Yale Daily News

After a monthslong struggle, Yale researchers and New Haven officials are implementing a saliva testing program within some community spaces around the city, though not within New Haven’s public schools as researchers originally hoped.

The testing program uses SalivaDx, an affordable and streamlined method of using saliva to test for the coronavirus that has gained national acclaim since its development at Yale. While last fall saw several roadblocks in the program’s implementation, Yale researchers have secured grants and coordinated with the city to fund a testing program for adults working in some of the city’s learning hubs — spaces inside some city churches and recreation centers where small groups of students can take classes if they do not have internet, a safe and quiet environment or adequate nutrition at home. With tests available on site at these hubs, staff might be more likely to get tested than if they had to travel to New Haven’s existing testing sites — which do not offer saliva tests —  assistant professor of epidemiology at the Yale School of Public Health Nathan Grubaugh said.

The effort began in August after SalivaDx researchers got federal emergency use authorization. The Yale Office of Public Health Practice assisted the project, and Grubaugh and his lab reached out to New Haven city officials to examine the feasibility of getting the saliva testing into city schools.

But with no precedent or national plan for these testing systems, the team has faced obstacles. Grubaugh had to secure his own funding to pay for the operational costs of the learning hubs pilot project, and as for public schools, Mayor Justin Elicker announced in November that schools would not reopen in the fall.

While no one has reached out to him personally, University President Peter Salovey confirmed that Yale researchers and others are trying to bring saliva testing to the city.

“I know Saliva Direct testing, we’ve tried to figure out ways to share with the city,” Salovey said. “We’re not going to hoard COVID resources. We’re going to share whatever we can once we take care of the Yale-connected community.”

But while the saliva testing will begin in learning hubs, it will require more time to take it to the school district as a whole. The team from Yale — the OPHP and Grubaugh — emphasized that the New Haven community has to take the lead in bringing the saliva testing to the public school system. Yale cannot impose an effort on New Haven, as this could exacerbate distrust, Grubaugh said. He first reached out to city officials with the idea, and the University has supported his efforts, he added.

Valerie Horsley, associate professor of molecular, cellular and developmental biology and parent of two children in New Haven Public Schools, said she would hope the University would provide funding for a testing program in public schools, as asymptomatic screening helped Yale contain cases among undergraduates in the fall term.

Horsley said she does not yet feel comfortable letting her children return to in-person classes. She said she might send her younger daughter in if there were a more robust testing program. 

“We should work actively to improve our communities,” Horsley said. “Yale’s had a long history of kind of ignoring New Haven and pretending like New Haven is not a part of its community, and I think that’s changed a lot, but I do think that we could do more. … If we really are about truth and light, we should be spreading that to the community in a way that helps bring everybody up.”

The learning hub “mini program”

Last week, the team of SalivaDx researchers and OPHP’s personnel ironed out the final logistics for implementing a saliva testing program in New Haven’s learning hubs.

The SalivaDx team secured its own funding from Fast Grants, an organization that provides quick funding to COVID-19 researchers, and has allocated $35,000 from the grant for the program, which will cover weekly testing for up to 100 adults. The Yale Pathology Lab will process the samples.

As of now, the program will only test adults, as they are more likely to transmit the disease, Grubaugh said.

The learning hubs are each independently operated, but their leaders meet weekly, said Sarah Miller, a community health organizer at Clifford Beers, a local mental health clinic. Clifford Beers is the administrative coordinator for the nonprofit hubs in the city and facilitates the weekly meetings between the operators.

Mehul Dalal, the city’s community services administrator, first suggested that the learning hubs could benefit from a testing program in the fall while the team was sharing its approach with the Yale School of Medicine Community-Engaged Research Steering Committee, of which Dalal is a member. From there, the New Haven Health Department and Yale team developed the proposal and assessed the idea’s feasibility, Dalal told the News.

As part of the program, Clifford Beers clinicians will administer the tests for adults who work in the hubs. They plan to start in early March by partnering up with the YMCA, which operates the largest number of learning hubs. Miller said she hopes to eventually offer testing at every learning hub so staff never have to leave their hub to get a test. 

“Testing is available in the city,” Miller said. “But it’s one thing for it to be available and another thing for it to be done on site systematically for every adult.”

Grubaugh explained that the city has set up free testing sites available to everyone involved in the school system. Still, barriers to access persist, particularly in low-income communities. By setting up a testing collection system that operates out of the learning hubs, it is likely to be more accessible, he said.

New Haven Director of Public Health Maritza Bond said she was looking forward to having “another option in our toolbox” for testing. Still, saliva tests will only be available at the nonprofit learning hubs that Clifford Beers coordinates — the city has not considered saliva testing for the learning hubs it operates.

Grubaugh said he has an additional $100,000 from Fast Grants earmarked for expanding testing. Grubaugh hopes to offer saliva tests at the existing sites around the city, thereby increasing the city’s testing capacity. Additionally, more people might want to get tested given the simplicity and accessibility of the saliva test compared to the nasal swab test, Grubaugh said.

Fall term efforts

Grubaugh first approached the New Haven Health Department about implementing the tests in public schools in October. He also reached out to Richard Jacob, Yale associate vice president for federal and state relations, and Lauren Zucker, associate vice president for New Haven affairs and University properties. At that time, after a successful stint monitoring outbreaks in the NBA bubble, the SalivaDx team had momentum and their data suggested routine asymptomatic screening with saliva tests could help control outbreaks.

Grubaugh then began drafting plans to get funding for a testing program, and also tried to figure out how such a program would operate. Alexander E. Dreier, Yale general counsel, vetted the approach and said the University could be involved. Sten Vermund, dean of the School of Public Health, then connected Grubaugh with the OPHP, which has experience in the area, for assistance.

The OPHP team met with Associate Dean for Health Equity Research Marcella Nunez-Smith, who now leads President Joe Biden’s Health Equity Task Force, in early October. Nunez-Smith validated the approach and stressed that they should connect with parents and families in the school system, OPHP Executive Director Susan Nappi said. The New Haven Health Department then connected with the students.

“This has to be led by the Health Department,” Grubaugh said. “I think we need to be careful of our perception and make sure we aren’t taking the ivory tower approach. We can’t do anything without being invited to do it.”

Despite SalivaDx reaching headlines in The New York Times and The Wall Street Journal, the team initially struggled to get it off the ground in New Haven. 

In early November, Grubaugh met with the Board of Education to explain how the cost-effective and simple method of obtaining samples could help schools safely reopen. He said he saw momentum and enthusiasm for the testing system at the meeting. But a few days later, Elicker announced that schools would be fully remote for the fall, and the initial funder of the testing project pulled out of the deal because the schools were not opening.

“While we may have public health knowledge, including approaches to testing that best control the spread of COVID-19, communities know which strategies will work best,” Nappi wrote in an email to the News. “Our role must be to connect communities to resources, support these efforts, and take their lead.”

But the city’s health department — the community partner that Nappi and the team are working with — is already tackling a host of other pandemic responsibilities including rolling out the vaccine. Though the health department is doing a strong job, its resources are limited, he said. Similarly, Grubaugh is helping the state conduct genomic surveillance for new coronavirus variants, which has limited his availability to work on the saliva testing project.

“I hate to say it, but everything with this pandemic, including what’s happening here, is being held together by duct tape,” Grubaugh said. “That is not directed at any one individual; everyone’s just doing so much work. It’s just hard, there’s not enough of us.”

New Haven schools partially opened for pre-kindergarten through fifth grade on Jan. 19. Sixth through eighth graders will have some in-person options starting on March 4. Now that public schools have opened for some in-person classes, Grubaugh said that he is optimistic about expanding the saliva testing program beyond the learning hubs. The next step is coordinating contracts with the public school system. Testing will still be necessary into the next school year, he said. He is trying to set up a team of community liaisons to facilitate partnerships in New Haven.

A need for further resources across the country

The researchers developed SalivaDx to be an open-source, uncommercialized protocol, with no kit required, in an effort to make it accessible to labs across the country. They have extended the emergency use authorization to more than 96 labs in 35 different states, said associate epidemiology research scientist Anne Wyllie, a lead researcher who developed the protocol.

Wyllie said the team is continuing to make their EUA guidelines more flexible so that labs across the country can work with their existing systems and avoid accruing additional costs. She is also connecting many of the labs with nearby school districts that hope to implement saliva testing.

But many of the labs need additional staff and instrumentation to bring saliva testing to their surrounding communities. Wyllie and staff at the OPHP and Office of Cooperative Research are trying to help them, she said. But they have not received additional funding or support from Yale’s administration or Yale Health.

“We haven’t received any funding from any sources to help us with community testing,” Wyllie said. “That is being driven by us because it’s something that needs to be done, but there’s currently no funding behind it.”

The saliva testing protocol received emergency use authorization on Aug. 15, 2020.

Rose Horowitch | rose.horowitch@yale.edu