CDC does not recommend Covid-19 entry testing for colleges

[polly_mer]

The CDC has posted considerations (explicitly not guidance) for higher ed administrators for fall: https://www.cdc.gov/coronavirus/2019-ncov/community/colleges-universities/ihe-testing.html

In bold is "CDC does not recommend entry testing of all returning students, faculty, and staff" followed by:

However, some IHEs are planning to adopt and implement this testing approach. IHEs planning for this testing approach should take into account the following:

* Acceptability of this testing approach among students, their families, faculty and staff.

* Limited availability of dedicated resources and the logistics needed to conduct broad testing among students, faculty, and staff in IHE settings. Examples of resources include trained staff to conduct tests, personal protective equipment, and physical space for conducting testing safely and ensuring privacy.

* Limited usefulness of a single administration of testing. Single administration could miss cases in the early stages of infection or subsequent exposures resulting in transmission, and would only provide COVID-19 status for individuals at that specific point in time.

* Specific features of their campus. For example, residential college communities that do not have frequent interaction with surrounding communities might have less potential exposure to COVID-19 than an IHE campus with commuter students or campuses where students engage frequently and/or live within the community.

[Puget]

I'm not an epidemiologist, but this seems stupid, on par with not recommending masks for so long-i.e.,-"it might be hard and won't work perfectly so we won't recommend it." It is really sad how much the CDC seems to have been pulled off course by politics.

* Acceptability of this testing approach among students, their families, faculty and staff.

At least here, most will find *not* testing a whole lot less acceptable.

* Limited availability of dedicated resources and the logistics needed to conduct broad testing among students, faculty, and staff in IHE settings. Examples of resources include trained staff to conduct tests, personal protective equipment, and physical space for conducting testing safely and ensuring privacy.

Sure, this may be a problem for small, under-resourced institutions-- it seems like the guidance to them would be not to bring students back if they can't test, not to not test. Any large research university has all of this. Many will be able to run their own tests.

Limited usefulness of a single administration of testing. Single administration could miss cases in the early stages of infection or subsequent exposures resulting in transmission, and would only provide COVID-19 status for individuals at that specific point in time.

I have not heard anyplace talking about single tests. We'll be testing weekly or near weekly-- that is the plan of most universities in our area.

Specific features of their campus. For example, residential college communities that do not have frequent interaction with surrounding communities might have less potential exposure to COVID-19 than an IHE campus with commuter students or campuses where students engage frequently and/or live within the community.

This may certainly be true, but doesn't seem like a good argument for not testing students on residential campuses-- in fact, testing may be most beneficial for campuses that can test and then semi-isolate their students on campus. (If that's what this point was trying to say, it didn't communicate it well.)

[kaysixteen]

Do we know yet roughly how long it takes from 1) exposure to covid to 2) ability to test positive?  Repeated tests will not be very efficacious the greater amount of time betweeen 1 and 2 there is.  Thus even daily testing may well not be enough, but testing on anything close to a daily basis is probably just not something the average college kid, low paid adjunct, etc., would likely submit to...

[eigen]

Honestly, I think the main reasoning here is cost and number of tests needed.

If you want them to be useful, you also need to test about 3x per student, spread over 3 day increments.

[Puget]

Honestly, I think the main reasoning here is cost and number of tests needed.

If you want them to be useful, you also need to test about 3x per student, spread over 3 day increments.

I agree, but then it seems like the CDC advice should be to do it right, not to not do it at all.

At least as it was explained to us here, a university with a level 3 biohazard lab that does PCRs can get FDA approval to do in-house testing, which makes it pretty cheap. We have apparently already stockpiled all the necessary materials to be ready to go when we get our approval. Smaller institutions will likely need to use commercial tests at higher cost, and many might need financial help to do so. Congress could act on that. If not, it seems they should reconsider having students on campus.

And of course, testing isn't going to catch every case, but it still seems critical for public health surveillance, contact tracing, and mitigating risk.

[Cheerful]

Some people won't cooperate with contract tracing, including telling lies. A New York county will send subpoenas to try to force compliance.

From ABCNews: 
Party host with COVID-19 spreads virus to at least 8 guests
Rockland County, New York, is seeing a coronavirus cluster attributed to a large party -- one of the many gatherings in the area, county Health Commissioner Dr. Patricia Schnabel said Wednesday.

The host of the party was ill at the time and the virus spread to at least eight others -- all young adults, Schnabel said at a news conference.

"Large gatherings remain an issue," she said. "The risk for transmission of the virus is high and very real."

Schnabel said some people contacted by health investigators are denying being at the party and are refusing to speak to the investigators.

"Many do not answer their cell phones and do not call back," she said. "'Sometimes parents answer for their adult children and promise that they have been home consistently -- when they have not been."

"This must stop," she said. "Unfortunately I am now forced by these circumstances to send subpoenas to the individuals who are required to cooperate with us."

[eigen]

Honestly, I think the main reasoning here is cost and number of tests needed.

If you want them to be useful, you also need to test about 3x per student, spread over 3 day increments.

I agree, but then it seems like the CDC advice should be to do it right, not to not do it at all.

At least as it was explained to us here, a university with a level 3 biohazard lab that does PCRs can get FDA approval to do in-house testing, which makes it pretty cheap. We have apparently already stockpiled all the necessary materials to be ready to go when we get our approval. Smaller institutions will likely need to use commercial tests at higher cost, and many might need financial help to do so. Congress could act on that. If not, it seems they should reconsider having students on campus.

And of course, testing isn't going to catch every case, but it still seems critical for public health surveillance, contact tracing, and mitigating risk.

For a university without the staff to do it in house, the cost for commercial contracts for a small LAC was in the millions, just for a single test for all students.

Collection rates for testing centers are ~ 40 per person per day. So you either need a huge workforce of trained people to collect swabs, or you need to space out your collections. Costs don't include PPE for the workers or salary/training.

I'll also add that having a BSL3 setup is rare. BSL-2 is common, BSL-3 is not (you may well know this, but I'd bet it's not common knowledge). Schools with medical campuses will most likely have a BSL-3 certified lab, but how large it is will be another concern when it comes to rate of testing. Even with a BSL-3 setup, how many spaces for individuals to work/how many tests are you going to be able to process in a day?

There are definitely campuses doing this, but it's in the minority.

[Puget]

Honestly, I think the main reasoning here is cost and number of tests needed.

If you want them to be useful, you also need to test about 3x per student, spread over 3 day increments.

I agree, but then it seems like the CDC advice should be to do it right, not to not do it at all.

At least as it was explained to us here, a university with a level 3 biohazard lab that does PCRs can get FDA approval to do in-house testing, which makes it pretty cheap. We have apparently already stockpiled all the necessary materials to be ready to go when we get our approval. Smaller institutions will likely need to use commercial tests at higher cost, and many might need financial help to do so. Congress could act on that. If not, it seems they should reconsider having students on campus.

And of course, testing isn't going to catch every case, but it still seems critical for public health surveillance, contact tracing, and mitigating risk.

For a university without the staff to do it in house, the cost for commercial contracts for a small LAC was in the millions, just for a single test for all students.

Collection rates for testing centers are ~ 40 per person per day. So you either need a huge workforce of trained people to collect swabs, or you need to space out your collections. Costs don't include PPE for the workers or salary/training.

I'll also add that having a BSL3 setup is rare. BSL-2 is common, BSL-3 is not (you may well know this, but I'd bet it's not common knowledge). Schools with medical campuses will most likely have a BSL-3 certified lab, but how large it is will be another concern when it comes to rate of testing. Even with a BSL-3 setup, how many spaces for individuals to work/how many tests are you going to be able to process in a day?

There are definitely campuses doing this, but it's in the minority.

Yah, I don't have a good answer except it seems like places that can't test maybe should reconsider having students on campus this fall, or we need to find a way to help them do it.

Smaller schools might be able to form consortiums with larger universities in the area to handle their testing at cost -- I believe some of that is happening in my area, but we have a density of R1s that makes that possible. Certainly, I would think state systems could have their med school(s) do the testing for their other campuses if necessary.

(For what it's worth, we don't have a med school but do apparently have BSL-3 virology labs. I completely believe you that many places don't though).

[Hibush]

I think we will do the testing that goes beyond even the CDC guidance. A number of conditions make that possible. A relatively isolated residential campus in a region with very low incidence has potential to contain outbreaks. An R1 with existing high-throughput testing capacity in place can handle the logistics of doing thousands of tests. We have  powerful compliance leverage: students who don't test will get their library card suspended. No, Mr. Google does not substitute.

[polly_mer]

There's no way Super Dinky or any of the close competitors could do anything like testing described in the last few posts.  There's just not the resources in the entire county or even in a region of several counties.

My alma mater is a couple miles from the hospital--the only hospital in a county that is almost 7000 sq. miles and poor as all get out with the average household income below the poverty line for a family of four.  There's no way to get the testing capacity, even if Alma mater technically has the right lab facilities on campus, because there aren't enough trained people.

[polly_mer]

It turns out that testing capacity in the US is reaching a problem status:

https://www.theatlantic.com/science/archive/2020/06/us-coronavirus-testing-could-fail-again/613675/

That article seems to indicate that more testing capacity won't be available to higher ed campuses.

[PScientist]

Our Provost has been talking about how we will have testing capacity on campus, and I know that we don't have a BSL-3 facility, so I looked into the requirement.  The CDC (https://www.cdc.gov/coronavirus/2019-ncov/lab/lab-biosafety-guidelines.html) says that "Routine diagnostic testing of specimens, such as the following activities, can be handled in a BSL-2 laboratory using Standard Precautions: Using automated instruments and analyzers; Processing initial samples; etc."

[Bonnie]

Meanwhile Illinois (not my school) is hiring 100 workers for the 20 testing sites it will have around campus. They developed a saliva test (I don't know the accuracy). Everyone will be tested upon return to campus, 3 or 4 days later, and then have access throughout the semester to additional tests.
https://www.news-gazette.com/coronavirus/coronavirus-response-ui-hiring-more-than-100-to-operate-coronavirus-testing-sites/article_5539a3fd-946d-523c-a667-562287ff42e6.html

[FishProf]

Our Provost has been talking about how we will have testing capacity on campus, and I know that we don't have a BSL-3 facility, so I looked into the requirement.  The CDC (https://www.cdc.gov/coronavirus/2019-ncov/lab/lab-biosafety-guidelines.html) says that "Routine diagnostic testing of specimens, such as the following activities, can be handled in a BSL-2 laboratory using Standard Precautions: Using automated instruments and analyzers; Processing initial samples; etc."

Below it says: Note: This guidance does not apply to clinical pathology, which involves laboratory testing on patient specimens, such as blood, body fluids, stool and urine.

I read that as BSL-2 is OK for OTHER anatomic testing for potentially contaminated specimens (it give autopsies as an example).  I have only ever seen BSL-3 for processing CV-19 diagnostic tests.

[FishProf]

Follow-up.  Good-grief it is damn near impossible to get a direct statement about what BSL is required for doing the serological testing.  I can hardly slog through the information and it is in my (general but not specific) area.   How does anyone ever operate with confidence that they are following the regulations (or even the suggestions)?