Testing, Tracing, and Supported Isolation

Last month, Ithaka S+R launched an effort to aggregate and synthesize information related to the fall reopening of colleges and universities to facilitate institutional collaboration and planning. As of July 13th, we have synthesized 57 institutional plans into a single resource (click here to view), and plan to continually update this resource with new and evolving information. We are publishing the findings from our review of these plans in a series of blog posts hosted on our COVID-19 page. In the first blog post of the series, we presented preliminary, overarching, findings on institutional plans to invite students back to campus, and anticipated changes to the academic calendar and modes of instruction.

In this post, we answer the following, critical question about plans for fall reopening:

For those institutions that are bringing students back to campus in the fall, what are their plans for COVID-19 testing, tracing, and supported isolation, and how do they plan to keep their communities safe?

As we report in our previous post, all 57 institutions included in this resource plan to welcome at least some students back to the campus in the fall (see here for more details on the institutional characteristics of included colleges and universities, and on specific plans for resuming on-campus activities in the fall). If institutions decide to have students, faculty, and staff on campus this fall, then implementing a comprehensive testing, tracing, and supported isolation (TTSI) plan is essential to keep their communities as safe as possible. Below, we present our preliminary findings on institutional plans for TTSI.

Preliminary Analysis of Institutional Plans for Testing, Tracing, and Supported Isolation

As COVID-19 cases surge in several parts of the country and many colleges plan on reconvening at least some students on and around campus, perhaps the most urgent question is how colleges plan to implement a rigorous health and safety program that provides sufficient COVID-19 testing, fast-acting contact tracing, and resources for supported isolation.

There is widespread consensus among health organizations, state governments, and higher education associations that an effective Testing, Tracing, and Supported Isolation (TTSI) program is essential to resuming any on-campus activity safely and to mitigating the chance of community spread within dense campus environments (see guidance from the Centers for Disease Control (CDC) , the American College Health Association (ACHA) , and several states’ guidelines). Guidance differs, however, on the specific approach to TTSI, particularly for establishing a COVID-19 testing protocol. While most published guidance recommends testing individuals who develop symptoms, guidance conflicts on whether colleges and universities should test all students upon first arrival to campus (the CDC “does not recommend entry testing of all returning students, faculty, and staff”; states, however, such as Connecticut do support this approach) and on whether colleges and universities should test asymptomatic individuals on a regular basis to identify and address infections more quickly (ACHA cautions against doing so without sufficient resources, and many states leave the decision up to local health departments).

We examine the trends in institutional plans related to each of the three elements of TTSI—Testing, Tracing, and Supported Isolation. Because we are not public health experts, there is little definitive guidance about appropriate TTSI protocols, and institutions are making decisions fairly autonomously, we focus our analyses on the details of the plans and their comprehensiveness, rather than whether the approach is sufficient.

Trends in COVID-19 Testing

In our data collection, we track the specific approaches to COVID-19 testing mentioned in institutional plans to understand how institutions are planning to implement a testing protocol on campus. For example, we document whether or not an institution plans to a) test all students upon reopening, b) conduct regular screens of the population, and/or c) test all individuals who develop symptoms.

Of the 57 institutional plans we have processed, the vast majority mention at least one testing protocol they plan to implement in the fall. Only three institutions—Stanford University, St. Mary’s College of Maryland, and College of William and Mary—did not specify any approach to COVID-19 testing on campus. As a reminder, all 57 of the institutional plans we have processed indicate that at least some students will return to campus in the fall.

Student Testing

In the matrix below, we lay out the distribution of institutional approaches to COVID-19 testing. The columns indicate whether or not an institution plans to test returning students upon arrival and the rows specify approaches to testing carried out throughout the fall semester. Thirty-five (35) institutions articulated plans to test all students who return to campus immediately before arrival, on arrival, and/or a short period after arrival. Of these institutions, thirty-three (33) plan to pursue at least one other approach to testing students throughout the fall semester. Of the twenty-two (22) institutions who do not plan to test students upon first arrival, nineteen (19) have identified at least one other testing approach to implement throughout the fall.

As seen above, the vast majority of institutions have publicly committed to pursuing at least one approach to COVID-19 testing. Yet, a much smaller number have explicitly laid out a more comprehensive approach that includes testing all students at/around the beginning of the semester, implementing regular screens among asymptomatic individuals, and testing all students who report symptoms. Only 12 institutions have published plans that explicitly mention all three.

Of those 27 institutions with plans for regular testing protocols, six provide specific details about the frequency of screening. For example, Bowdoin College plans to test the entire student population twice a week. Similarly, Harvard University plans to test all students in residence every three days throughout the fall semester. Some institutions are employing other, less frequently mentioned approaches to testing. For example, Montana State University and the University of South Carolina-Columbia plan to use wastewater samples to detect disease prevalence in on-campus communities as an alternative means of regularly testing students.

Of note, few institutions have stated intentions to test targeted subgroups of the student population— those that do mention this strategy specify that it relates to student athletes or residential students (as opposed to students residing off-campus). This approach aligns with current guidance from agencies like the American College Health Association (ACHA), which cautions against using targeted screening that could result in inequitable treatment of students (e.g., testing students from “high-incidence” communities may stigmatize certain student populations).

Resource constraints, both in terms of access to tests and the financial wherewithal to pay for large volumes of tests, play into an institution’s ability to offer a comprehensive approach to COVID-19 testing. As such, it may make sense that of the 12 institutions planning to pursue universal testing, regular screening, and diagnostic testing, nine of them are research universities with in-house laboratories and affiliated hospitals or medical centers. The remaining three—Colby, Williams, and Smith Colleges—have each formed partnerships with the Broad Institute of Harvard University and MIT, a Boston-based biomedical and genomic research center, to secure sufficient testing for the fall semester, demonstrating the value of external partnerships in enabling testing implementation and the resumption of campus activities. In fact, several other surveyed colleges in the Northeast including Middlebury, Skidmore, and Brandeis also mention partnerships with the Broad Institute, which has emerged as a key player in aiding COVID-19 testing in the New England region.

Colby College provides an example of what a multifaceted approach to testing looks like for a college campus, and demonstrates that such an approach requires a significant financial commitment, out of reach to all but the wealthiest institutions. Colby is welcoming nearly all undergraduates back to campus (except for those who choose to learn remotely), and has outlined a rigorous testing program for its students, and its faculty and staff. Colby will not only test all community members on arrival, it will ask students to test themselves prior to arrival on campus using at-home test kits provided by the institution. Throughout the semester, Colby will perform regular screenings of students and staff, and will test all individuals experiencing symptoms. In addition to its partnership with the Broad Institute, Colby has initiated partnerships with the Harvard School of Public Health, Massachusetts General Hospital, and MaineGeneral Health to ensure sufficient testing.

Colby, a campus of only 1,800 students, expects to administer as many as 85,000 tests throughout the fall semester. These public health provisions, along with other expenses associated with COVID-19, will cost Colby $10 million dollars this year, which represents more than a five percent increase to Colby’s operating expenses and is equivalent to about $5,555 per student. If we assume a fixed cost per student, a similar approach to testing at a much larger institution—say Ohio State University, which has an undergraduate enrollment of 46,820 students—would cost $260,085,100.

Faculty and Staff Testing

While the majority of institutions articulated how they plan to test students for COVID-19, only 19 articulated testing protocols for faculty and staff, either testing all faculty and staff upon arrival (five institutions), only regular screening throughout the semester (eight), or both (six). (Note: The plans’ lack of detail on faculty and staff testing may have to do with the student-facing nature of the planning documents/web pages that institutions are publishing.)

Trends in COVID-19 Contact Tracing

While the vast majority of institutions specify at least one approach to implementing COVID-19 testing, far fewer lay out detailed plans for contact tracing in their institutional announcements. Thirty-nine (39) of 57 institutions mention plans for contact tracing in the resources consulted, and of those, a majority (27) plan to use online symptom trackers, through which members of the campus community will report whether they are experiencing any COVID-19 symptoms on a daily basis. The CDC and several states recommend the use of online symptom screening in lieu of regular, expansive testing protocols, which can help preserve tests for those who are symptomatic. Some experts have suggested that the use of online symptom screens and self-reporting may be less costly than and equally preventative as regular, expansive testing protocols, but whether that will hold true on a college campus remains to be seen.

Between the two predominant modes of contact tracing—1) tracing through personal interviews and manual data collection, and 2) using digital apps to detect close contacts via GPS or Bluetooth— institutions appear more likely to favor the interview-based approach. Eighteen (18) of the 39 institutions are planning to conduct contact tracing interviews, three are relying on digital apps that use GPS and/or Bluetooth, and five are using a combination of the two.

Given the potential density of community members on college campuses, tracing can pose a real challenge for colleges, particularly those that plan to reconvene greater numbers of students and conduct a higher percentage of in-person academic courses. One strategy that emerged from the plans of the 39 institutions with a stated contact tracing strategy is for instructors to maintain strict seating charts in classroom settings and take attendance for every class, and to use these class lists in tandem with residential data to maintain up-to-date contact lists for each individual student. This strategy, combined with interviewing those individuals who do develop symptoms, may help facilitate timely contact tracing. Institutions of different sizes—from Penn State University (undergraduate enrollment of 46,000) to Middlebury College (2,600)—have specified this strategy in their contact tracing programs.

As is the case with testing, partnerships appear to be a critical component of several institutions’ plans to implement a contact tracing program, particularly smaller institutions without large student health services departments. While the majority of partnerships mentioned in the context of testing are with private laboratories or hospital networks, local health organizations and government agencies appear central to many institutions’ tracing efforts. For American and Howard Universities, the Washington D.C. The Department of Health will lead contact tracing efforts, offering scale and resources that augment the institution’s ability to trace effectively.

Some institutions are employing comprehensive tracing programs with both in-house components and external partnerships. Worcester Polytechnic Institute (WPI) will coordinate closely with the Worcester Health Department and has hired a Testing and Tracing Coordinator to oversee their health response and manage a team of internal contact tracers. Similarly, UT-Austin has created the “Protect Texas Together” app, through which all community members will be prompted to log and report symptoms on a daily basis. In collaboration with Austin Public Health, UT Austin will use this information to conduct contact tracing for UT community members. Staff members from two university-affiliated teams, HealthPoint Occupational Health Program and the Dell Medical School, will contact UT Austin community members who test positive and then conduct investigations into contacts on campus and contacts outside of campus, respectively.

Trends in COVID-19 Supported Isolation

Of the three elements of TTSI, there appears to be the least amount of variation in institutional plans related to providing supported isolation for students who develop symptoms. Forty-six (46) out of the 57 institutions provide details for isolation in their plans, and of those, 42 noted that they have set aside dormitories on-campus for students in need of supported isolation. Some institutions provide details on the number and location of dormitories set aside for students in isolation. For example, Purdue University, which enrolls over 30,000 undergraduate students, has set aside 500 beds for supported isolation. Tulane University has converted an entire dormitory complex into an additional infirmary. And, the University of South Carolina-Columbia makes clear in its plans that on-campus isolation dormitories will only be made available to students already residing on campus. Students living off-campus are expected to isolate in their own homes.

Evaluating the Comprehensiveness of Institutional Plans for Testing, Tracing, and Supported Isolation

The analysis presented here demonstrates the wide variety in institutional approaches to implementing a TTSI program, highlighting that institutional approaches to TTSI are highly dependent on an institution’s individual circumstance and characteristics. In our next blog post, we continue our evaluation of institutional plans for TTSI and ask the following question:

To what extent do these plans represent comprehensive approaches to resuming operations in the fall and implementing a rigorous testing, tracing, and supported isolation program?

All future blog posts will be hosted on our COVID-19 page. To find out more about this project, and how your institution can participate in this effort, please contact Elizabeth Banes (Elizabeth.Banes@ithaka.org).