COVID-19 Testing
Tips to ensure a safe, seamless, and cost-efficient program
By Jeff Boschwitz
Running a summer camp is very rewarding. That said, it’s also a worry-inducing, energy-draining, survive-each-day grind of ensuring each child is happy and healthy from the moment of arrival until the last high-five of the season. For better or worse, taking on the role of parent has always been the name of the job.
Photo: © Can Stock Photo / alexbowmore
And then the pandemic happened.
For many camp operators, 2020’s toughest moment was hitting “send” on that email announcing that camp—filled with summer-defining traditions small and large—would be canceled. Those camps that did open saw mixed health results for campers and staff members, and often a vastly altered experience.
In the midst of a more hopeful 2021 season, the key to ensuring summer camp feels as “normal” as ever lies in the design and effectiveness of specific COVID-19 testing regimens. Vaccines are only approved for those 16 years old and older. While many counselors may be vaccinated, odds are your campers aren’t. And just having testing isn’t enough. It must be a program that fits your specific environment.
If you're responsible for COVID-19 safety at a sleepaway or day camp, asymptomatic testing—testing the broader population of people on camp grounds rather than those who exhibit symptoms—should be a key strategy in reducing the spread of the virus. It's important that asymptomatic testing is carried out widely and frequently so infected employees or campers are identified and placed into quarantine.
The implementation of regular COVID-19 testing is new territory for camps, so having a program that is reliable, seamless, and efficient to manage will help ensure a fun summer-camp experience is also a safe one.
What Type Of Testing Is Right For My Camp?
For those who choose to test campers, the first step to implementation is deciding which type makes more sense, PCR or rapid antigen.
PCR (polymerase chain reaction) testing works by amplifying the genetic material of the COVID-19 virus and is widely used for most infectious-disease testing. In fact, the Centers for Disease Control (CDC) refers to PCR testing as the “gold standard” because it is the most sensitive/accurate testing method available to detect COVID-19 (and most other respiratory pathogens). The primary disadvantage of PCR testing is it typically must be performed at a central laboratory, and results can take two to three days to receive, during which time an asymptomatically infected person can unknowingly spread the virus.
The rapid-antigen test works by using antibodies in the test kit to detect viral proteins. Results are typically received within 15 minutes, which works to greatly limit unwitting viral spread; however, research shows that rapid-antigen tests are significantly less sensitive than PCR tests. As a result, many more campers with COVID-19 will go undetected by the rapid-antigen testing method.
The tradeoff between result speed and accuracy leans toward PCR, if the camp can get results back the day after collection. That means finding a laboratory within courier distance of the camp (150 miles typically) and one that is willing to guarantee in-lab turnaround time of 24 hours or less for a reasonable price. If not, then rapid testing may prove more advantageous, especially if serial rapid-antigen testing can be employed for a reasonable cost (i.e., giving multiple tests within a short time window).
And, of course, the level of risk in camp should also play a role in determining testing type. Higher-risk camps should lean towards the more accurate PCR tests.
Minimizing Cost
Rapid testing is often less expensive than PCR testing, although use of serial testing may neutralize that advantage. However, there are ways to make a PCR-testing program cost comparable to rapid antigen.
Although it is not widely known, the high cost of testing is driven in large part by the cost of sample collection, since most organizations don’t want to administer swabs themselves. So-called “testing agencies” that opened during the pandemic often perform the collection and contract with a laboratory to do the testing. This model results in charging the customer two times (or more) the laboratory price.
However, most laboratories have their own collection programs customized specifically for organizations, including camps. Contracting directly with a laboratory for testing will typically reduce PCR-testing costs.
The testing expense can be further reduced by using saliva as the specimen type. Saliva can be self-collected by children (under observation by a camp employee), reducing PCR-testing costs to $55 or less when working directly with a laboratory instead of through a third party, even for 24-hour, in-lab turnaround time. A recent report, published in the Journal of the American Medical Association (JAMA), strongly supports the use of saliva for COVID-19 testing, and many school systems across the country have already turned to saliva testing.
With saliva testing, the collection process is faster than it is for nasal swabs, meaning there is less disruption to the day. A person drips a small amount of saliva into a tube while being observed by a trained camp employee. Individuals cannot eat, drink, smoke, or chew gum for 30 minutes before providing a sample. This method also greatly reduces the testing fatigue that often comes with repeat testing that uses a more invasive swabbing method.
Photo: © Can Stock Photo / SeventyFour
Frequency Of Testing
How often a camp’s population should receive testing depends on the number of people a camper or employee interacts with and the duration of the interaction. The CDC categorizes the risk of COVID-19 spread in camp settings into four groups:
The lowest-risk group includes small numbers of campers who stay together daily, without exception. These children and teens should keep a distance of at least six feet, not share objects such as sporting equipment, and prioritize outdoor activities over indoor sports and events. Campers in this group also hail from the same geographic area (county, town, city, etc.)
The next risk level includes campers who mix between groups but who also maintain social distancing of six feet, do not share objects, and who also prioritize being outside. The campers in this risk category also are from the same local area.
Those in the “even more risk” category are campers who mix between groups but are not social distanced. They are, however, from the same local community, city, or county.
The highest-risk category comprises those children who come to camp from various geographic areas, mix between groups, and do not social distance.
While daily testing is ideal, it is cost prohibitive for most camps. Twice weekly testing is used in many workplace settings and colleges, and will greatly reduce spread in higher-risk camps. Lower-risk camps may be able to get by with weekly testing.
Managing Test Administration
The logistics of sample collection can seem insurmountable. To help make this necessary task as easy as possible for camps, look for partners who make the entire process paperless and will minimize the burden on you. Analyze how tests are ordered, collected, and resulted. Also, ensure there are simple-to-use tools to make COVID-19 testing management easy for camp administrators, most of whom are asked to wear the unfamiliar and daunting hat of COVID-testing coordinator. This can include customizable, electronic dashboards to manage the testing and calls for all positive results.
If you go the PCR route, it's also essential to ensure the camp partners with a professional and experienced lab, with staff members who understand the regulatory guidelines and operational challenges of running a high-throughput, rapid-turnaround time operation. Be cautious of start-up labs launched during the pandemic or pre-pandemic ones that are small businesses. If you work through a third party for collection, ask what laboratory is used, and research its pre-pandemic history.
Having a comprehensive testing program in place at camp this summer can give parents and guardians peace of mind while their children and teenagers return to having a fun, tradition-filled summer.
Jeff Boschwitz, Ph.D., is the general manager of New York-based Acupath Laboratories, Inc.'s COVID-19 testing business. Dr. Boschwitz is a 25-year life sciences veteran with over 10 years of operations and sales senior executive experience at small and large laboratories, including Quest Diagnostics. He can be reached at jboschwitz@acupath.com.