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Demand for COVID Tests Overwhelms N.H. Parents, Schools and Healthcare Workers

BeckieKelliherandHollyMintz
Sarah Gibson
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Beckie Kelliher (left) and Dr. Holly Mintz (right) say calls to Elliot Health System's pediatric practices have tripled since school started. Many of these are related to COVID-19.

On a recent morning, Kelly Chausovsky got a call from the school nurse at her daughter’s Bedford middle school. Her daughter had a headache, one of the 11 possible symptoms of COVID-19 listed by the Centers for Disease Control and Prevention (CDC). Her daughter needed a COVID test before she could return to school, and Chausovsky had to get it for her.

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But finding a test proved difficult. “There was not a single appointment I could find anywhere within thirty miles of me,” Chausovsky recalls. “I was looking in northern Massachusetts. I was willing to drive to get this girl tested.”

Chausovsky’s pediatrician was booked for days. All the stores nearby were out of rapid at-home tests. And drive-through testing was also out of the question.

Chausovsky eventually booked one of the last appointments at a nearby urgent care clinic, and her daughter’s test was negative. But her family’s experience is becoming common.

School nurses are doing their best to follow public health guidance: sending students home if they have a new, unexplained symptom of COVID-19.

In most cases, they aren’t allowed to return to school until their symptoms improve and they get a negative COVID-19 test. But with a shortage of health care workers and at-home rapid tests, New Hampshire is struggling to meet the demand for COVID tests. The lack of tests means missed class time for kids, missed work for parents and overwhelmed health care workers.

Screening algorithm from NH DHHS.PNG
New Hampshire Department of Health and Human Services
Most school nurses in New Hampshire are following this algorithm from state health officials for dealing with potential COVID cases.

Jeanna Lopez Carrasco, the head nurse of the Nashua school district, says school nurses don’t yet have access to rapid antigen tests, which are relatively accurate with symptomatic cases. For now, most of their time is spent monitoring COVID symptoms and deciding who to send home for a COVID test.

“It’s a lot of pressure,” she says. “I’m sure some of my nurses try to go home not crying.”

Most of the students whom Carrasco sends home come back with a negative test. She says until there’s widespread vaccination, this level of caution is necessary, but there’s a cost. Parents are frustrated. Many can’t afford the test. They’re calling Carrasco for help.

“One mom said to me the other day, you know, just going to Convenient MD, they’re charging $175,” Carrasco says. “It used to be that public health [departments], when we were mid-COVID, had free clinics. Now there aren’t those free clinics anymore, which makes it a hardship.”

A lot of the state’s free public testing sites closed this year. Tests are technically available across the state in pharmacies and at clinics and hospitals. And the state has also used federal funding to set up a program specifically for testing in schools.

But so far, only about a third of schools are enrolled in it. Other districts, including Nashua, are in the process of joining it a month into the school year.

But in the meantime, the mounting demand for tests falls on urgent care facilities and clinics.

Elliot Health System, which serves Manchester and surrounding areas, estimates calls to urgent care and pediatric clinics have tripled in the last month. Many of these are related to a patient with COVID symptoms. And many of those are kids who need a COVID test before returning to school or daycare.

Beckie Kelliher, the clinical nurse manager at one of Elliot’s pediatric clinics, says her triage nurses can’t keep up with the calls.

“They’re burnt out. They’re tired. They’re working long hours,” she says. “They’re dedicated to patient care and it stresses them out to not be able to get to patients in what they consider a timely matter.”

Dr. Holly Mintz, chief medical officer of Ambulatory Services for Elliot Medical Group, says the issue for Elliot Health System isn’t a shortage of testing materials; it’s a shortage of staff. They have about two-thirds the staff they need in normal times, let alone to manage the pandemic.

SARS antigen tests.jpg
Sarah Gibson
Elliot Health Systems uses both PCR and rapid antigen tests, depending on the presence and length of COVID-19 symptoms.

At Kelliher’s clinic, three antigen test analyzers spit out results from all the rapid tests in that office. Mintz says they’re lucky to have three analyzers here; some clinics only have one. Nearby, an assistant in head-to-toe PPE puts PCR test tubes in a cooler to get picked up later that day. Mintz suspects the assistant has been taken from another essential task to administer tests.

“You could say: ‘Why can’t you designate four people and do four times the testing?’ But then there’s nobody left to do all the other things that patients need right now: Well child checks, immunizations of children, sick visits that are unrelated, follow-ups for chronic diseases,” she says. “Those things need to be taken care of too.”

Mintz says the state and schools are working actively to expand testing. But with COVID transmission expected to increase this fall, and mask-optional policies continuing in many school districts, Mintz expects the need for tests to persist.

To meet demand this week, Elliot Health Systems is trying to expand hours of operation. And with its limited staff, that means more people will have to work 12-hour days.

“It’s a fine balance of trying to meet the community need and not completely burn out all the providers and all of the staff,” Mintz says.