COVID-19 testing and contact tracing is an evolving topic with many unknowns, but several critical tips emerged from a recent discussion among peers at different institutions, both residential and commuter.
by Daniel Fusch, Academic Impressions
On May 28, 2020, academic leaders, student health, and student affairs professionals from just under two dozen campuses met online to compare notes as their campuses prepare to reopen. The topic at hand was how to manage COVID-19 testing and contact tracing as students return to campus, and a variety of institutions were represented, from urban residential campuses to small, rural commuter schools. We used an Open Space format to surface the most critical questions and working collaboratively to produce solutions. This virtual workshop was unique in its format, the second in an ongoing series of collaborative events held by Academic Impressions to help institutions navigate how to reopen campus and resume operations. (You can find out about this series here.)
Open Space is a format you don’t usually see in a virtual professional development event; each of our virtual workshops provides an active learning environment where participants can set the learning agenda collaboratively, explore ideas, get inspired by what their peers are trying, and get a sense of the wider range of possibilities in confronting a given problem. They leave the session with practical solutions they can take back to their team or task force.
In this case, the discussion was facilitated by Traci Callandrillo, Ph.D., Assistant Vice President of Campus Life at American University, and Ruperto M. Perez, Ph.D. Associate VP for Student Health and Wellbeing at the University of Alabama.
We’d like to share with you several tips that emerged during the conversation:
1. Have a Plan for Measuring Community Spread
A lot of our participants had questions about whether to invest in antibody or antigen testing. Over the course of the conversation, it quickly became apparent that there are a number of concerns currently with antibody testing - both about its validity and about the degree to which it will produce helpful information if it can't be required of the entire campus community. Additionally, the medical science isn't clearly yet on whether individuals who have contracted COVID-19 and then recovered are immune from contracting it a second time.
Screening for symptoms may also be of dubious use, particularly later in the fall, for two reasons. First, the symptoms for COVID-19 look similar to symptoms for the common cold and the flu, meaning that many students will be exhibiting symptoms. Second, members of the campus community can be both positive for COVID-19 and contagious without showing any symptoms at all.
Most of the institutions at our event were focused instead on way to measure community spread. The most prevalent approach is to test random samples from around campus at regular intervals. To keep testing both affordable and scalable, you can submit batch tests. For example, you might batch one floor of a residence hall or the staff from one facility on campus. If a batch comes back positive, then you know there is at least one case in that location. You can then target additional testing to the individuals at that location. By batch testing random samples at regular intervals, you will be more able to understand and monitor community spread on your campus.
2. Be Specific in Defining the "Contact" in "Contact Tracing"
Contact tracing is time and labor-intensive, and may not be practical for many commuter campuses. But if an outbreak occurs on a residential campus, contact tracing may be crucial so that you can identify members of the campus community who may need to be tested (as resources permit) or quarantined.
Our participants noted that two things can quickly go wrong when tracing contacts of a COVID-19 case:
- Some students may be reluctant to report symptoms or volunteer the information needed for contact tracing. They and their contacts may have a lot of fear of contracting COVID-19, fear of the stigma, or fear of restrictions on their movement or civil liberties. (Other issues could come into play as well. One participant shared the story of a campus that attempted to enforce social distancing guidelines earlier in the pandemic by fining students who weren't adhering to social distancing guidelines. Now that strategy may well backfire, because students will not be quick to help with contact tracing if they think they will be fined.)
- On the opposite end of the spectrum, people who are more distant from an outbreak may seek actively to be tested and traced, creating a situation in which you are trying to trace contacts of contacts of a student with symptoms.
It will be crucial to be very specific about what "contacts" are. One of our participants took the stance that contacts of contacts are not contacts unless symptomatic. They are defining "contact" as exposure within six feet to an individual who is confirmed positive for COVID-19. "You have to approach this with real organization," this participant stressed.
Before the fall, work with your local public health agencies to define what contacts you will need to trace and why, as specifically as possible.
3. Prep Your Students for the Fall
Among the suggestions:
- Consider videoconferencing or telehealth consults for students who report symptoms.
- Provide COVID-19 kits for all students (kits could include two face masks, hand sanitizer or soap, disposable thermometers, and a copy of written guidelines for self-screening).
- Plan self-quarantine spaces in advance, particularly for residence halls.
- Engage students in conversation about how screening, quarantine, and student health will be handled on campus before they return in the fall.
"The messaging to students is really critical," Ruperto M. Perez of the University of Alabama emphasized. "It’s going to be incumbent on them to be invested in this process and this endeavor. I think it’s important to have student voices involved in the discussion of what you plan to do, and have them engaged in a process that is voluntary for them. Rather than mandate downloading a contact tracing app (there is no guarantee they will), we need to appeal to their sense of personal responsibility and their responsibility to the student community."
Our participants also shared word with each other of some of the screening and contact tracing apps that are already available to share with students. For example, these three:
- The Apple COVID-19 app, which includes information, social distancing guidelines, and an interactive screening tool.
- HEALTHLYNKED COVID-19 Tracker, which empowers users to self-report symptoms and alert their contacts.
- Healthy Together is an example of a regional app, in this case developed in partnership with the state of Utah to help residents get access to testing services, support public health officials contact tracing efforts, and get updated information about community spread in their area. It is likely that other state- and province-specific apps will also become available.
Reopening Campus, Resuming Operations:
Participate in Virtual Events Like This One
Convening online—at a social distance—to address questions like these, and to share advice and strategies, is important. We plan to hold these expert-facilitated Group Collaborations regularly to address an array of issues faced by campuses planning to re-open.