The return of tens of thousands of college students to Massachusetts from all corners of the US and world, once feared as a super-spreading provocation, has instead proved to be one of the few successes of the pandemic, thanks to an extensive testing system that could serve as a model for the rest of society.
The immense undertaking by many New England colleges and universities included testing students when they first arrived on campus, requiring them to wear face masks and limit social gatherings, and, throughout the fall, making everyone on campus undergo a nose swab test for COVID-19 at least once a week — with results usually available within less than 24 hours.
With several thousand students on many of the state’s college campuses, higher education institutions have conducted more than 2.8 million COVID tests since Aug. 15, according to the Massachusetts Department of Public Health. The result is an infection rate among college students that is significantly lower than among the broader population in the state.
“It is a pretty good miniature blueprint of what we should be doing as a society,” said Marc Lipsitch, an epidemiologist at the Harvard T.H. Chan School of Public Health. “Frequent, rapid turnaround testing . . . that should absolutely be replicated at the societal scale.”
That’s a sharp contrast to the view back in August, when many — neighbors, local officials, and faculty — were dubious of plans by dozens of New England colleges and universities to bring students back to campus amid a global pandemic. Indeed, outbreaks of the virus early in the fall semester, at the University of North Carolina Chapel Hill and Providence College, and among athletes at Boston College, seemed to bear the skeptics out.
Now, replicating the stout prevention efforts on a broad scale in communities and businesses, specialists say, would take money, planning, and a collective willpower that Massachusetts has yet to harness and deploy.
Indeed, months into the pandemic, easily accessible widespread testing, with quick results, is still not in place in Massachusetts, despite calls from health experts and business groups since late spring to ramp up testing.
“Money certainly helps, but the biggest single ingredient isn’t money, it’s commitment,” said Ashish Jha, dean of the Brown University School of Public Health.
Central to the campus successes was the decision to partner with a powerful local resource: the Broad Institute in Cambridge, a research collaboration between the Massachusetts Institute of Technology and Harvard University.
Since its launch in 2004, Broad has been at the forefront of cutting edge genome and gene-editing research. But this past March, as COVID-19 cases skyrocketed and hospitals and the state’s public health laboratory found themselves ill-equipped to deal with the crisis, the Broad expanded into virus testing. It used a $10 million state grant and federal funding to build capacity for as many as 100,000 tests a day.
After sending students home in mid-March as the virus swept across Massachusetts, local college presidents, many with science backgrounds, began to develop plans to reopen schools in the fall, with quick and affordable testing as a key component.
They approached the Broad, which offered to charge colleges $25 per test — much less than the $100 commercial price — and promised results within 24 hours. The Broad has conducted more than 6 million tests since late March; it has previously estimated that nearly two-thirds of the 70,000 tests it processes on average each day are from colleges and universities.
Meanwhile, a handful of institutions, including two of the largest — Boston University and Northeastern University — spent millions building their own testing laboratories.
As a result, the seven-day weighted average positive test rate in Massachusetts higher education has never exceeded 0.37 percent this fall, whereas the statewide positive test rate has passed 3 percent in recent days. (The positive test rate is the number of positive tests divided by the number of total tests administered.)
“Regular testing across the whole campus community is really essential to success,” said Laurie Leshin, president of Worcester Polytechnic Institute, who led the state’s task force on college reopening. “The testing was really critical. . . . It’s not a secret formula.”
Contrast that with scenes of residents waiting hours in long lines in the cold at free state testing sites ahead of the Thanksgiving holiday, or the lengthy delays in getting results that make the tests far less useful. Public school systems have struggled to bring students back to classrooms in the fall, while businesses have been reluctant to bring workers back to office buildings, crippling the restaurants and retailers that rely on them for their livelihoods. And many lower-wage employees who have little choice but to return to work have felt unsafe and at higher risk of contracting the virus.
The lack of direction and resources from all levels of government has accelerated the damage to the economy and cost lives, said Jha, the Brown University dean.
“That we could have figured it out for Harvard and we couldn’t have figured it out for public schools, doesn’t seem right to me,” Jha said. “The key point from colleges is, if you are committed to being open through the pandemic, you can do it, and do it safely.”
For example, public K-12 schools may not need the extensive testing colleges conducted. But quick spot or sample testing of younger students and teachers could have allowed administrators to isolate those at risk and keep the virus from spreading rampantly through the school community. If there had been more funding and organization for such efforts, more students could have returned to the classroom, Jha said.
Last week, during a virtual panel of the Massachusetts High Technology Council, business leaders said a coordinated national testing strategy matching companies with laboratories would have lessened the economic fallout from the pandemic and allowed more people to remain employed while working safely.
Still, the high cost of testing and the slow turnaround for results have been deterrents for businesses, too, said Michael Mina, an assistant professor of epidemiology at the Chan School who has consulted with colleges and CEOs on reopening plans and is a vocal advocate for rapid antigen tests.
The antigen tests have not been as accurate as the molecular tests, but they can be distributed more widely and offer faster results. But the federal government has been slow to approve their broad use. Meanwhile, public funding for increased testing in schools has stalled in Congress.
And within Massachusetts, Northeastern University epidemiologist Samuel Scarpino said, there should have been more effort by Governor Charlie Baker’s administration to expand testing.
“We never made the decision as a state. We just decided that we couldn’t afford it,” Scarpino said.
State officials, however, point to the $10 million investment in Broad in the spring to boost testing capacity and Baker’s announcement earlier in November to roll out quick turnaround tests to 134 public school districts, charters, and special education collaboratives in early December. These tests will be used to screen K-12 students and staff who show COVID-19 symptoms.
“Massachusetts leads the nation in COVID-19 testing efforts and has invested over $150 million in testing statewide as a public good for employers, businesses, long term care facilities, higher education, and the public,” said Kate Reilly, a spokeswoman for the COVID-19 Response Command Center.
Yet experts say Massachusetts should have acted more quickly, as colleges did. School presidents said they had to move fast, with little guidance from federal health officials. And while it has cost them millions of dollars, some schools have big endowments to help fund the efforts, and others used federal stimulus money or passed the costs on to students through added fees.
“This is a decision every employer and every business made for themselves,” said Boston University president Bob Brown. BU initially pegged its annual costs for COVID testing and safety measures at about $70 million, although Brown said it will likely be lower because the testing was less expensive than anticipated.
“We believe very much in the residential environment for the kind of educational experience we give and we wanted to open it,” Brown said. “We made the commitment to do that. Just like any segment of society, you decide how much money are you willing to spend to supply what you do.”
A former Budweiser beer distribution center in Cambridge has served as the epicenter of the region’s college testing program. The squat, block-long building is home to the Broad’s Genomic Platform laboratory, where tens of thousands of polymerase-chain-reaction, or PCR, tests are processed daily.
In the evenings, couriers from around New England deliver vials of swab tests to be analyzed overnight. The institute also processes tests for nursing homes and the state’s Stop the Spread testing sites. The Broad said the federal and state funding allowed it to reduce the costs of testing.
While the college program began with a handful of private colleges, it has grown to 108 institutions, from small schools such as Regis College and Lasell University to Middlebury College in Vermont, Framingham State University, and Yale University in Connecticut.
The Broad set up a vast international supply network for testing materials that only occasionally has showed signs of strain: In October, a package of plastic tips used in testing machines en route from China was briefly delayed because shippers were busy delivering the new iPhone 12 models, said Stacey Gabriel, senior director of the Genomics Platform, who heads the testing program.
And while the Broad lab can conduct 100,000 tests a day, it has tipped over that high mark just twice so far.
The institute also had logistical issues, such as getting test samples to Cambridge efficiently. Broad hired a courier service that fans out messengers daily across eight different routes. Gabriel said the institute also has a call center that handles thousands of inquiries a day about forgotten passwords and test results.
“We have learned a lot,” she said, adding that the institute hired about 300 additional workers.
Outside of New England, the response to the coronavirus pandemic has led to different solutions and mixed results.
Some institutions, including Duke University and the University of Illinois Urbana-Champaign, have also set up extensive testing programs of their own. Other universities test only students with symptoms. Many other institutions, however, chose not to bring back students and are offering courses remote-only.
The cost of testing and the conversion of lab space into COVID testing facilities are hurdles but can be overcome, said Leshin, the WPI president.
“What we did at the Broad, it’s not rocket science,” Leshin said. “It could be done regionally across the country. You could build these kinds of labs all over the country; there’s literally nothing preventing it. It’s the will. The initial capital investment was important. But just as important was the commitment of [Broad] to figuring out the process and making it work.”
The Broad is now in discussions with some public K-12 school systems about conducting more affordable group testing. A pilot between Tufts University and Medford and Somerville public schools is set to launch in January.
Northeastern is also in discussions with businesses and local health centers to take on some of the testing load.
Public health experts said that despite promising news this month, vaccines will be unavailable to most of the public for months to come, meaning frequent testing will remain key to keeping communities safe.
“People have the impression that there is enough testing,” said Jared Auclair, an associate dean at Northeastern who heads its testing lab. “There’s not.”