In the hallway at her Baton Rouge high school, Zion Wardsworth stood patiently while a woman in a blue lab coat drew circles with a swab around the inside her lower nostril to check whether or not she’d been infected with COVID-19.
Afterward, the 14-year-old was nonchalant. After her parents suggested the idea, Wardsworth signed up for the weekly testing in August without thinking about it much. The draw was simple.
"I was only thinking about the money part," admitted Wardsworth, a ninth-grader at Cristo Rey Franciscan Baton Rouge High School.
Thousands of students in Louisiana are likewise getting tested routinely for the deadly coronavirus. Like Wardsworth, they are getting money for their brief inconvenience: $25 for the first swab and $10 for each one after that.
Adults who work in schools are eligible too. Over the course of the school year, they can earn as much as $350.
The first installment began arriving Nov. 12 and will keep coming every month through May.
"They all came in at once and people had like $60, $80," said Rebecca Cascio, an English teacher at Cristo Rey. "That’s a pretty good deal just for getting a test. Especially in high school where money is a limited resource."
Cheree Duvic is supervisor of health services for the East Baton Rouge Parish school system, where every school site is participating. Duvic said the incentives have been a hit overall and they can make a small difference in people’s lives.
"I got a family that called me and said they are going to use the incentive to buy Christmas gifts," Duvic said.
David Slaughter, chief executive officer of Orion Laboratories of Baton Rouge, said at a few schools, including St. Joseph’s Academy in Baton Rouge, the incentives have been the primary driver of student interest.
"They heard about the incentive and that just kind of caught fire," Slaughter said.
At the same time, Orion, which is testing schools in the Baton Rouge and Lafayette areas, has found that the $10-per-test incentive has worked against participation in more politically conservative communities where some adults see it as "too good to be true."
"They’re basically like, 'The government doesn’t do anything for us, so why would they do this?'" said Slaughter.
Diné Butler is statewide testing coordinator for the Louisiana Department of Health. She helped design Louisiana’s "Safer, Smarter Schools" program.
Butler said Colorado is the only other state she’s aware of that is offering incentives as part of their school COVID testing program. She said it did not occur to her that the incentives could prove controversial, saying she viewed the testing as similar to clinical trials where it’s common to pay people to participate.
"Some people have asked why would you pay people, and the answer for us is we really want to do something to thank you for doing something for your community," Butler said.
Will it take forever?
Common in other spheres, routine surveillance screening for COVID is a recent addition to K-12 school settings.
What made it possible this school year was $10 billion in federal funding, $140 million of which is earmarked for Louisiana. The goal is to provide school leaders with a regular snapshot of the extent of coronavirus on their campuses so they can act more quickly to limit its spread among students and staff.
At Cristo Rey, Orion's team of "specimen collectors" shows up every Thursday morning, pulling a cart from room to room. They are in and out in about 30 minutes. During that time, they test all of those on campus who’ve signed up — about half of the students and staff at this small private school. The results are available within 24 hours.
"At first I wondered if it would take forever, but honestly it doesn’t," said Cascio. "They know who has signed up. They get it done in less than five minutes. Everybody’s back in. Nobody is uncomfortable."
Less than two weeks into the new school year, the East Baton Rouge Parish school system has instituted far-reaching changes aimed at curbing t…
Cristo Rey’s school leader, Eric Engemann, said the incentives have helped to steadily draw in more students since the first round of testing in late August. But he said there were misconceptions about how invasive the swabbing process would be.
"It’s like anything else," Engemann said. "If you were nervous about it and you watched somebody else do it, now you feel a little bit more comfortable with it."
Duvic, with East Baton Rouge Parish, said Orion's staff have become faster and more efficient as the school year has progressed.
"There’s very limited missing of class time for the kids now," she said.
In mid-October, Slaughter sent out an email to participating schools with some eye-catching numbers about the "enormous impact" of Orion’s testing program. To illustrate, he shared a simple comparison.
"In our regions, schools located in parishes not participating have had an average of 5.8 times more cases per week than the schools we are testing," Slaughter wrote.
Over a seven-week period, non-participating schools collectively reported 1,326 cases versus 199 at participating schools, Slaughter said. That time frame covered the last week of August, when the delta variant was near its peak in Louisiana, to the first full week of October, when delta was in steady retreat.
Orion serves schools primarily in six parishes: East Baton Rouge, Evangeline, Iberville, Pointe Coupee, St. Landry and St. Martin Parish school districts. It serves just one school, a public charter school, participating in Lafayette Parish. Seven other parishes in the region have no participating schools: Acadia, Ascension, East Feliciana, Iberia, Vermillion, West Baton and West Feliciana parishes.
At The Advocate’s request, Slaughter updated Orion’s numbers to include five weeks of data since that first report. The updated numbers show that the weekly differential had shrunk from 6-to-1 to about 2-to-1. Non-participating schools, which had been seeing about 200 cases a week, were now seeing collectively about 40 cases per week. Participating schools, with already low cases counts of about 30 per week, were closer to 20 cases per week overall.
Orion is one of four providers of COVID testing in schools under contract with the Louisiana Department of Health. LDH’s Butler said she’s seen similar data when looking at schools across the state.
"We have compared participating to non-participating schools," Butler said. "Our percent positivity is lower in participating schools."
Butler, however, cautions that such comparisons run the risk of comparing "apples with oranges" because of differences in the schools being compared. For instance, schools not in the program are having students tested only if they show symptoms of the illness, she said, whereas participating schools are testing all students who sign up, symptomatic or asymptomatic.
Another factor is that many of the participating schools are more strict than other schools when it comes to COVID.
Cristo Rey is such a school. It is not only still requiring mask-wearing even after most schools dropped the practice, it is also limiting class changes to minimize contacts between students and lessen spread.
"We haven’t had a single positive case on campus this year," said Engemann.
By contrast, Cristo Rey was compelled twice last year to shut down in-person instruction and go completely online due to COVID infections on campus. Cascio said she was one of those infections.
"There was a student who got sick and she hugged me and I got sick," she recalled. "She loved me so much she wanted to share her germs."
The East Baton Rouge Parish school system has seen its overall case counts shrink from 151 in late August to just 11 the week before Thanksgiving break. Duvic said COVID has caused much less disruption this year.
"This year we haven’t even had to consider closing a school," she said.
The year, however, is far from over. Based on daily COVID data nationally and locally, plus what he's seeing in his own lab, Slaughter sees signs that Louisiana is in store for another wave.
"You’re seeing it," he said. "It’s coming, it's definitely coming."
Limited interest, future growth
Cristo Rey is one of the schools where Orion has made the most inroads with students. The highest participation of almost 100% has been at Louisiana Key Academy, a charter school in Baton Rouge — that school had mandatory COVID tests last year as part of a research project. The East Baton Rouge Parish schools system rests at about 26% participation overall.
State health officials recommend at least 20% participation, but Slaughter said reaching that threshold has been a struggle.
"Many of the schools in (the Lafayette region) are unfortunately in the single digits," he said.
He said Hurricane Ida, which arrived during the second week Orion was supposed to be visiting schools, also hurt participation.
Orion is trying a variety of promotional efforts to generate interest — "You name it, we've done it," Slaughter said — but he said its best success has been when the school makes a regular push to increase participation.
For instance, Louisiana Key Academy sent parents a text message every week reminding them to sign up and participation steadily increased. He said that showed that parents are more likely to trust the word of school leaders than Orion, but also that you can’t just send one message and be done with it.
"People have a lot going on. You’ve got to give them a lot more opportunities," Slaughter said. "On their priorities of the day, this is not high."
Another factor is when there's a spike in cases.
“We had a school with low participation that had an outbreak,” Slaughter recalled. The outbreak quadrupled the number of cases at the school "and now they are one of our best schools."
COVID testing also may become more commonplace soon because of the Biden administration's proposed vaccine mandate for companies that employ 100 or more people. The proposed rule is set to take effect Jan. 4, but is being challenged in court.
A key part of the rule is that unvaccinated employees would have to undergo weekly COVID testing.
East Baton Rouge Parish has already imposed a similar mandate on its employees, though the district requires all employees, vaccinated and unvaccinated, to be tested; Orion is handling that testing. A small number of other schools have their own local employee mandates in place.
Cristo Rey has many, though not all, employees getting tested at present. The way Cristo Rey is organized, it will fall under the federal mandate, but Engemann said it won’t be hard to comply.
"If that comes down, we’ll have a testing option right here on campus every Thursday morning," he said.
Slaughter said he's already spoken with leaders of several school districts who’ve expressed interest in Orion's services if the employer mandate goes into effect.
"If it’s vaccination or testing, they are going to go with testing," he said.