Regular testing to catch “silent” COVID-19 spread among students will be key to safely reopening colleges this fall, campus infection control experts say.
Extensive modeling suggests that testing college students for COVID every two to three days using a low-cost, less accurate test would be the best strategy for campuses to safely reopen this fall, according to research led by David Paltiel, a professor of health policy at the Yale School of Public Health.
“What really is concerning me are the many schools out there that are considering the option of not doing any testing, but of simply monitoring students for symptoms of COVID and using those signs and symptoms of illness to trigger testing, isolation, contact tracing and quarantine,” Paltiel said during a HD Live! interview.
“We explored thousands of scenarios in our simulation model, and we did not find even one plausible circumstance under which that strategy would be sufficient to contain an outbreak. You simply cannot catch up with this virus,” Paltiel noted.
Most universities are considering less extensive COVID-control measures than those called for by Paltiel and his colleagues.
For example, University of California, San Diego plans to test students once a month, coupled with other monitoring methods designed to catch the coronavirus before an outbreak occurs, said Natasha Martin, an infectious disease modeler with the university.
“That was based on our simulations indicating that level of testing would allow us to identify outbreaks early. We want to detect outbreaks early, and we feel like we have the test capacity and the situation in place to do that,” Martin said during the same HD Live! interview.
Despite their differences, both Paltiel and Martin agreed that some level of proactive testing is needed to stop the virus in its tracks and prevent a campus shutdown.
“If you’re trying to understand why that might be, a lot of it has to do with the asymptomatic spread of the disease and the fact that it can be transmitted by asymptomatic so-called ‘silent spreaders,'” Paltiel said. “It’s very hard to play catch-up with this virus. You want to get out ahead of it, and the best way to do that is to screen with high frequency.”
One innovative approach UC San Diego plans to use is to test the wastewater flowing from college dorms and residences for signs of COVID-19 coronavirus, Martin said.
The university hopes that wastewater monitoring “can give us an early signal in terms of if there’s viral activity or infections within a specific dorm, and then we can go in and do more widespread testing to identify those infections and act on them,” Martin explained.
Colleges need to plan for outbreaks, closures
Paltiel said his approach overlaps with Martin’s in the “view that one has to hit this early, hit it hard, recognize the silent spreaders, test frequently, stop an outbreak in its tracks before it starts, recognize that nothing you do is going to be perfect and therefore you’re going to have to both set aside sufficient isolation capacity and have an exit strategy.
“My difficulty is that many schools are planning as if everything that could possibly go wrong is going to go right,” Paltiel said. “They aren’t giving themselves enough wiggle room.”
Both experts said it is inevitable that there will be COVID-19 infections on campus, so colleges have to be equipped with plans to control infections and, in the worst case, efficiently and safely shut down.
“I think every university needs to plan an exit strategy and have a criterion that says this is when we are out of control and we really need to move to a plan where we shut the school down,” Paltiel said.
One potential positive is that an early pilot run of UC San Diego’s plan found solid student buy-in for testing and COVID control, Martin said.
“One of the very strong messages we learned from them is they wanted to know this testing was part of a broader public health program, that it was something everybody was engaged with to keep the campus as safe as possible and to enable some amount of in-person activities on campus,” Martin said. “They were less interested in the idea they would know their status or that they would be testing for themselves. They really wanted the message to be about the broader public good, which it is.”
Given that student support, it’s now the job of universities that are reopening to promote strategies and options that will keep students engaged on-campus in safe ways, Paltiel said.
“The schools can’t just hand out a mask and a bottle of hand sanitizer and maybe a leaflet and wag their fingers at the students and say ‘behave,'” Paltiel said. “That’s just setting them up to fail. It’s also setting them up to be scapegoated at the end if something does go awry.
“We’re the grownups in the room,” Paltiel continued. “We have a responsibility to provide them with resources and with imaginative, compassionate, realistic low-risk options to stay socially connected, to get the human interaction that they richly deserve and that they need, and to make the on-campus social event sufficiently attractive that it discourages them from wanting to head down the road to do Jell-O shots in the basement of the frat house, which is what I really want to avoid.”
Colleges also need to pay attention to the surrounding community when managing their COVID-control strategies, Martin added.
Colleges “need to be thinking about what their capacity is on campus, but also what the situation is in their local community and really assessing it week by week to ensure they feel they are in the right position to reopen,” Martin said.
UC San Diego has more about its campus reopening strategy.
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