For In-Person College, Coronavirus Testing Will Be Key. But Is That Feasible?

The coronavirus test wasn't as bad as Celeste Torres imagined. Standing outside a dorm at the University of California, San Diego, Torres stuck a swab up a nostril, scanned a QR code, and went on with the day.

"The process itself was about five minutes," Torres says, "I did cry a little bit just because it's, I guess, a natural reaction."

Torres hadn't been exhibiting symptoms, and didn't end up testing positive. Rather, they are a data point, part of a mass testing effort at UC San Diego to make sure an in-person fall semester is possible. "We're not trying to test to see if we can detect an outbreak right now," explains Dr. Robert Schooley, a virologist and professor of medicine, who is helping lead the project. "We're trying to make sure that we can scale to be able to do that in the fall."

Getting colleges and universities going is the main goal for leaders across the country — and it will remain so over the next several months. The CDC released guidance on reopening higher ed institutions this week, and almost daily now, colleges are releasing their own plans for how they intend to open with students on-campus come fall. For many schools, part of the plan includes testing for SARS-CoV-2.

"We're at the stage when every college and university president is acutely aware that if they open in the fall, they will need a testing regime," says Terry Hartle, of the American Council on Education, which represents 1,700 higher education groups, including colleges. "What they haven't figured out yet is where they'll get the tests, what the regime will look like and what the protocols will be. But those are things that they are thinking about every single day."

At UC San Diego, there are about 5,000 students currently living in dorms on campus; many were unable to return home this spring. Starting last week, Schooley and his collaborators are asking students to voluntarily test, so they can see if their modeling and protocol for fall will work. They're hoping to scale up when the campus returns to full capacity — about 30,000 undergrad students — aiming to test about 70 to 75% of the community every month. Along the way they're learning valuable lessons: Wi-Fi at testing spots needs to be strong in order to link students' ID numbers to the code on the sample. Posting up outside a dorm at 7 a.m. isn't a great tie to get a lot of students. And students are really freaked out about that swab; they'd much prefer a saliva test.

Administrators are also learning about students' motivations. When the pilot launched last week, the initial messaging to students was, 'Are you curious? Come see if you're shedding the virus!' They didn't get a lot of volunteers. By day three, they had changed the pitch to, 'If you take this test it can help us have in-person classes in the fall.'

Students came in droves.

"They really want to get on with their lives and get on with their education," says Schooley. "If we can't get the university going, it's going to be very hard to get the rest of society going."

UC San Diego is in a unique position because it has a lab, a hospital and a designated procurement team, which helps source components of the test. They're not facing test shortages like other communities have. Researchers there are working to develop new tests and components, to help diversify the materials used, so there are fewer shortages.

"If you're a large university and you have a school of public health, obviously, that gives you a leg up," says Hartle. Smaller schools, he says, may need to work with local and state health departments to figure out a testing plan. But many schools are still in the early planning phases.

"How do we get access to tests? I think that's the biggest question, because right now, locally, the access is for folks that are showing symptoms," says Kirsten Brinlee, the executive director of the Baltimore Collegetown Network, which works with 13 schools in the Baltimore area. "We've started to have some conversations about, you know, what could group ordering look like?"

Joining with other colleges to plan has proved useful for colleges across the country, and it could make it easier to purchase tests in bulk, says Todd Greene, who leads the Atlanta University Center Consortium, a group made up of four historically black colleges in Atlanta, including Morehouse School of Medicine. Together they serve about 9,000, so that gives them leverage, buying power and an opportunity to think about scale. The medical school has "led the force" when it comes to testing, Greene says, but as a whole, the group hasn't made any final decisions regarding how they'll go about testing in the fall, though they're actively working through different scenarios. He says many testing companies and consultants have reached out to help.

At their group meetings some important questions have emerged: Do we test our students before they arrive on campus? Or immediately upon arrival? And then how often to test? Are the tests available actually reliable? He says they're particularly concerned with issues of privacy and the disproportionate impact of the virus on communities of color.

High costs when budgets are tight

Even if colleges can get their hands on tests, they cost a lot: anywhere from $50 a test to triple that. Even with so much happening in-house, the project at UC San Diego is anticipated to cost more than $2 million per month in the fall.

Timothy White, chancellor of the California State University system, which announced it is planning for a virtual fall semester, mentioned the cost of testing as a key factor in that decision. He estimated that mass testing would cost about $25 million a week. "It's just not practical at all for us to do that level" of testing, he told NPR. "For the size of our university, it is beyond the realm of the financial or practical possibility."

Colleges are facing extreme financial pain right now, because of the pandemic. And the uncertainty surrounding the tests, how to get them and what tests are effective has made education leaders less likely to make large purchases now.

"My gosh, if we could say, let's order these little saliva packs and we knew they'd be effective, then I think every college, every campus health center director would be like, 'how do I get that into my budget? Let's go get it.' But we're not quite at that level yet," says Judy Smith, who runs the health center on campus at Mercyhurst University, a campus of about 4,000 students in Erie, Pa.

Smith says she's constantly following the news about testing and test developments, which are happening at "warp speed," and she's in communication with the local community about the coronavirus testing they're doing and the labs they're using to process those tests.

"We know — well, we think we know — that we're not going to purchase diagnostic COVID testing at this point in time, when the test has to be done in the laboratory," she says. "We're not going to build a laboratory here on campus, I'm pretty confident in saying that."

Regardless of the unbuilt lab, Smith says she's focused on making sure students on campus will be good with masking, social distancing and cleaning, when they open in the fall.

A kind of insurance

While the cost may be prohibitive for some colleges, others see it as an essential investment for being in-person. "We pay for all kinds of insurances," says Michael Le Roy, the president of Calvin University, a small Christian college in Western Michigan. "In many ways this is a similar kind of cost."

He's planning for the 3,500-person campus to be open this fall. There are still lots of details to work out, with elements of social distancing, and reimagined dorms and in-person classes, but before the school solidified its plans, Le Roy felt it was especially important to get his hands on some tests.

"No matter how you think about it, a program of testing was going to be critical to everything else," says Le Roy. "If we couldn't do that, almost everything else was going to be impossible or much harder."

Through connections in the school's chemistry department, Le Roy made a deal with Helix Diagnostics, a commercial laboratory. For an undisclosed amount of money, the company will provide 5,000 coronavirus tests for students at Calvin.

"It felt almost inappropriate, or wrong, to wait for the state or federal government to provide the tests," says Le Roy, "I just felt like, we're going to have to be tenacious."

Now that the deal is done, there's a bit of relief. "I'm not saying that it solves everyone's problems," he says, "but it might be a way forward for us to begin to solve many problems." He says, there's still a long road ahead. "You feel a little like you're in the great beyond, so you get one thing in place and you're like — OK, the next thing!"

Le Roy is the chair of Michigan Independent Colleges and Universities, and he's working to open up opportunities for other small schools throughout the state to get access to testing. He acknowledges that it may be harder, the more tests he needs to acquire.

That's because there isn't an unlimited supply. "The reality is that reagents and supplies are still a challenge for a lot of us," says Michael Rao, the president of Virginia Commonwealth University and the president of the school's health system. "I do think that ultimately it's unrealistic and it has been unrealistic and it probably will remain unrealistic for some time to assume that we can all be tested all the time."

He says in lieu of testing, screening and symptom tracking can be just as important for containing outbreaks. But, ultimately, it's going to come down to student behaviors. Because even with testing, the moment a student swabs their nose, and goes on with their day, they're making a million different decisions that impact the larger community.

For campuses to function safely, he says, they are going to need a strong social contract that honors certain behaviors, and puts the health of the community first.

"It's really less about just you and more about taking responsibility for everyone," he says, "The bottom line is that once we're together, we really do have to agree that these will be the fundamental policies and procedures that we're going to follow to respect each other and to protect each other and to help create a safe environment."

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