW have made him uneasy. Still, without it, “we wouldn’t know if anyone was positive, unless they became symptomatic,” he told me. “It’s still a better solution than the alternative, which is, we just don’t do testing.”
Not all districts have had to settle for the state’s take on testing; many are using their own funds to amend the program. One is Harvard—Thalia’s district—which began a nearly identical pooled-testing program before the state announced its own. Early on, school officials uncovered a positive pool. No BinaxNOW tests caught the positive sample; PCR tests did. “So we said, ‘We need to keep doing the PCR test, to be more accurate,’” Nigzus told me.
Harvard still signed on with DESE to take advantage of state funding, and it’s using the BinaxNOW. But it checks each one with a PCR test via a second swab—an additional step that the DESE program doesn’t cover. It’s a fail-safe, Nigzus said, and will provide the schools and scientists with valuable data on how well the rapid test performs.
Nigzus’s district also disregards DESE’s guidance on people in positive pools; according to the state, they don’t need to quarantine or isolate before they receive their follow-up test results. In Harvard, “we still tell them they need to quarantine or isolate until they know more,” Nigzus said.