Colleges and universities are crafting plans to bring their students back to campus for the fall semester. Well-developed protocols for mask-wearing, social distancing, symptom reporting, handwashing, and quarantines upon arrival for students from coronavirus hot spots are critical for a safe reopening. However, the most essential element for a safe reopening must be frequent testing for the presence of COVID-19 infection.
At the University of Massachusetts Medical School, beginning in mid-May, we brought back more than 2,000 students, faculty, and staff in three discrete cohorts, most of whom were involved in our vigorous biomedical research enterprise. Before the return to campus, each was tested via a health-care-provider-administered nasopharyngeal swab. The swabs were sent to a commercial lab at a cost of more than $100 each and results were reported back within 48 hours.
We were encouraged that only a few of the 2,360 tests conducted in this initial phase found active coronavirus in asymptomatic employees. This strongly suggested that our community members had effectively adopted the practices known to prevent the spread of the virus. Employees who tested positive were required to remain home in quarantine per Centers for Disease Control and Prevention guidelines. Importantly, we also engaged in robust contact tracing to ensure that the source of their infections was not linked to our campus. Once on campus, personnel are required to complete a daily symptom check via a smartphone app.
By the end of June, our medical school had established regular surveillance testing for all employees and students coming to campus at least two days per week. Each employee or student schedules a weekly, self-administered Q-tip like swab “twirl” in the front of the nose, 15 seconds in each nostril. This manner of testing is more easily tolerated. With outstanding support from the Broad Institute, which has converted part of its clinically certified lab into a high-throughput COVID-19 testing facility, we have been able to test more than 350 people daily with a highly specific and low-cost test, the results of which are e-mailed to our employees and students within 36 hours.
In the first four weeks of this surveillance testing, the number of asymptomatic positive test results has been low: just four in total out of 4,867 tests performed. Three of the individuals found to be positive worked in the same open laboratory wing, indicating a small cluster of asymptomatic positives. With this information, we were able to undertake independent confirmation of the positive tests using another laboratory, trace contacts for all of those who had interactions with the three employees, and establish a quarantine period for those who were identified as having had exposure. Independent testing confirmed that others working in the same space remained negative.
As a result of increased community spread of COVID-19 throughout the nation, we know that Massachusetts will be challenged with “external shocks” of COVID-positive individuals coming to the Commonwealth to attend our colleges and universities. Given the influx of 18- to 25-year-olds to our campuses, numerous college and university leaders have outlined clear expectations for a behavioral “compact” that will be necessary for a safe return to campus.
There are significant lessons for colleges and universities from our early experience reopening our campus in Worcester. As outlined in the Report of the Massachusetts Higher Education Testing Group, to diminish the potential for a rapid spread of coronavirus infection in the early days of the return to campus, it’s essential to adhere to state recommendations for quarantine for those coming from areas of the nation where there is significant spread of the disease. Students from these areas should quarantine for 14 days; provision for meals, personal needs, and academic enrichment can be arranged. If space, cost, or other limitations make quarantine impractical in a college-aged population, then frequent testing, perhaps every two to three days, with early isolation until results are returned, should be implemented.
Testing schedules should assure that individuals who work or — for residential colleges — live together should be varied. If 50 people work or live on the same floor, testing 10 of them each day will afford an indication that disease exists within that unit. Models demonstrate that frequency of testing is also important to consider. Given the lower prevalence of disease in Massachusetts at the present time and the fact that UMass Medical School is not a residential campus, we have found that weekly testing is sufficient to control the prevalence of infection. That said, when positive cases are identified, it may be necessary to increase the frequency of testing in the area where the positive cases exist. We also learned that transparency of testing results has helped our community be better informed and feel safe.
The cost of testing is substantial. Where testing has been provided free of charge by the government, the frequency of testing increased. The federal recovery legislation currently being developed should consider providing colleges and universities with funds to assure that testing is frequent and affordable. This testing is essential for the safe reopening of our institutions and, by extension, the well-being of the communities in which we operate.
Our experience confirms that with low-cost, frequent testing, like that made possible by the Broad Institute, along with a rapid turnaround of results, contact tracing, and isolation can wall off disease for a campus community. These principles could serve our nation well.
Dr. Michael F. Collins is senior vice president for health for the University of Massachusetts system and chancellor of the University of Massachusetts Medical School.