Aug. 5, 2020 -- College students who are returning to campus in the fall can expect a lot of new rituals to help keep them safe from COVID-19 -- from wearing masks to regular health checks and alternate day in-person classes.

One other new strategy that experts say will be key to preventing widespread transmission of the disease is testing.

“What happens after classes is a free-for-all,” says infectious disease expert Ravina Kullar, PharmD, an independent consultant and adjunct professor at the University of California, Los Angeles. “In the college environment, one needs to assume that almost everyone is potentially positive.”

About a quarter of 3,000 colleges and universities surveyed plan to have in-person or mostly in-person instruction, according to The Chronicle of Higher Education. Another 16% will start with a hybrid of in-person and virtual learning.

Experts say that testing -- frequently and with fast results -- will be needed to keep those colleges open. “Some form of high-density and ongoing testing” is what is going to be important to college communities,” Sarah Fortune, chair of Harvard’s Department of Immunology and Infectious Diseases, said at a news conference.

A recent JAMA Network study found that testing students every 2 days is an effective way to contain the coronavirus.

Even using a low-quality, rapid test catching 70% of positive COVID-19 cases is better than testing weekly with a more sensitive test that takes longer to return results, the study found. Testing nationwide has been hampered by slow results -- sometimes taking a week more -- making them virtually meaningless.

"There has to be testing made available, because we know how easily this virus spreads. That's what makes it so sneaky,” Kullar says.

No Consensus on School Testing Plans

Some universities are taking extra measures to ramp up their testing, often spending millions of dollars. “Universities are really blanketing their communities with testing in order to open safely, and that gives those students a certain measure of freedom in thinking about their daily lives,” Fortune said.

But while schools are fairly uniform on measures such as setting up dorms or other areas to isolate students that test positive and doing contact tracing, they vary widely in how they will conduct testing.

The University of Georgia, for example, received certification to run human COVID tests at its Veterinary Medicine Diagnostic Lab. Results are expected to be available in 48-72 hours to participants and the Georgia Department of Health.

UGA plans to test 300 asymptomatic student, faculty, and staff volunteers per day, according to a letter from President Jere W. Moreland. In all, the university is spending an estimated $6 million on coronavirus prevention measures.

UGA’s COVID-19 Medical Oversight Task Force says the testing will be voluntary and at no cost to participants. “Our surveillance testing program is designed to help us identify these [asymptomatic] individuals so that they can be quickly isolated and their close contacts notified,” says the team. “As a result, fewer individuals will be exposed to the virus.”

The University of Alabama plans to test 2.5% to 5% of the campus population each week, although the testing is voluntary. It says results will be available within 3 days.

The University of North Carolina at Chapel Hill is taking a different approach in its reopening strategy. It is testing people who show symptoms, are exposed to someone who has the coronavirus, or are at high risk for serious illness with infection.

The University of Texas is also planning to test symptomatic students but will be calling on asymptomatic volunteers as well. It says this hybrid strategy is hoped to “further reduce the spread of COVID-19 while creating a more complete picture of the presence and impact of the disease on campus.”

Is Testing Before School Starts Needed?

Some schools, such as the University of Michigan and University of South Carolina, are requiring students to produce a negative test result before returning to campus or show that they’ve had the virus and recovered. At the University of Indiana, only students living on campus are required to be tested before returning to school.

The schools either send students a self-test kit or partner with a lab.

But experts question whether this step is needed, and CDC guidance recommends against it. It’s not known, the agency says, whether this will help prevent future transmission. Instead, the agency suggests testing people with symptoms and working with state and local officials on other testing plans.

While it’s great that universities are taking those steps, entry testing “tells you where you are at a given point in time, but is not going to protect you in as soon as 2 weeks,” says Fortune.

When it comes to testing at school, Fortune says they don’t know enough yet to outline the best approach. There’s a “healthy debate” about which one is best, she says, and about which types of testing are most effective going forward.

A Different Approach

The University of South Carolina is also testing something else as part of its prevention plan: wastewater.

Debbie Beck, EdD, assistant vice president of health and wellness and executive director of Student Health Services, says the university plans to regularly test wastewater at various spots on campus to help identify coronavirus hot spots. That will let them do targeted testing of particular sections of campus.

“If it’s increasing, we know we need to target that area or the individuals that live in that area,” she says.

As for ongoing testing during the semester, the student health center will be available to students to get tested, whether they’re showing symptoms or not. They’ll be using both the antigen tests and the polymerase chain reaction, or PCR, nasal swab to collect samples.

The Medical University of South Carolina will also have staff on campus for 8 days to provide drive-up and walk-up testing, the state Department of Health and Environmental Control will have a testing center nearby 3 mornings a week, and a local pharmaceutical company will provide saliva tests as needed.

“We’re not going to be able to test a couple times a week, but we are going to be able to have comprehensive testing coverage,” Beck says.

If -- or when -- a student tests positive, she says, the university has hired contact tracers to work out of the student health center, and it has partnered with an electronic health vendor to create a contact-tracing app for smartphones.

The university has also set aside an entire residence hall to quarantine those who test positive or come in close contact with someone who has.

If a student tests positive, “We wrap our services around the student who is positive,” Beck says. “We make sure they have their food, can continue with their academic courses. We’ll take care of them. And we’ll reach out to all of their contacts.”

Show Sources

Ravina Kullar, PharmD, infectious disease expert.

JAMA Network Open: “Assessment of SARS-CoV-2 Screening Strategies to Permit the Safe Reopening of College Campuses in the United States.”

CDC: “Interim Considerations for Institutions of Higher Education Administrators for SARS-CoV-2 Testing.”

University of Georgia: “Plans for Surveillance Testing and Notification.”

News conference, Sarah Fortune, chair, Harvard Department of Immunology and Infectious Diseases, July 29, 2020.

University of Michigan: “Campus Blueprint.”

Indiana University: “Frequently asked questions about IU's response to coronavirus.”

Debbie Beck, EdD, assistant vice president of health and wellness and executive director of Student Health Services, University of South Carolina.

WGAU: “UGA top brass hosts Zoom call to update plans for fall semester.”

The Chronicle of Higher Education: “Here’s Our New List of Colleges’ Reopening Plans.”

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