Tension, timing mark advent of school testing program
Women who worked to bring COVID testing to Aspen School District met by hesitation from Pitkin County
The efforts of a group of local women to bring serial COVID-19 testing to the Aspen School District a month ago unquestionably opened the floodgates for more widespread testing now available in Pitkin County.
To some, the success of those efforts implied that the county sat on its hands doing nothing about testing for months when all this group of women had to do was ask in order to finally bring more capacity to the area. That narrative, however, is untrue, according to county officials and emails obtained by The Aspen Times under an open records request.
“I’ve spent thousands of hours trying to get testing for this community,” Pitkin County Public Health Director Karen Koenemann said during an interview with The Times last week. “I think the more testing we can have is better for our community. We tried our best to support the schools in their goal to have in-person learning. But the landscape was shifting under our feet.”
The Aspen School District, instead, appears to have benefited from good timing, rapidly changing state mandates and a sizable pile of federal largesse that must be spent on COVID mitigation before the end of the year, not to mention the industriousness of the group of women affiliated with the district.
But for three of those women – Katy Frisch, who serves on the Aspen School Board, Pitkin County Board of Health member Dr. Jeannie Seybold and health board alternate Dr. Christa Gieszl – Pitkin County Public Health officials initially appeared to be unsupportive of their efforts to bring testing to the schools.
“The county comes in all of a sudden, from our point of view, and totally puts the kibosh on it,” Frisch said. “They had every reason why we couldn’t do it. The big question is why is there no asymptomatic testing from Pitkin County Public Health?”
Aspen Superintendent David Baugh said he also wondered why local public health officials weren’t advocating for serial asymptomatic COVID testing in Pitkin County, especially when it appeared to be so readily available.
“I was surprised at how easy it was to get testing when you just asked for it,” he said. “That continues to blow me away.”
However, Baugh said he didn’t feel like local public health officials pushed back against the school district’s testing proposal, though they were concerned about having enough manpower to trace a surge in positive cases the program was expected to turn up.
“They didn’t say, ‘We don’t want you to do it,’” Baugh said. “They said, ‘You can do that.’ They wanted us to work closely with them. (But) they were very concerned we would find a lot of positives they would have to contact trace.”
LOCAL TESTING A STRUGGLE
Part of the larger story behind the Aspen School District’s serial COVID-19 testing program is an oft-heard feeling among county residents that testing availability here has been lacking throughout the pandemic. People who traveled elsewhere – Denver, Los Angeles, Santa Fe, even Grand Junction and Leadville – found that anyone could get a free test in those places at anytime without any hassle about a doctor’s prescription.
“There is a lot of demand in our community and too many people who are dissatisfied with the paucity of testing here when it is easy to get a free or affordable test in so many other locations in Colorado (Leadville, Denver, etc.),” Seybold wrote in a Nov. 3 email to Pitkin County officials. “I have heard from people who have had mild symptoms and still had trouble getting tested at (Aspen Valley Hospital).
“Some individuals have resorted to a local (nurse) who charges $350 to test you at your house. This is only a resource for the wealthy.”
Local nurse Bari Ramberg, who was instrumental in getting the ball rolling on the school testing program, said she believes every U.S. citizen has the right to be tested for free and “know what they are sick with.” Pitkin County residents, by and large, did not have that option, she said.
“All my friends were struggling to get tests here,” Ramberg said.
Frisch said her impression of the testing situation in Pitkin County was the same.
“For the first seven (or) eight months (of the pandemic), testing was just not available in town,” she said.
Pitkin County officials and Aspen Valley Hospital CEO Dave Ressler have disputed that charge. They say the county has been able to conduct adequate testing over the course of the pandemic for people with symptoms and those who have possibly come into contact with them.
“We’ve had (symptomatic) testing in the community for a long time,” Koenemann said. “That’s the strongest disease containment strategy.”
However, that’s not to say local public health officials weren’t trying to expand testing availability here, including eliminating the doctor’s prescription necessity that was a barrier for many, she said.
In fact, Peacock said Pitkin County had been asking for testing support from the Colorado Department of Public Health and Environment since March to no avail. The state paid for the establishment of testing sites in Denver and Grand Junction (Leadville is a bit of a mystery) first because those are larger population centers, he said.
“There’s this perception that we are Manhattan or L.A.,” Koenemann said. “We are a rural community that was not getting prioritized (for testing).”
It simply took awhile for widespread testing to become available in rural areas like Pitkin County, which has just under 18,000 residents, Peacock said.
“If we had had a good solution that was accurate and readily available, that’s what we were looking for,” he said. “But that’s not the world we’re in.”
The testing world for Pitkin County finally began to come into clearer focus in September.
That’s when the state of Colorado finalized a contract with Curative Inc., the L.A.-based COVID-19 testing company Ramberg visited in October, Peacock said. Public health directors in rural counties across the state received an invitation Sept. 15 from two state public health officials to a virtual meeting about the new Curative tests, according to an email to Koenemann obtained by The Aspen Times through a Colorado Open Records Act request.
“We are ready to send out our first 45k Curative COVID-19 Test Kits,” Sarah Tuneberg, leader of the state’s Coronavirus Innovation Response Team, wrote at the time. “Hooray! We are prioritizing distribution to Colorado’s rural and frontier (local public health agencies).”
The Google meeting invitation also included a spreadsheet detailing each county’s allocation based on 5% of its population. Pitkin County’s share was 900 Curative tests, according to the spreadsheet.
The county received those tests, which state public health officials said needed to be used to serve “underserved” populations, like residents who were uninsured, underinsured, high-risk or migratory workers, Peacock said. The county worked with AVH and Mountain Family Health to distribute those tests, which eventually was done through the hospital’s primary care facility in Basalt, he said.
Meanwhile, in early October Ramberg traveled to Los Angeles, where she took a free Curative test at a drive-through test center run by the company. The whole process required no human interaction – she was able to saliva swab herself – about five minutes time and she had the results on her phone before she woke up the next morning, she said.
Ramberg said she wondered why such a thing wasn’t available in Pitkin County. So when she arrived home, she called Curative in L.A., where a company official said they’d be happy to set up testing here, she said. Then she called the state public health department and spoke with Ian McMahon, who was then the COVID containment deputy director for policy and practice, and another department official who gave her unexpected good news.
“The state said, ‘Whatever you need,’” Ramberg said. “’We will get you Curative tests – as many as you need. We were like, ‘OK.’ And we were off and running. It took me two weeks to do all of that.”
COLORADO’S FIRST PUBLIC SCHOOL SCREENING
Seybold sent an email Oct. 23 to Koenemann, Peacock, Ressler and others saying she and Ramberg had been in touch with Curative and McMahon.
“Ian can send as many Curative tests as our community needs and set up a free testing site in our community ASAP,” Seybold wrote in the Oct 23 email.
A confused Koenemann responded less than 20 minutes later.
“… (Since) we are already working with Ian, I am curious as to his offer to set up a free testing site and provide as many tests as needed – as so far, all of that responsibility has fallen to the local community,” she wrote, “and we haven’t gotten any confirmation that we will be receiving any more than the 1,000 already allocated to us thus far.”
Twenty minutes after that, Seybold confirmed that she and Ramberg had spoken to McMahon that very afternoon, when he told them CDPHE’s next step was to “set up sites in our valley with more than the already supplied 1,000 tests …” according to the email chain.
In addition to being told that the 1,000 tests was all they’d receive and that they would have to be used for underserved populations, Pitkin County had also been told that Curative tests had not been approved for asymptomatic testing under an emergency use authorization granted by the FDA, Koenemann said.
She relayed that fact to Seybold, Superintendent Baugh and other school district officials in an Oct. 25 email, after Seybold told her the district wanted to proceed with testing school staff and students. At the time, Koenemann also volunteered to reach out to McMahon at CDPHE for the Curative test kits the school district wanted, and asked how many they wanted and how often they wanted them, according to the email.
School district and county public health officials met Oct. 28 to try to get on the same page. Pitkin County Deputy Public Health Director Suzuho Shimasaki summarized what district officials told them about the school testing program in an email that same night to Tuneberg and McMahon at CDPHE.
She said the district was “under the impression” the state public health department would provide 1,850 Curative tests per week through the remainder of 2020, with an extra 1,850 provided the week after Thanksgiving. In addition, the district said it was allowed to use the Curative tests for asymptomatic testing and didn’t need to be saved for marginalized or underserved communities, according to Shimasaki’s email.
McMahon responded within half-an-hour, saying that Curative tests were allowed to be used for serial asymptomatic testing and that “we were explicit that marginalized communities and underserved populations are a priority for the state’s community testing efforts,” according to the email chain.
However, he disputed the number of tests the state promised the district.
“This was never agreed upon,” McMahon wrote. “We discussed the ability to do serial testing using Curative – the initial round of testing for the school teachers, staff and students was fine, but that more would need to be discussed with all stakeholders (you, us, them, Curative) for any ongoing testing utilizing the state’s agreement with Curative.”
That same night, Seybold wrote an email to McMahon saying the school district was beginning the new testing program and working on a press release about it.
“We are excited to launch the first public school screening in Colorado on Friday of this week,” Seybold said on Oct. 28. “We are delighted that the state is supporting our weekly screening of students and staff to keep our public schools open. Please add in your comment about the level of commitment (almost 2,000 Curative tests a week!).”
About an hour after McMahon responded to Shimasaki, he wrote back to Seybold.
“I apologize but it seems like we have a disconnect here,” McMahon wrote. “We were under the assumption that this was being more closely coordinated with local public health, especially the pieces about the ongoing testing in schools and the broader community.”
A week later, the state backtracked on providing unlimited Curative tests solely for the school district. McMahon also left his job not long after, and his replacement sent a follow-up email saying the district could have as many of a different kind of COVID test that district officials did not like, Baugh said.
Frisch, Gieszl and Seybold said they couldn’t believe Pitkin County Public Health officials seemed to be against serial asymptomatic testing, especially when it had been shown as a way to keep kids in school.
“That’s the elephant in the room,” Seybold told The Times in late November. “I don’t know (the answer).”
Frisch said she made a strong case for keeping schools open.
“Our whole economic system is tied to kids being in school,” she said. “The community cannot function unless kids are in school. Remote learning doesn’t work for little kids.”
In addition, Frisch, Seybold and Baugh said in separate interviews they got the somewhat Trumpian impression that local public health officials didn’t want more testing because that would turn up additional positive cases and influence statistics and contact tracing efforts.
“We heard a lot of, ‘If we test (more) people, our numbers will go up,” Frisch said.
Indeed, Koenemann told Seybold in an Oct. 23 email – when the school testing program was first proposed – that manpower was an issue.
“We just don’t have the bandwidth … to do more than what we are currently working on, which is expanding testing capacity by 2-5 new sites and up to 8 major employers,” Koeneman wrote in the email.
However, both Peacock and Koenemann said during interviews last week it wasn’t that they didn’t want to know about new positive cases, it was that they wanted to be prepared for them.
“I wanted to understand how serial, weekly testing … would impact contact tracing,” Koenemann said. “I was trying to figure out the impact to our team. We weren’t like, ‘No you shouldn’t do this.’”
The testing happened the week of Nov. 1 and 190 individuals — mainly adult staff and faculty members — were tested that Tuesday as well as hundreds of students that Friday. Of those tests, one came back positive for a district staffer and one positive for a student.
District officials offered to hire a contact tracer, though the county has a dedicated contact tracer for both Aspen and Roaring Fork school districts, she said. County public health officials preferred that the district use county tracers, though the district decided to go ahead with the hire anyway, Koenemann said.
Peacock said the county also wanted to make sure that it had access to test result data from the school program, and that students, staff and parents would follow all isolation and quarantine orders that might follow a positive test.
Beyond that, county officials were learning from school district personnel about the availability of thousands more state-funded tests than they’d been told were available, Peacock said. That lack of knowledge about the changing state mandates “makes us look bad,” he said.
“That the community says, ‘What gives?’ I get that,” Peacock said.
Frisch and Baugh both said county officials appeared surprised they could get more tests during a conference call in late October with state public health officials.
“Pitkin County was on the call with us and they were startled there were so many tests available,” Baugh said. “My impression was they’d asked (for more testing) and heard, ‘This is what you get.’ I think the state changed the landscape.”
The confusion on the part of county public health officials, coupled with efforts to make sure the school testing program was administered and reported correctly, may have been mistakenly interpreted by Frisch, Seybold and others as push back, Koenemann and Peacock said. It was not meant to be adversarial, they said.
“When they (first) said, ‘We’re going to do 2,000 tests week for free,’ we were a little skeptical,” Peacock said. “I give credit to these three ladies at the school district for getting this going. Their timing was certainly great.”
Koenemann said the county has never refused any testing support from the state.
STATE’S PIVOT ‘THE REAL STORY’
Emails among Peacock, Koenemann and school district officials back up their statements about their attitude toward the school testing program, laden as they are with concerns about how the school district program would be run and no statements forbidding the program.
“We weren’t putting up barriers, we were following the rules,” Koenemann said. “We were being told this is what you’re to do and all of a sudden we’re being told something different. It was very confusing.”
Moreover, they emphasized that they have nothing against asymptomatic testing in Pitkin County.
“Our mission is to stop transmission,” Koenemann said. “That’s what this is all about – to contain the disease. If the school district testing will help stop transmission, we are in complete support of it.”
As for CDPHE, a spokeswoman said in an email last week that the agency is “grateful” for its Aspen relationships and “proud” of being able to supply testing materials here. Curative testing has been made available to all “rural and frontier counties” in the state using a population based formula, said Gabi Johnston.
“As those tests are used, (local public health agencies) are able to reorder Curative supplies,” she said in the email. “Additionally, at the request of the Aspen Public Schools, CDPHE provided an additional 4,000 Curative tests for surveillance testing.”
The county ended up requesting 14,000 Curative tests from the state and had received 8,500 by last week, Peacock said. In addition to the free testing site in Basalt, Pitkin County and the city of Aspen started a free testing site behind City Hall in downtown Aspen that also uses the state-funded Curative tests. The county is also sharing the Curative tests with the school district, which will continue school testing as needed through the end of the year.
“The way the state pivoted is the real story,” Peacock said in an interview last week. “This all changed in a few days. It was a pretty big pivot in a short period of time.”
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