Every week, students at KIPP Infinity Middle School, in West Harlem, file into a large auditorium and take their places on the designated floor markings, making sure to stand six feet apart. Then they pull down their masks and fill sterile tubes with their spit.
The school’s teachers try to make the experience fun, running competitions to see who can fill their tube fastest and holding dance contests while students wait for their classmates to finish.
“It’s kind of enjoyable,” said Bradley Ramirez, a seventh grader at the school who likes math and Minecraft. “It’s way better than just sticking a stick up your nose.”
Bradley and his classmates are participants in a coronavirus testing pilot program created by the Mount Sinai Health System, the nonprofit Pershing Square Foundation and KIPP NYC, a network of 15 local charter schools. Since early March, the program has conducted more than 13,000 saliva-based tests of KIPP students, teachers and staff members, identifying several dozen cases of the virus.
Now Mount Sinai and Pershing Square are hoping to expand. On Tuesday they announced the Mount Sinai Covid Lab initiative, inviting additional charter schools, as well as local businesses and organizations, to sign up for the saliva-based testing program. They are putting the finishing touches on a new laboratory that they say will be capable of processing as many as 100,000 coronavirus tests a day and are preparing a formal proposal to take the program to New York City’s public schools this fall.
The announcement comes the day after Mayor Bill de Blasio said that the city planned to fully reopen schools, eliminating remote learning, in the fall.
“The way you keep a school safe, the way you make teachers feel comfortable with the reopening of schools, the way you make parents feel comfortable sending their kid, is you have a testing program,” said William A. Ackman, a hedge fund manager who founded the Pershing Square Foundation.
The testing program originated in December, when Mr. Ackman decided that he wanted to find a way to get New York City children back to school and approached Mount Sinai with a proposal: What if he provided funding for the hospital to build a laboratory that could process 100,000 coronavirus tests a day? The hope was that the lab could devote some of that capacity to corporate clients, such as businesses that wanted to test their employees, and use the revenue to fund wide-scale testing for New York City schoolchildren.
Mount Sinai quickly agreed. “We began on a concerted effort that people at Mount Sinai have really rallied around,” said Dr. David Reich, president and chief operating officer of Mount Sinai Hospital. “It’s just one of those projects where you never have to worry about people wanting to show up for your Zoom meeting — they’re all there, and they’re all smiling.”
The Pershing Square Foundation, whose trustees are Mr. Ackman and his wife, Neri Oxman, agreed to provide $20 million, and Mount Sinai began to convert an old laboratory space at its downtown campus into a high-volume coronavirus test processing center.
At the time, scientists at Mount Sinai’s Icahn School of Medicine were among a number of groups across the country that were working to develop saliva-based coronavirus tests. The gold standard diagnostic tests are known as P.C.R. tests, which can detect even minute amounts of the virus in biological specimens. During the early months of the pandemic, these tests generally required medical professionals to stick a swab deep into a patient’s nasopharynx, a procedure that can be deeply uncomfortable and put clinicians at risk.
Saliva-based P.C.R. tests, many scientists came to believe, would be safer and less invasive. They would also be much more suitable for young children than the deep, nasopharyngeal swabs. “A brain scoop, for a kid? Really? That’s a no-no,” said Dr. Alberto Paniz-Mondolfi, a pathologist at Mount Sinai who led development of the new saliva test.
As the partnership between Mount Sinai and Pershing Square began to take shape, Dr. Paniz-Mondolfi and his colleagues accelerated their work, validating their saliva test in 60 adult patients. But they knew that in the real world, children could not always be relied upon to follow clinical procedures to the letter.
“When we start getting this from the schools, we’re going to have pieces of pretzels, old gum floating in the saliva,” Dr. Paniz-Mondolfi said.
So Dr. Paniz-Mondolfi and his colleagues asked their own children to make a sacrifice for science: to snack on an array of junk food, including pizza and Oreos, and then spit into some testing tubes. Using these samples, the researchers confirmed that even if a student’s sample was contaminated with one of these foods, the tests should still work properly.
“This was practical science, designed by parents to get their kids back to school,” Dr. Paniz-Mondolfi said.
Then it was time to pilot the tests in a real school environment. In January, Mount Sinai connected with KIPP NYC, which had been offering remote instruction since last spring. But it was hoping to reopen its schools in March, and administrators knew they would need to do some kind of in-school virus testing.
“One of the biggest fears that we had was around what it would mean to keep students safe,” said Glenn Davis, the principal of KIPP Infinity Middle School.
Mount Sinai and KIPP NYC agreed to begin a pilot saliva-testing project at five schools. The testing program, which eventually grew to include nine KIPP schools, was free for the schools and mandatory for all students who opted to return to in-person learning. (Some families chose to continue with remote education.)
Students, teachers and staff members are tested once a week. Medical assistants from Mount Sinai supervise the saliva collection and pack the bar-coded tubes into coolers for transportation back to the laboratory. (The samples are currently being processed at an existing Mount Sinai lab, but will be sent to the new lab when it opens next month.)
During the pilot project, 99.2 percent test results were returned within 24 hours, Mount Sinai says. Students or staff members who test positive typically have to quarantine for 10 days.
If a student tests positive, Mount Sinai also offers to send a team of “swabbers” to his or her home to administer free coronavirus tests to their family members and close contacts.
“We’ve detected a few mini outbreaks in that fashion, and hopefully prevented them from spreading by virtue of this screening program in the schoolkids,” Dr. Reich said.
Between March 10, when the pilot project began, and May 9, Mount Sinai conducted 13,067 tests and identified 46 coronavirus cases, a positivity rate of 0.4 percent. There have been no false positives and no known false negatives, Mount Sinai says.
The Mount Sinai team has submitted the data to the Food and Drug Administration, hoping to receive an emergency use authorization for the test.
Later this week, Mount Sinai will submit a formal proposal to New York City to take its testing program to the city’s public schools when they reopen in the fall. Mount Sinai declined to disclose the terms of the proposal, including what it plans to charge schools for the tests, but says it hopes to attract commercial clients to help defray, or possibly even eliminate, costs for schools.
In the meantime, it is approaching other charter school organizations in the city about using its tests during their summer sessions and programs.
“We can’t just sit there when this lab goes live in June and say, ‘OK, we’re waiting for September,’” Dr. Reich said. “Before the fall, we need to be doing a lot of tests.” The lab will initially have the capacity to run 25,000 tests a day, with the ability to scale up to 100,000 if there is sufficient interest.
For its part, KIPP NYC plans to expand the program to all of its schools in the fall, although the testing frequency may change, said Efrain Guerrero, managing director of operations for KIPP NYC. “I think parents see it and staff see it as just an additional safety measure that they appreciate,” he said. “For us it’s a no-brainer to continue to test at some frequency.”
Olga Ramirez, Bradley’s mother, had not initially wanted him to return to in-person learning. “I was very afraid at first,” she said. But Bradley, who desperately wanted to go back to school, managed to convince her, with the help of an informational video about the Mount Sinai testing program.
Ms. Ramirez now thinks that returning to school was the right decision. Bradley’s virus tests have all come back negative, and his grades are up since returning to in-person learning.
“I’ve seen his grades improve quite a lot, and I feel that my son is in good hands,” she said. She’s not alone, she added. “There’s so many mothers who are feeling the way I do.”
Elda Cantú contributed translation.