In order to curb the spread of coronavirus within college campus communities, vigilant testing is essential. In some cases, campuses have seen a lower incidence rate of the virus than the communities that surround them due to robust on-campus testing programs.
One example of this is in Wisconsin. Between September 4 and October 5 of 2020, the average percent positive rate of the virus statewide was 14%, according to the Wisconsin Department of Health Services. Despite this, some colleges and universities within the state were seeing positivity rates of less than 1% on campus . This difference has been attributed in large part to regular testing of students and thorough contact-tracing efforts.
So, what are some factors to consider when implementing an on-campus testing strategy? First, it is essential to select the appropriate test type. There are several options on the market: real-time polymerase chain reaction (PCR), fast PCR, rapid antigen diagnostic test (RADT), and loop-mediated isothermal amplification (LAMP). These options differ in accuracy, turnaround time, cost, throughput, scalability, ease of use, footprint, and regulatory status. For a thorough comparison of the different types, please see this guide.
When testing an entire campus community regularly, it is important to note that scalable, highly accurate solutions with a large throughput, such as PCR or fast PCR, are likely to be more practical than point-of-care solutions, such as RADT or LAMP. Let’s take a closer look:
- Accuracy—According to the US Food and Drug Administration (FDA), real-time PCR tests are highly accurate and do not need to be repeated. On the other hand, there is a higher chance of false positives with antigen tests, and negative results may need to be confirmed with a more accurate test . Additionally, in a fall 2020 study, the Centers for Disease Control and Prevention (CDC) found that a type of antigen test had a sensitivity of only 41.2% in asymptomatic persons compared to 80.0% in symptomatic persons . Therefore, RADT can be unreliable when it comes to asymptomatic population testing.
- Scalability—PCR tests are more scalable than antigen tests. Hundreds of samples can be run simultaneously using a PCR machine. This is in contrast to antigen testing devices, which can only read one sample at a time. When operating a large-scale testing program on campus, choosing PCR over RADT would save time and require fewer staffing resources.
Another important consideration for college testing is sample type. In a January 2021 study, saliva testing was found to have a similar sensitivity and specificity to that of nasal testing . This makes collecting saliva samples an attractive alternative considering the ease of use. Another issue is whether to offer at-home or supervised testing. Given that there is a higher chance of poor compliance and cheating with at-home testing, a supervised approach is generally preferred.
A critical question that university administrators must ask is what should be done once a member of the campus community receives a positive coronavirus result. When one person is positive, a crucial component of contract tracing is notifying others who came into contact with that individual. One example of a robust contact-tracing strategy is what has been implemented at many campuses in the University of California system. In their voluntary program, smartphone users are notified of possible coronavirus exposure if they have been within 6 feet of an infected individual for longer than a cumulative 15 minutes within a 24-hour period . The system relies on those who receive a positive result to anonymously indicate it on their device.
Lastly, another critical step in curbing the spread of the virus on campus is to require those who have received a positive result (or are experiencing symptoms) to quarantine for the necessary predetermined length of time. During this time, an infected person should stay home except to receive medical care . Universities might consider setting aside an isolation dormitory for infected students.
These steps—or others similar to them—can be implemented as part of a strategy to help curb the spread of the virus at your institution.
- “Some universities and colleges are seeing lower COVID-19 positivity rates than their communities are.” NBC 26. Posted October 5, 2020. nbc26.com/news/local-news/some-universities-and-colleges-are-seeing-lower-covid-19-positivity-rates-than-their-communities-are.
- “Coronavirus disease 2019 testing basics.” U.S. Food and Drug Administration. Updated November 6, 2020. https://www.fda.gov/consumers/consumer-updates/coronavirus-disease-2019-testing-basics
- “Performance of an antigen-based test for asymptomatic and symptomatic SARS-CoV-2 testing at two university campuses.” CDC. Updated January 1, 2021. https://www.cdc.gov/mmwr/volumes/69/wr/mm695152a3.htm
- “Comparison of saliva and nasopharyngeal swab nucleic acid amplification testing for detection of SARS-CoV-2.” JAMA Intern Med. 2021;181(3):353-360. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2775397
- “UC Berkeley launches COVID-19 exposure notification system.” Berkeley News. Posted November 16, 2020. https://news.berkeley.edu/2020/11/16/uc-berkeley-launches-covid-19-exposure-notification-system/.
- “Coronavirus Frequently Asked Questions.” CDC. Updated February 8, 2021. https://www.cdc.gov/coronavirus/2019-ncov/faq.html#If-You-or-Someone-You-Know-is-Sick-or-Had-Contact-with-Someone-who-Has-COVID-19.