Nurse Liz Pray set the trend for school-based testing in Moses Lake School District.
Moses Lake School District
It was the end of summer 2021 and the delta variant was starting to surge throughout the US. It would be the most severe version of the disease that we’d seen so far, and hospitalizations were beginning to soar. The monovalent vaccine had been authorized for emergency use for ages 16 and up, but it wouldn’t be available for younger kids until late-September. The previous school year saw closures, hybrid learning, and divided communities.
This was the scenario when Liz Pray left the elementary level to become the sole nurse at Moses Lake High School in Central Washington.
The large campus sits just east of the serpentine Moses Lake and serves approximately 2,000 students in grades 9-12 from the surrounding area. The building had been unusually quiet the previous spring as kids ended the year with a blended learning model: two days of in-person learning per week and three days of remote. But students were coming back full time in the fall, and there was a lot of uncertainty about this change, especially as delta cases increased. Families needed to know that their kids would be safe, and that another school closure wasn’t just around the corner.
When Liz joined the team at Moses Lake High School, her top priority was establishing a COVID-19 testing program. She knew that onsite testing would be critical to curbing outbreaks and sustaining in-person learning during this crucial back-to-school period. She also knew that access to testing was of vital importance to the Moses Lake community.
Moses Lake is a rural area, home to many migrant families who work in agriculture and nearby processing plants, some of the highest risk occupations for COVID-19. Migrant communities had been disproportionately impacted by the pandemic, and Liz felt strongly that school-based testing could open up access to these families and help integrate them into other networks of support.
Moses Lake is a rural area, home to many migrant families who work in agriculture and nearby processing plants, some of the highest risk occupations for COVID-19.
She started advocating for school-based testing that summer, building relationships with administrators at the school and district level and leaning on connections at the Grant County Health Department. Despite some initial pushback in the community, Liz made key partnerships that helped drive testing forward. She credits Sheila Kries, vice principal at Moses Lake High School that year, and Triscia Hochstatter, principal, with helping to implement testing before the start of the school year. With the support of the administration, Liz enrolled in Learn to Return and started ticking off all the prerequisite steps to launching a program.
With Liz spearheading the program and support from the Learn to Return team, Moses Lake High School was able to quickly sign a memorandum of understanding with Grant County Health Department, renew the CLIA waiver for on-site testing, set up their supply pipeline, and start implementing their testing and reporting protocols.
Going into the 2021-2022 school year, Moses Lake High School would be the first school in its district to offer on-site testing for all students and families.
Amy Norton was Liz’s mentor through the 2020-2021 school year. She was the outgoing president of SNOW, the School Nurse Organization of Washington, as Liz was beginning her term as president.
Cindy Welsh, RN!
Cindy Welsh RN, expanded testing access for communities in the north end of the school district.
Jeremy O’Neil, chief operations officer for Moses Lake School District, applied for funds through the DOH Labor Support Fund to add testing staff throughout the district.
Samantha Lara became Liz’s Learn to Return program manager right before the “perfect storm” was about to hit and gave them crucial support throughout this time.
Sheila Kries, current principal at Moses Lake High School, was instrumental in pushing the testing program ahead.
Before Moses Lake High School started testing, community sites in the area were overwhelmed. People had to wait in long lines for up to an hour to get tests. But once word got out that the high school was providing free COVID-19 testing, a lot of people started showing up. Within a couple months, Moses Lake was conducting 200 tests per day for students, staff, and family members. This took the burden off local providers and expanded testing access for the Moses Lake community. Anyone (including those without a direct connection to the high school) could call, text, or email Liz’s team, pull-up in the parking lot at a designated time, and get free, rapid results. Soon, Moses Lake became the largest testing site in the county.
But the Moses Lake School District covers a large geographical area, and Liz would need a network of school programs to ensure access for those furthest from the centrally located high school. Enter Cindy Welsh, school nurse for two elementaries and a middle school in the Larson Community in the north end of the school district. Like Liz, she felt an urgency to provide access to testing for her community members, many of which are migrant families and people whose incomes fall below the federal poverty line. Once Moses Lake High School started testing, Cindy was quick to jump on board. She pushed to implement testing at her three schools despite resistance from some families who thought COVID concerns were overblown. Cindy’s determination opened up access to testing and other support services for families in the Larson Community and surrounding areas.
Liz ended up recruiting Cindy to come work with her at Moses Lake High School. Cindy’s tenacity and drive to increase access made her the perfect person to support ongoing efforts within the school district.
The success of the programs at Moses Lake High School and the Larson Community schools motivated others to follow suit. By late fall, most schools had launched an onsite program, and a central district site had been established. But schools needed more boots on the ground to run these programs.
Liz’s colleague, Jeremy O’Neil, chief operations officer for Moses Lake School District, applied to the DOH Labor Support Fund to pay for additional testing staff. He worked with a local agency to place 11 staff at different schools throughout the district. With these staff in place, the district-wide testing programs were running smoothly and could manage steady the demand for tests.
Moses Lake School District covers a large geographical area, and Liz would need a network of school programs to ensure access for those furthest from the centrally located high school.
Open communication with the school community was essential to building trust with families and getting them to buy into the testing program. The Nurse’s Nook page on the Moses Lake website became the centralized repository for all information related to testing and COVID-19 management at the high school. Anytime WIAA or DOH guidance changed, Liz and her team would update the site. Any time the MOU with the health department had to be revised, they’d add it to the site. They included everything that had to do with testing: consent forms, symptoms to watch out for, guides for administering the tests, symptom decision trees, and a COVID-19 dashboard that tracked the number of positive cases among students and staff. Liz wanted families to have every bit of information that she had so that they could ask the right questions and make informed decisions.
She also made herself available for one-to-one conversations about testing and other safety strategies. She learned that high school students can help set the tone in the community when it comes to controversial issues.
Masking at Moses Lake.
Many families in Moses Lake were not excited about school masking mandates. In fact, Liz estimates that up to half of the families they serve expressed frustration or opposition to masking. But her philosophy of open and direct communication with the students helped mitigate this pushback. She believed in frank conversations with students about why masking was important. She would tell a student, “You’re not just wearing a mask for yourself, you’re wearing it for the person next to you in class; you’re wearing it for their family member who may be immunocompromised.” At the high school level, Liz says, you can have these conversations with students, and it will end up having an impact on how their families approach the issue. “The students are old enough to do the research and make decisions for themselves,” she says, “and they can communicate why they are making those decisions to their families.”
Moses Lake also maintained stocks of PPE so that all students could have a fresh mask (or multiple masks) everyday as needed. This took the burden off families to provide masks for their students and gave families who opposed masking a little less to focus on. The administration team at the Moses Lake High School used this opportunity to connect with students at the building entry points, hand out masks, and answer questions. By doing this, it helped ease the minds of students who were entering the building for the first time.
A perfect storm.
By December, the testing program at Moses Lake was running like a well-oiled machine, winter sports teams were testing three times a week, and the school community knew they could rely on tests when they needed them. Moses Lake was serving a large part of the community and getting supplies by the pallet to keep up with demand. But a new phase of the pandemic was about to begin that would push the testing program to its limits.
Omicron wasn’t just another variant; it began a new lineage of the virus that was much more transmissible. The variants in circulation today are the sub-lineages of Omicron, and they’re the reason the bivalent boosters were developed. In late 2021, the country was about to experience the biggest wave of COVID-19 and unprecedented levels of hospitalization and death. The need for testing was never greater.
But just as Omicron was starting to surge in mid-December, the nationwide testing supply chain broke down. A combination of events including reduced supply, winter weather, and skyrocketing demand froze the pipeline for several weeks. Schools immediately felt the impact.
Then, around the end of December, a massive snowstorm hit Central and Eastern Washington, shutting down supply routes across the region. Even as supplies became available in Western Washington, the pass to get to Moses Lake remained closed. Schools in Central and Eastern Washington felt the effects of the supply shortage longer than their counterparts in the western part of the state.
As cases surged that winter and inventory dwindled, Liz and her team scrambled to find tests. She reached out to community partners and the health department seeking extra stores of rapid tests. Some of these groups couldn’t honor the expiration extensions that had been approved by the FDA and DOH, but schools could. They stockpiled as many donated tests as possible, using those that were closest to their extended expiration date first. This stopgap helped them sustain testing for the school community through the winter. Liz and her team did everything they could to provide tests, masks, and timely information to families until their testing pipeline could be fully restored.
“The thing that kept me going at that time,” Liz recalls, “was knowing we had to keep kids safe and in school. When they’re here, we at least know they’re safe, warm, and fed.”
In January, DOH allocated testing inventory to ESDs who then managed distribution to their schools over the next several weeks until the supply chain could be repaired. Moses Lake was able to get supplies again when they needed them, but it took several months for things to get back to normal.
Reflecting on this challenging time, Liz feels grateful for her Learn to Return program manager, Samantha Lara, who started working with Liz at the end of 2021: “We wouldn’t have made it through all of this without her [Samantha]! She was amazing, especially coming on during the craziness of that winter. She stuck it out, and I’m glad she did.”
Liz speaks enthusiastically about life at Moses Lake High School these days. She sees kids returning to a normal day-to-day routine, getting back to their social groups, and participating in extracurriculars. They only have one to two COVID cases a month and feel prepared for any shocks to the system that might arise. She and Cindy lead a strong health care team at Moses Lake and have continued to educate students about why some people continue to mask at school. Testing has also been expanded in the district to include the BD Triplex test which can detect both COVID-19 and Influenza A/B.
Liz says you really need a trendsetter, someone who has a clear North Star, to help move things along during times of uncertainty. For her, it was testing for students and families so that they felt empowered to go back to school during some of the most trying times of the pandemic.