Colleges short of needed testing

Experts say only frequent tests can keep schools safe

The infectious disease specialist in Seattle and the public health expert in Connecticut agree: The key to college campuses returning to normal activity before there’s a widely available COVID-19 vaccine is absolutely, unequivocally a four-letter word: test.

Test the students. Test the faculty. Test the staff.

Then test ’em all again a few days later.

“And if twice-a-week doesn’t cut it,” said Carl Bergstrom, a professor at the University of Washington, “then you have to be prepared to change the cadence. Test everybody, every day.”

From Chico to San Diego — at public schools and private schools, semester schools and quarter schools, urban campuses and rural campuses — the state of coronavirus planning in higher education in California this fall is a scattered, confusing, infuriating mess.

And absent a vaccine, experts agree, there is just one way out: Cheap, quick, plentiful tests would allow universities to reclaim their pre-coronavirus lives, with full dormitories, crowded dining halls and freespending students.

Mitigation strategies such as masks and social distancing will help, Bergstrom said, but they won’t prevent outbreaks.

Nor will testing once a week, according to a study published on the Journal of the American Medical Association’s open network. Yale School of Medicine

public health expert David Paltiel ran computer simulations of a college campus and determined that “screening every two days” would give universities a fighting chance.

But schools in California aren’t close to meeting that standard.

Chico State didn’t require COVID-19 tests prior to returning to campus. One week into the semester, with case counts rising, the school told students to scram.

San Diego State experienced a similar, rapid rise in case counts but — crucially — so far has found space for hundreds of students needing to be quarantined or isolated.

Stanford never got its fall quarter started, at least in seminormal fashion. After planning to welcome half of its undergraduate students onto campus, the university reversed course and told them to stay away.

But no return-to-campus situation is more bizarre than the one unfolding at Cal Poly, where hundreds of faculty members, alarmed at the absence of a testing requirement before the fall quarter, published an open letter to students on social media:

“We are writing to alert you to the significant health and safety risks posed by Cal Poly’s current campus reopening plan. We appeal to you to consider these factors as you make your decision whether to return in person for fall quarter.”

A week later, the university announced a revision, requiring COVID-19 tests for the thousands of students planning to live on campus. Additional tests are only necessary for those showing symptoms of illness (or close contacts of those infected).

“I’m worried about the lack of surveillance testing — that’s my biggest concern,” said Cal Poly biological sciences professor Candace Winstead, an author of the faculty letter and member of the San Luis Obispo health commission.

“Iwantittowork.iwant to be back in the classroom. But I want them to start testing yesterday,” she said.

The outbreaks and lack of testing infrastructure led the California State University system to announce Thursday that it will remain remote through the spring.

Neither Winstead nor Bergstrom is surprised by the campus outbreaks or policy reversals. Because for all their differences, universities across California have one thing in common: They have students.

And whether they’re living on campus or off campus, students like to socialize, especially when they aren’t feeling sick — and sometimes, even when they are.

“You can figure out as many behavioral and structural interventions as you want,” Bergstrom said. “You can minimize the opportunities for exposure. You can try to control frat parties. You can make classrooms safe.”

You can even hire a private security firm to enforce social distancing and mask-wearing, as San Diego State did recently, according to the San Diego Uniontribune.

“But no matter how much you do,” Bergstrom said, “you’re unlikely to get (containment) because the socializing students don’t realize they’re sick. You have to use the tests to find the people who are sick and don’t know it.”

Speed is crucial. It often takes three or four days on average for an infected person to become contagious, but they may not begin to feel sick even then. That’s why testing everyone twice a week is a reasonable starting point, according to Bergstrom.

“For a few days, there isn’t enough virus in your body to test positive,” he said.

Paltiel, the Yale expert, used a hypothetical campus of 5,000 students for his computer simulation and “identified no circumstance … under which symptom-based screening alone would be sufficient to contain an outbreak.”

Instead, his modeling determined that testing every two days, combined with mitigation measures, would “yield a modest number of containable infections.”

What’s more, the analysis assumed a cost of $10 to $25 per test. Apply the high-end figure to a campus with 30,000 students, faculty and staff — each of them tested twice a week for five months — and the total outlay would be $30 million for one semester.

That’s a steep price, except when compared to the crushing cost of empty campuses. Cal and UCLA, for example, are estimating a $900 million (combined) impact on their budgets from the coronavirus.

But there are other obstacles to attaining testing utopia.

Ideally, universities across California would use antigen tests, which are less accurate but produce results in one hour, rather than PCR tests, which are expensive and can often take backlogged labs several days to return results.

That’s more than enough time for an asymptomatic student to infect one or two friends — or an entire fraternity.

But the antigen test supply hasn’t yet reached the necessary threshold for higher education or society writ large. Experts hope that will change this year or early in 2021, with millions of antigen tests becoming available.

“Part of it is a resource issue,” Winstead said. “The pipeline isn’t easy, but I think we’re close with the rapid tests.

“I wish we had waited (to open) until we had it all together.”