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From page 193... ... COVID-19 Testing Strategies for Colleges and Universities DECEMBER COVID-19 TESTING STRATEGIES FOR 2020 COLLEGES AND UNIVERSITIES Authors: Tara O'Toole* Martin D Read the entire page →
From page 194... ... COVID-19 Testing Strategies for Colleges and Universities COVID-19 TESTING STRATEGIES FOR COLLEGES AND UNIVERSITIES 1 EXECUTIVE SUMMARY This rapid expert consultation summarizes what is known to be effective with respect to testing strategies for college and university campus reopening, including the types of diagnostic testing employed, testing frequency and targets, metrics typically reported, responses to positive tests, and efforts to ensure compliance. Experience from the fall 2020 semester suggests that fast, frequent testing can help mitigate the spread of COVID-19 in a large and diverse university community, but it must also be emphasized that testing is only one component of a coherent mitigation strategy. Read the entire page →
From page 195... ... COVID-19 Testing Strategies for Colleges and Universities COVID-19 TESTING STRATEGIES FOR COLLEGES AND UNIVERSITIES 2 BOX 1 LESSONS LEARNED ABOUT COVID-19 TESTING STRATEGIES 1. Testing as one component of a mitigation strategy based on a comprehensive, coherent plan with redundancies. Read the entire page →
From page 196... ... COVID-19 Testing Strategies for Colleges and Universities COVID-19 TESTING STRATEGIES FOR COLLEGES AND UNIVERSITIES 3 To better understand the university experience, the National Academies' Societal Experts Action Network and Standing Committee on Emerging Infectious Diseases and 21st Century Health Threats hosted four public information-gathering webinars on October 28–29, 2020. 2 This rapid expert consultation draws heavily on the experiences shared in the course of those discussions; the appendix provides brief summaries of the case examples presented at each session. Read the entire page →
From page 197... ... COVID-19 Testing Strategies for Colleges and Universities COVID-19 TESTING STRATEGIES FOR COLLEGES AND UNIVERSITIES 4 • The testing environment is highly dynamic, with new test types and formats emerging rapidly. More than 200 COVID-19 reverse transcription polymerase chain reaction (RT-PCR) Read the entire page →
From page 198... ... COVID-19 Testing Strategies for Colleges and Universities COVID-19 TESTING STRATEGIES FOR COLLEGES AND UNIVERSITIES 5 context, as decision makers are mindful of the risk of transmission among students; among students, faculty, and staff; and between students and the surrounding community. Read the entire page →
From page 199... ... COVID-19 Testing Strategies for Colleges and Universities COVID-19 TESTING STRATEGIES FOR COLLEGES AND UNIVERSITIES 6 performing arts, members of athletics teams, or the Greek system. This strategy allows for rapid isolation and has the potential to minimize transmission. Read the entire page →
From page 200... ... COVID-19 Testing Strategies for Colleges and Universities COVID-19 TESTING STRATEGIES FOR COLLEGES AND UNIVERSITIES 7 across these key considerations, their experience suggests that any surveillance testing system needs to be clearly planned, transparent, comprehensive, data-driven, agile, and timely. Type of Diagnostic Testing A variety of molecular, antigen, and antibody tests have been developed for the SARS-CoV-2 virus and authorized by the Food and Drug Administration (FDA) Read the entire page →
From page 201... ... COVID-19 Testing Strategies for Colleges and Universities COVID-19 TESTING STRATEGIES FOR COLLEGES AND UNIVERSITIES 8 BOX 2 EXAMPLES OF COVID-19 TRACKING DASHBOARDS Surveillance metrics need to be collected in a routine, systematic, consistent, and timely manner. A number of colleges and universities have public dashboards that provide information to students, faculty, staff, and the public. Read the entire page →
From page 202... ... COVID-19 Testing Strategies for Colleges and Universities COVID-19 TESTING STRATEGIES FOR COLLEGES AND UNIVERSITIES 9 BOX 3 Performance Trade-offs in Screening Tests Both nucleic acid and antigen POC [point-of-care] tests have been reported in developmental studies to have specificity comparable to that for standard RT-PCR [reverse transcription polymerase chain reaction] Read the entire page →
From page 203... ... COVID-19 Testing Strategies for Colleges and Universities COVID-19 TESTING STRATEGIES FOR COLLEGES AND UNIVERSITIES 10 As noted earlier, colleges and universities have been relying on RT-PCR 7 testing, and many are planning to add or transition to rapid point-of-care tests. 8 These rapid antigen tests can be useful and are cheaper and more convenient than PCR tests, but they are not a panacea, and false positives may decrease the testing population's faith in testing and willingness to comply unless the testing strategy is clear and well communicated. Read the entire page →
From page 204... ... COVID-19 Testing Strategies for Colleges and Universities COVID-19 TESTING STRATEGIES FOR COLLEGES AND UNIVERSITIES 11 diagnostic testing, "Diagnostic tests may be used to screen individuals to allow them to participate in school, sports, work, or other activities. Tests for this purpose of assurance must provide rapid results and may be useful if repeated with sufficient frequency, even if each individual assurance test has lower sensitivity and specificity than a more definitive test.…All positive antigen tests should be followed up with a more specific test as needed to ensure an accurate conclusion, and test results should be provided to local public health officials." 12 The University of Arizona, for example, administers rapid antigen testing for asymptomatic individuals whereby results are typically available within 1 hour. Read the entire page →
From page 205... ... COVID-19 Testing Strategies for Colleges and Universities COVID-19 TESTING STRATEGIES FOR COLLEGES AND UNIVERSITIES 12 University of New Hampshire, which did not have a medical or veterinary school on campus, chose to build its own CLIA-certified laboratory, going from "zero to CLIA in 100 days." The University of California, San Diego, utilized its health system's CLIA-certified laboratory, and also transformed several research laboratories into pop-up labs for testing. Costs. Read the entire page →
From page 206... ... COVID-19 Testing Strategies for Colleges and Universities COVID-19 TESTING STRATEGIES FOR COLLEGES AND UNIVERSITIES 13 and university context, targeted surveillance may involve use of diagnostic tests to screen individuals so they can participate in sports, classes, or other on-campus activities. Tests for this purpose of assurance "must provide rapid results and may be useful if repeated with sufficient frequency." 18 Testing strategies need to take account of the prevalence of COVID-19 in the surrounding community, the number of off-campus students who frequent the campus, and evolving data and results from the current testing program, among other factors. Read the entire page →
From page 207... ... COVID-19 Testing Strategies for Colleges and Universities COVID-19 TESTING STRATEGIES FOR COLLEGES AND UNIVERSITIES 14 routinely to laboratories, and the availability of facilities and spaces of an appropriate size to allow for physical distancing. A number of participating college and universities described testing strategies that involved ramped-up testing related to on-campus arrivals at the beginning of the fall quarter/semester, as well as increased testing around fall breaks. Read the entire page →
From page 208... ... COVID-19 Testing Strategies for Colleges and Universities COVID-19 TESTING STRATEGIES FOR COLLEGES AND UNIVERSITIES 15 In addition, a number of colleges and universities are using or piloting exposure notification technologies. The University of Alabama, one of the first institutions of higher education to implement such technology, uses the GuideSafe Exposure Notification App to alert the campus community of potential close contacts with someone who has had a positive test. Read the entire page →
From page 209... ... COVID-19 Testing Strategies for Colleges and Universities COVID-19 TESTING STRATEGIES FOR COLLEGES AND UNIVERSITIES 16 Another important consideration when deciding on strategies for increasing compliance with testing is attention to issues of equity and regard for historical patterns of marginalization and distrust in the health care system. Representatives from Morgan State University noted concerns among students about fairness, disproportionate impacts, and distrust of institutions and health interventions resulting from historical patterns of marginalization, especially within Black and Native American communities. Read the entire page →
From page 210... ... COVID-19 Testing Strategies for Colleges and Universities COVID-19 TESTING STRATEGIES FOR COLLEGES AND UNIVERSITIES 17 APPENDIX TESTING STRATEGIES ON COLLEGE AND UNIVERSITY CAMPUSES: CASE EXAMPLES As described in the introduction to this rapid expert consultation, to better understand the college and university experience, the National Academies' Societal Experts Action Network and Standing Committee on Emerging Infectious Diseases and 21st Century Health Threats hosted four public information-gathering webinars during October 28–29, 2020. The presentations made during the webinars are summarized in this appendix. Read the entire page →
From page 211... ... COVID-19 Testing Strategies for Colleges and Universities COVID-19 TESTING STRATEGIES FOR COLLEGES AND UNIVERSITIES 18 DUKE UNIVERSITY In advance of reopening for the fall 2020 semester, Duke University in Durham, North Carolina, set up an on-campus program to test students, faculty, and staff. 23 A pooled surveillance testing approach is used to test students. Read the entire page →
From page 212... ... COVID-19 Testing Strategies for Colleges and Universities COVID-19 TESTING STRATEGIES FOR COLLEGES AND UNIVERSITIES 19 testing program: the first tier is asymptomatic testing of all students and front-facing staff/faculty, while the second is symptomatic and close-contact testing of students. 26 For asymptomatic testing, Hampshire College uses the services of the Broad Institute in Cambridge, Massachusetts, which offers RT-PCR testing with an 18- to 24-hour turnaround and provides the testing supplies and lab capacity. Read the entire page →
From page 213... ... COVID-19 Testing Strategies for Colleges and Universities COVID-19 TESTING STRATEGIES FOR COLLEGES AND UNIVERSITIES 20 begin assisting with test administration in spring 2021. Testing is just one component of MSU's holistic approach, which also emphasizes active campus risk communication to encourage mask wearing, physical distancing, and handwashing. Read the entire page →
From page 214... ... COVID-19 Testing Strategies for Colleges and Universities COVID-19 TESTING STRATEGIES FOR COLLEGES AND UNIVERSITIES 21 UNITED TRIBES TECHNICAL COLLEGE The United Tribes Technical College (UTTC) is a tribal college serving students from 75 federally recognized tribes in Bismarck, North Dakota. Read the entire page →
From page 215... ... COVID-19 Testing Strategies for Colleges and Universities COVID-19 TESTING STRATEGIES FOR COLLEGES AND UNIVERSITIES 22 ROTC students, undergo more frequent testing because of their high(er) risk from essential in person activities. Read the entire page →
From page 216... ... COVID-19 Testing Strategies for Colleges and Universities COVID-19 TESTING STRATEGIES FOR COLLEGES AND UNIVERSITIES 23 testing program in May 2020, UCSD launched its testing program by testing all students upon their arrival to campus for the fall 2020 semester. After an initial test, on-campus students are required to be tested once every 14 days, and off-campus students and faculty and staff are encouraged, but not required, to be tested once every 2 weeks. Read the entire page →
From page 217... ... COVID-19 Testing Strategies for Colleges and Universities COVID-19 TESTING STRATEGIES FOR COLLEGES AND UNIVERSITIES 24 The university is planning to provide tests before students leave for Thanksgiving and upon their return in January, with an emphasis on high-risk groups, such as those in residential housing, Greek life, and ROTC. The university also has a clear plan in place in the event that a student on campus tests positive for COVID-19. Read the entire page →
From page 218... ... COVID-19 Testing Strategies for Colleges and Universities COVID-19 TESTING STRATEGIES FOR COLLEGES AND UNIVERSITIES 25 exposure notifications directly to users' phones. The phone of an individual who has up-to-date testing and tests negative flashes a check mark that allows entry to the buildings on campus. Read the entire page →
From page 219... ... COVID-19 Testing Strategies for Colleges and Universities COVID-19 TESTING STRATEGIES FOR COLLEGES AND UNIVERSITIES 26 were key concerns in planning a testing program. UNH therefore decided to build its own lab, a decision made more difficult by the fact that the campus did not have its own medical school, veterinary school, or other labs. Read the entire page →
From page 220... ... COVID-19 Testing Strategies for Colleges and Universities COVID-19 TESTING STRATEGIES FOR COLLEGES AND UNIVERSITIES 27 closely with the local health department, university housing, and other campus partners to isolate that student and conduct contact tracing. In addition to addressing cost concerns, the university had to address the concerns of students who were unable to access testing in their home communities. Read the entire page →
From page 221... ... COVID-19 Testing Strategies for Colleges and Universities COVID-19 TESTING STRATEGIES FOR COLLEGES AND UNIVERSITIES 28 We also thank the following individuals for their review of this rapid expert consultation: Ana Mari Cauce, President, University of Washington; Darko Draganic, Health and Wellness Director, United Tribes Technical College; Michelle Fisher, Assistant Vice President for Student Affairs, Delaware State University; Lynn R Goldman, Michael and Lori Milken Dean of the Milken Institute School of Public Health, George Washington University; and Scott Tims, Assistant Vice President, Campus Health, Tulane University. Read the entire page →
From page 222... ... COVID-19 Testing Strategies for Colleges and Universities COVID-19 TESTING STRATEGIES FOR COLLEGES AND UNIVERSITIES 29 SOCIETAL EXPERTS ACTION NETWORK (SEAN) Read the entire page →
From page 223... ... COVID-19 Testing Strategies for Colleges and Universities COVID-19 TESTING STRATEGIES FOR COLLEGES AND UNIVERSITIES 30 STANDING COMMITTEE ON EMERGING INFECTIOUS DISEASES AND 21ST CENTURY HEALTH THREATS HARVEY FINEBERG (Chair) , Gordon and Betty Moore Foundation KRISTIAN ANDERSEN, The Scripps Research Institute RALPH STEVEN BARIC, The University of North Carolina at Chapel Hill MARY T Read the entire page →

From page 193...

... COVID-19 Testing Strategies for Colleges and Universities DECEMBER COVID-19 TESTING STRATEGIES FOR 2020 COLLEGES AND UNIVERSITIES Authors: Tara O'Toole* Martin D