Test plans vary with no known answers
Colleges take wide range of approaches to safety
COVID-19 outbreaks already are interrupting colleges’ plans to reopen across the country. But just how big those interruptions are – and whether the outbreaks can be contained – hinges in part on colleges’ plans to test students rapidly.
And some campuses don’t have much of a plan at all.
The approaches vary nationally. Some institutions, like the University of Illinois at Urbana-Champaign, plan to screen thousands of people daily using new federally approved tests that rely on saliva rather than invasive nose swabs.
Others, like Notre Dame or Purdue, required students to test negative for the virus before they were even allowed to set foot on campus.
But the University of Northern Georgia skipped mass testing for students coming back to campus and is instead simply asking students who develop COVID-19 symptoms to stay home from class. And Liberty University’s plan to test only people who have symptoms, without testing possibly asymptomatic carriers, has drawn criticism from other universities slated to play the Virginia institution in football.
No college’s approach is the same. That’s thanks in part to contradictory federal guidance on mass testing for higher education. The Centers of Disease Control, in guidance updated June 30, said such efforts are unproven and that it “does not recommend entry testing of all returning students, faculty, and staff.”
In contrast, Dr. Deborah Birx, the White House coronavirus coordinator, recently said universities should implement entry tests and be prepared to test up to 10,000 people a day, the Center for Public Integrity reported.
Most universities’ plans fall somewhere between the no-testing and
constant monitoring approaches. The consequences of each approach will play out in real time, said Amesh A. Adalja, a senior scholar at Johns Hopkins’ Center for Health Security.
“This isn’t something we have worked out,” he said.
Adalja questioned how effective a massive testing campaign would be if people were still allowed to come and go from the university when they pleased. (Many of the outbreaks on college campuses so far have been tied to off-campus gatherings.)
In any case, most universities are unlikely to be able to reopen safely, no matter what their testing approach is, said A. David Paltiel, a professor at Yale’s School of Public Health. He recently built a mathematical model to track the spread of the virus on college campuses. He found scenarios in which universities can open safely, he said, but “it’s an incredibly high bar. It’s probably one that most universities can’t reach.”
And one of the requirements for reaching that bar? Frequent testing, up to every two days in some cases.
In no scenario, the report reads, would “symptom-based screening alone ... be sufficient to contain an outbreak.”
Testing plans changing
Without clear federal guidance, students and families must assess whether a college’s plan is sufficient.
Campuses are going to have cases, but that doesn’t mean the situation is out of control, Adalja said. He said families may want to consider how robust a university’s plan is compared with similar institutions. And he said colleges ought to set up their courses such that students can feel comfortable switching between in-person and virtual learning should they get sick.
As it is, universities’ testing plans are changing frequently.
Testing students before they came to campus was a crucial part of the University
of Notre Dame’s plan to launch inperson fall classes. The private Indiana university sent tests to roughly 12,000 people ahead of their return to campus. Fewer than 1% of them tested positive for the virus. The university said those results were encouraging.
They didn’t last.
As the university reopened, cases climbed rapidly within the first week. Administrators blamed the outbreak on students who went to off-campus parties.
To slow the spread, the university paused in-person classes for two weeks and increased testing of random people on campus.
Purdue University had planned to test students only before they came back, and then if they reported symptoms. But the institution has since altered its plans to try to test 10% of the population every week. The change in plans comes just days after the university suspended dozens of students in connection to an off-campus party.
Smaller campuses are changing plans too, as outbreaks pop up at colleges around the country. The College of Charleston hadn’t planned to require students to be tested before returning to campus, but has since required those moving to campus to do so. The situation was the same for the University of the South in Tennessee, which now will require students to take a test on campus before they can move into their dorms.
Others plan to test their communities aggressively and require compliance for anyone who wants to be on campus. The University of Illinois started class Monday with plans to use a newly developed saliva test to check up to 20,000 people a day. The method doesn’t rely on nasal swabs, and produces results in an hour, according to the university.
“The faster we can notify people, the faster we can stop the spread,” said Rebecca Lee Smith, a pathology professor at the university.
Some communities may be targeted more than others. For example, the University of Kentucky has already tested much of its student body, but it plans to retest students in Greek organizations. The university found that those students have a higher rate of infection compared with their peers, after outbreaks last week began at fraternities and sororities around the country.
Of course, not every university has the research capabilities of a public flagship university like Illinois.
Some colleges are relying on thirdparty testers, like the Broad Institute, which is working with colleges in Massachusetts, or the Just Project, which has provided testing equipment to historically Black universities.
‘No business reopening’?
Still others are taking a looser approach that transfers a large share of the responsibility for managing the virus’ spread to its community members.
The University of Northern Georgia, for example, said its health services division will test only symptomatic patients. Officials have also asked that people planning to come to campus monitor themselves for high temperatures or COVID-19 symptoms. In explaining its testing policy, the university specifically cited the CDC guidance that said mass testing was not recommended.
Arkansas State University wants its students to fill out a form before receiving further instructions about whether and where they should be tested. The University of Southern Indiana’s plan asks that anyone who may have coronavirus fill out a form, stay off campus and call their doctor.
Paltiel said he was wary of universities relying solely on symptomatic tracking. That’s like calling the fire department after a blaze has already consumed a building, he said. His team’s research found no scenario where testing solely based on symptoms was sufficient to prevent wider outbreaks.
“You can’t play catch up with this virus,” he said.
Paltiel also criticized the CDC’s guidance and said the agency was wrong in its assessment that mass testing wasn’t necessary, given the large role that people without obvious symptoms play in spreading the virus.
And a re-entry test alone is insufficient to prevent outbreaks, he said.
Universities that lack the capacity, or are unwilling, to test large numbers of people regularly, he said, “have no business reopening,” he said.