With less than three months to go before the start of the fall semester, many residential colleges say they’re confident they’ll be able to resume some level of in-person operations even amid the Covid-19 pandemic. Undergirding that confidence is a belief in two tools: widespread coronavirus testing and contact tracing.
Those methods have been used many times in the past to curb infectious diseases, for a simple reason: They work. Smallpox was eradicated in part due to contact tracing, said Linda Niccolai, an epidemiologist at Yale University. Extensive testing and contact tracing — in which officials reach out to people who had contact with infected individuals and give them health instructions — have even worked in some countries to drastically reduce the spread of Covid-19. Iceland, for example, has closed very few businesses during the pandemic but now has almost zero cases because of an extensive testing and contact-tracing operation that sent many people into quarantine.
Could colleges and universities become their own little Icelands? Some are determined to try. But in truth, they’ve never done anything like this before, and precedents like Iceland’s aren’t a sure sign that it will work. Iceland is an island that could close its border, while colleges are porous communities designed to bring people together.
“There are some days where I think, OK, we can do this, we’ve got a good plan,” said Kristen Pogreba-Brown, an assistant professor of epidemiology who runs a contact-tracing program at the University of Arizona. “There’s other days where you just want to throw your hands up in the air and be like, This is never going to work.”
‘We’re Going After It’
Any coronavirus-containment strategy starts with testing.
For many campuses to be safe, they need to be able to test thousands of people a week so they can quickly isolate the infected to prevent further spread. The University of Texas at Austin estimated it would administer 500 tests a day, though a spokesman said on Thursday that the details were still being worked out.
The Johns Hopkins University aims to test everyone twice per week. When using tests as a mitigation strategy, anything short of that comprehensive plan is a waste of time, officials said. “We are developing our own very high capacity, like multiple thousands of tests a day,” said Jonathan Links, vice provost and chief risk and compliance officer.
“We’re not saying we know 100 percent we can pull it off,” he said, “but we’re going after it.”
The University of California at San Diego released a plan in May that officials hope will allow them to test its 65,000 students, staff, and faculty members on a monthly basis, starting in September. That’s a huge number, but still not enough under the Hopkins standards.
Coronavirus testing in America has been notoriously difficult. National, state, and local authorities struggled to scale up testing as the virus spread rapidly in March, and suffered well-publicized technical failures. Many current coronavirus tests take several days to show results.
But college and university leaders are relying on the idea that new tests — an antigen test and a saliva test — will soon be available and inexpensive. It’s not clear exactly when that will be, but the idea has been endorsed by Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases.
“With the newer tests coming online this summer, particularly the antigen test, you could literally test thousands of thousands of people reasonably expeditiously,” Fauci said in an interview with The Chronicle last month. “I’m not sure you could do that today or tomorrow, but we’re told that as we get into the late spring, early summer, that those types of tests would be available.”
The University of Alabama system is hoping to be able to use the saliva test. The institution plans to open all three of its campuses this fall, officials said, and will try to test everyone before they arrive.
“We’d like to test all of our students upon re-entry to baseline-understand that they have a negative test,” said Selwyn M. Vickers, dean of the University of Alabama at Birmingham’s School of Medicine.
Vickers said the tests the university is using now cost $22 to $40 per test, but the newer test would cost less than $10. Still, some back-of-the-envelope calculations reveal how expensive even the cheapest tests could prove to be. Say saliva tests were to cost $5 each. Testing the 100,000 plus students and staff members in the Alabama system just once would add up to a bill of at least half a million dollars.
“It’s still not a small amount of money to get this done,” Vickers said. Once students are back on campus, people who show symptoms will be tested, and there will be random, periodic tests to determine whether outbreaks are popping up among asymptomatic people, he added.
Brown University’s president, Christina H. Paxson, has said that testing will be key to reopening in the fall, and she acknowledged in a Senate hearing on Thursday that it would be expensive. “If this is what it takes, it is well worth it,” she said.
It’s clear that such an endeavor will be easier for institutions with large reserves to draw on. Smaller and less-wealthy colleges may struggle to bear those costs, especially given the likelihood that the pandemic will persist into 2021.
Already the California State University system has said it will be mostly online this fall, in part because officials estimate it will cost “tens of millions of dollars” to test all 535,000 of its students and employees a single time, a spokesman said.
‘A Lot Does Have to Fall Into Place’
After a positive test, the contact tracing begins.
In traditional contact tracing, public-health officials ask people with an illness whom they have been in contact with and so who might have been exposed to it. The officials instruct sick people on how to keep themselves and others safe, and call potentially exposed people and tell them the same. This work is carried out by state and county public-health departments, though some universities have been helping out during the pandemic. A handful of campuses plan to use new technology to augment that system.
The University of Alabama, for example, plans to use two apps people can download onto their phones to supplement the state health department’s in-person contact tracing.
One app will be required. It will ask students, staff, and faculty members questions about their health and then, in the following days and weeks, continue to prompt them via text message to answer whether or not they remain healthy. If they say they’re not healthy, they’ll be asked to report their symptoms.
The second app will be optional. It will rely on a feature, designed by Google and Apple, that uses Bluetooth technology to track users’ locations. Once the users have the app and Bluetooth is enabled, their phones will track their whereabouts. If people with the app test positive and they so inform the app, it will then notify all other users they were within six feet of for more than 15 minutes. If the app works, it will pick up on people you sat next to in a cafeteria or a classroom, people whose names you might not know to give to a contact tracer.
The university will not have access to the data, Vickers said. The app will not tell the notified users the identity of the person who tested positive, only the day they came into contact with that person.
Other institutions, including the University of Arizona, also plan to use the technology created by Google and Apple. But big questions remain. Will people actually download the app? Will those who do be inundated with notifications about sick colleagues and friends?
There is evidence that relying on phone-tracking devices is not popular with Americans, even during a pandemic. Surveys conducted since March by Beth Redbird, an assistant professor of sociology at Northwestern University, show that only 15 percent of Americans agree that the government should use GPS monitoring to track people who have tested positive for the coronavirus. Support is higher among whites than it is among blacks, Latinos, and Asian Americans, she said.
“I suspect because, like many systematic forces of government enforcement,” Redbird said, whites “don’t suffer the consequence of those things and the abuse of those things.”
But people are worried about their health, said Sue Feldman, director of graduate programs in health informatics at the University of Alabama at Birmingham. She hopes they’ll see the apps as a way to protect themselves.
“A lot does have to fall into place,” said Feldman, who is overseeing the development of what she calls the “exposure notification” app. “One of the things we think about is, if we wait for it all to fall into place perfectly, it’ll never happen.”
Then there’s the question of whether they will work. “A lot of these apps have not been tested,” said Linda Niccolai, the epidemiologist at Yale. “Privacy issues are one thing, and I would not be dismissive of those. I would be equally concerned about effectiveness. If they are thoughtfully designed, then great.”
Niccolai has been running two in-person contact-tracing programs — one that’s helping the health department in New Haven, Conn., and one for Yale. She expects the university one will expand in the fall if students return to campus, though Yale administrators haven’t yet said what the plan is.
“No matter what scenario, what plan,” Niccolai said, “it will involve a huge amount of testing.”
Megan Zahneis contributed reporting to this article.
