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Widespread Coronavirus Testing Critical for College Reopenings, But...

The University of Illinois at Urbana-Champaign developed a high-frequency coronavirus testing system that would be the envy of an country or corporation, testing students, faculty and staff twice a week, but it still failed to stem a major outbreak.
September 21, 2020, 12pm PDT | Irvin Dawid
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Colleges and universities throughout the country are seeing infections soar among their students, creating major tension in college towns that nervously awaited the return of students. Widespread, frequent testing plays a critical role in keeping schools open and communities safe, although it's no silver bullet by itself.

As noted in a post last month that focused on wastewater coronavirus testing, universities in the United States have the potential to effectively demonstrate COVID-containment strategies, provided the motivation and leadership are present. The University of Illinois at Urbana-Champaign (UIUC) meets that description by utilizing campus resources that may not be available to other universities.

"Researchers at the university, a science and technology powerhouse, designed a saliva test that would be easy to collect and process, to be taken twice a week," report Emma Court and Shruti Singh for Bloomberg Businessweek on Sept. 11 (source article). The test was approved by the Food and Drug Administration last month after UIUC performed a bridge study to a saliva-based COVID-19 test developed by researchers at the Yale School of Public Health that received an Emergency Use Authorization on August 15.

“Direct saliva testing can address bottlenecks of time, cost and supplies,"  wrote Liz Ahlberg Touchstone, the biomedical sciences editor for Campus News, which serves the University of Illinois System, on August 19.

"Our test also has unique features that enable fast and frequent testing on a large scale, and we are now working together with many partners to make our testing method broadly available as soon as possible,” said Dr. Martin Burke, a chemistry professor who helped to design the test.

Unlike most coronavirus tests, which involve a long, invasive nasopharyngeal swab, the Illinois-developed saliva test, called I-COVID, asks those tested to drool a small amount into a sterile test tube. 

Rather than sending the samples to commercial labs, resulting in slow turnaround times, processing is completed in as little as five hours at the university's Veterinary Diagnostic Laboratory, write Meredith Deliso and Dr. Jay Bhatt for ABC News in one of the more comprehensive articles on the testing program.

The lab runs tests 24 hours a day on weekdays, and nearly that on weekends.

When the lab scans the barcode on the test tube, it connects to the person's medical record. The results of the test are delivered via a HIPAA-compliant secure portal or app, dubbed Safer Illinois.

Safer Illinois is essentially Wuhan comes to Urbana-Champaign: Since April, Wuhan residents without a green code on their smart phones can't access the subway.

"Developed on campus, the innovative Safer Illinois app provides users their personalized coronavirus-testing results and reminders of their scheduled testing, along with a display of their current testing status that will serve as one of the mechanisms to gain entry to university facilities during the pandemic, all without showing any personalized health information to personnel assigned to university building entrances," states an August 13 UIUC Research News blog.

Students return

"While UIUC’s example illustrates how mass screenings can identify a problem early, it also shows they aren’t enough on their own to prevent virus spread," add Court and Singh.

The widespread, mandatory testing performed on the 35,000 returning students, as well as faculty and staff, performed like a "a real-world example of the sort of public health measures many experts long have been urging: frequent testing—even of people with no symptoms—combined with contact tracing and technology-enabled exposure notifications." 

With more than 255,000 tests performed, the school has done more than 5% of the state of Illinois’s total screenings so far and accounted for nearly 20% of them last week.

Yet critics—including some of the university’s own faculty—say the school has relied too heavily on its impressive technology and predictive analytics, while miscalculating about its own students, young adults still learning how to live on their own and eager for social contact after months of isolation.

“It’s not just about testing,” says David Wilson, a longtime geography professor. “It’s about people, their daily rituals and habits. That was not really considered.”

The New York Times college and university COVID tracker shows UIUC having the state's highest number of infections, 1,760 as of Sept. 10, followed by Illinois State University with 1,327. What happened?

On Sept. 2, the university sounded an alarm. Over the previous 10 days, 784 positive cases had emerged, and if the trend continued the count could rise to as many as 8,000 that semester.

The university's COVID-19 testing data dashboard shows daily new cases, which spiked on August 31, but it doesn't appear to show total, cumulative cases.

"It literally was parties on a Thursday or Friday night...and then we started seeing the rising cases, you know, three or four days after," Burke, the chemistry professor, told ABC News on Sept. 15. 

"The very good news is, is that because we had this very robust fast frequent testing going on we literally saw it as it was happening," he said. "And we saw those cases rising exactly where and we knew why, so we were able to make immediate corrective actions on multiple fronts."

Implications for opening offices

"The school cracked down on parties, told undergrads to leave their homes or dorms only for essential activities such as going to class and buying food, set up a new team to isolate positive cases quicker, and created an online form to report risky behavior," noted Court and Singh.

What happens on the Illinois campus this fall will have broad implications, not just for its own community but for other reopening colleges and the U.S. at large.

While UIUC’s example illustrates how mass screenings can identify a problem early, it also shows they aren’t enough on their own to prevent virus spread. “We’ve learned fast, frequent testing can work—because we’re seeing it work as we speak,” says Burke, who leads the school’s testing and tracing program. “But we’ve also learned it’s not a silver bullet.”

Types of testing

UIUC is among a handful of colleges and universities that subjects all students to frequent, mandatory testing, Yale and Northeastern among them. More typical are less widespread protocols, such as Ohio State University, which administers a surveillance testing program that "allow[s] the university to monitor and address real-time trends and prevalence and make timely decisions on intervention and response," according to the university's Student Health Services.

A surveillance testing program means that samples of students will be selected and tested for COVID-19, regardless of whether they have a known exposure or are showing symptoms of COVID-19. This allows us to make inferences about the level of spread in the student population and identify asymptomatic cases for isolation.   

In response to a query as to whether to call the testing part of COVID-19 SHIELD a surveillance testing program, since everyone, as opposed to samples, would be tested, Nigel Goldenfeld, a physics professor who’s helped with modeling, emailed that he calls it "high frequency, high-throughput deep testing of our target population." Goldenfeld referred to the three types of surveillance described by the World Health Organization, and indicated it would fit under "Accelerated Disease Control". 

"The reason is that the goal is eradication," he added.

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Published on Friday, September 11, 2020 in Bloomberg BusinessWeek
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