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

May 22, 2020
Originally published on May 23, 2020 8:34 am

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 time 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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What will college look like in the fall? Students want to know. Parents and faculty want to know. There are still a lot of questions. The CDC has offered recommendations for reopening, and we're starting to get a sense of what some colleges are planning. NPR's Elissa Nadworny covers higher education. She's been following this one. Hi, Elissa.

ELISSA NADWORNY, BYLINE: Hey, good morning.

KING: So what did the CDC recommend that colleges do?

NADWORNY: So the CDC guidelines this week offered a number of ways that colleges could help reduce the spread - so closing dining halls, students wearing masks as much as possible, faculty and staff teleworking. They said the lowest risk is going to be online classes. The highest risk are those regular in-person classes, campus events and shared dorms. Look, everybody wants to be on campus in the fall.

KING: Yeah.

NADWORNY: Students want to be on campus. Three in four say they want in-person classes. And so we've seen a lot of colleges announce that they're going to plan to be in person. But what we haven't seen is a plan for if there's an outbreak. So models indicate campuses are going to be ripe for that. We know that faculty and staff are in that older, more at-risk category in terms of age, and colleges are worried about liability. What happens if there's an outbreak on campus?

KING: This week, we saw some colleges - and I'm thinking of Notre Dame here - say that they're going to start the fall semester earlier than normal, and then they're going to end the semester before the Thanksgiving holiday. What is the thinking behind that move?

NADWORNY: That's right. The University of Notre Dame and some other colleges have announced they'll be starting the fall semester earlier and ending before Thanksgiving. It's essentially trying to sneak in a semester before a potential second wave in the late fall. The plan also eliminates the fall break so it cuts down on students' travel. That was a CDC recommendation. But Notre Dame's plan also includes a possible delayed start, and professors are prepping for online classes too - so lots of options here.

KING: If colleges are going to have in-person classes, there are some essential things that they will need to consider. I know you've been looking into a list of what has to get done. What do colleges need to do?

NADWORNY: So experts say if campuses are open, there will be contact tracing, social distancing and a big part will be coronavirus testing.

CELESTA TAURUS: The process itself was about five minutes.

NADWORNY: Last week, Celesta Taurus (ph), a student at the University of California, San Diego, took a coronavirus test on campus. The nose swab wasn't as bad as they'd heard. But...

TAURUS: I did cry a little bit just because it's, I guess, a natural reaction.

NADWORNY: Taurus didn't have symptoms and ended up testing negative. They're part of a random mass testing project by the university aimed at helping the campus be in person in the fall.

ROBERT SCHOOLEY: We're not trying to test to see if we can detect an outbreak right now. We're trying to make sure that we can scale to be able to do that in the fall.

NADWORNY: That's Dr. Robert Schooley, a virologist who's leading the effort at UC San Diego. The idea is to get enough students to participate so they can use modeling to spot an outbreak before it happens - sort of an early warning system. By testing the students currently on campus, they can see if it works and figure out the bottlenecks.

One lesson they've learned is about students' motivation to participate. At first, the message was aren't you curious? Come see if you're shedding the virus. Not many students showed up. But by day three, they changed to come get tested - it'll help us be in person in the fall. Students came in droves.

SCHOOLEY: If we can't get the universities going, it's going to be very hard to get the rest of society going.

NADWORNY: In the fall, Schooley envisions having to test about 70% of the community - that's students, faculty and staff - about once a month. That's a lot of tests. UC San Diego is able to do it because they've got a world-renowned lab, a hospital and a procurement office so they're not experiencing test shortages that other communities are. But even if colleges can get their hands on tests, they cost a lot - anywhere from $50 a test to triple that. At UC San Diego, even with so much in house, the project is anticipated to cost more than $2 million per month in the fall. It's not possible for all colleges, but for some, that investment may prove essential.

MICHAEL LE ROY: We pay for all kinds of insurances, and in many ways, this is a similar kind of cost.

NADWORNY: Michael Le Roy is the president of Calvin University in western Michigan. They're a small Christian college, and they're planning to be in person in the fall. They're working on details now. They know they're going to need social distancing and thinner dorms and classes, but before they solidify all that, Le Roy says he had to get his hands on some tests.

LE ROY: No matter how you think about it, testing - that was going to be critical to everything else. So if we couldn't do that, almost everything else was going to be impossible.

NADWORNY: Through connections in the Chemistry Department, Le Roy made a deal with a commercial lab named Helix Diagnostics. The company, for an undisclosed amount of money, will provide 5,000 coronavirus tests for students at Calvin. That's a deal Le Roy never expected to make as a college president.

LE ROY: You feel a little bit like you're in the great beyond. And so you get one thing like this in place and you're like, OK, now the next thing.

NADWORNY: Because he says purchasing the tests is just the beginning. There are still so many problems to solve. Where will they test? How often will they test? What will they do if a student refuses? And of course, there need to be plans and physical spaces for when students test positive.

KING: Elissa, one upside to this is that it is still only May, so there's a couple months to figure things out.

NADWORNY: Absolutely. There is still so much unknown for colleges. Terry Hartle of the American Council on Education described to me what it's like right now for colleges to make plans.

TERRY HARTLE: They're doing it in an atmosphere of enormous ambiguity. It's like the fog is so thick, you can't see the corner of your street.

NADWORNY: So given that, we have to take all of these announcements, these plans, with a bit of skepticism. Colleges need students. They need tuition. And while these plans are important to have, there is no guarantee that they'll be the plans colleges actually enact come August.

KING: NPR's Elissa Nadworny on the uncertainty of opening colleges in the fall. Elissa, thanks so much. Transcript provided by NPR, Copyright NPR.