For the University of California, San Diego, the key to returning to some in-person education on campus during the pandemic may be testing – but not the academic kind.
Beginning in the fall, the university plans to test its students, faculty and staff – roughly 65,000 people – regularly for Covid-19 on a regular basis.
School officials call the initiative the Return to Learn Program. The goal is to be able to track Covid-19 in the university’s population, and better position the university community for a return to some in-person activities.
“We want to be able to come back in the safest way possible and one of the key features of that is to be able to monitor for presence of the virus,” said Dr. Robert Schooley, a professor of medicine at UC San Diego and a lead on the university’s Return to Learn Program.
The school’s decision to have such an extensive testing plan in place comes as many institutions across the US face a similar concern: How can they keep their community of students, faculty and staff safe, while also going about regular day-to-day school activities?
California has reported at least 183,554 confirmed Covid-19 cases, and 5,557 virus-related deaths, according to Johns Hopkins University. The state was the first to issue a statewide stay-at-home order, effective March 19. Like many other schools, colleges and universities across the nation, UC schools and the California State University system began suspending in-class learning in March.
In May, the California State University system said it plans to move forward with virtual classes this fall.
But other colleges and universities nationwide said they expect to hold some classes on their campuses in the this fall. UC San Diego is planning on having all of its education offered both in-person and online in the fall.
Setting up collection boxes around campus
During the initial three-week phase of its Return to Learn Program, UC San Diego offered free, self-administered Covid-19 testing to the 5,000 undergraduate and graduate students who remained on campus after California’s stay-at-home order went into effect.
To make it easy for students to participate, the university set up testing sites in heavily-trafficked areas on campus.
“It was way better than I thought it was going to be. You follow the instructions with your own test kit, and you do it yourself,” said Eleanor Grudin, a third-year ecology, behavior and evolution biology major.
Dr. Schooley said in the fall, the university plans on “having all around campus a bunch of collection boxes, each of which would contain a stock of individually wrapped swabs.”
“Each swab would have associated with it a QR code,” Schooley said. “We’ll have loaded on the app a barcode reader that will attach the identity of the person using the swab. They will pop the barcode, pull the swab out of the sleeve, swab their mouths, stick the swab back into a plastic sleeve, and then drop it in the box.”
Those boxes of samples will be picked up every two to three hours and driven to the university’s Center for Advanced Laboratory Medicine, where the samples are registered into the system with barcodes. Then it is off to the molecular laboratory for Covid testing.
“Our goals are to try to provide results within a 24-hour period and that will allow us to identify students who are infected, be able to contact trace – meaning figure out who they’ve been in contact with – and test those primary contacts,” said Dr. David Pride, associate director of the clinical molecular microbiology laboratory at UC San Diego Health.
“We want the results to come out in a time frame that’s useful. So, for example, if you had a student who tests positive, but you can’t run the test for 72 or 96 hours, that’s a lot of people that the student may be able to spread that virus to within their dormitory or within their classroom.”
The university’s pilot program screened 1,578 students
The university’s pilot program was designed to help determine whether the Return to Learn Program was feasible.
Initially, the test was a nasal swab, but researchers quickly learned that students preferred saliva testing.
Another issue for the university is finding enough staff to oversee all the steps of the process and then getting all of the materials necessary to test the samples.
“We don’t rely on any single platform for most our testing,” Dr. Pride said. “If there’s a shortage in, say, a supply chain for one of the tests, we can switch to one of the other tests and still be able to provide results.”
In the end, the pilot test screened 1,578 students for the virus during the three-week trial run; not one student tested positive during that period. Researchers found the self-administered testing was quick, only taking about seven minutes in total – which proved it could be feasibly expanded in the future.
“We have a couple of months to scale up to the degree we need to – it’s going to take extra equipment. It’s going to take extra people,” said Dr. Sharon Reed, director of the clinical microbiology and virology labs at UC San Diego Health, who noted the program would run for eight months beginning in September. “Until (Covid-19) either burns out, which chances are it’s not going to happen, or until we’re pretty much immune from a vaccine, we’ll have to be extra careful.”
Researchers have determined they don’t need all 65,000 people to participate every month. However, the more they test, the earlier UC San Diego will be able to detect an outbreak.
“The simulations indicate that if even 75% of the population were tested per month, we would still be able to detect an outbreak before there were, say, about 15 detectable infections on campus,” said Natasha Martin, PhD, an infection disease modeler and associate professor in UC San Diego’s School of Medicine.
She said testing is just one part of the university’s response to Covid-19.
“The secondary component, which is really critical, is what we do once we identify an outbreak,” she said. “That’s where we’re going to rely heavily on measures such as contact tracing and isolation and quarantine and social distancing interventions.”
Martin said it is important for the program to remain adaptive. “We may see a viral rebound and we need to be able to act quickly and respond to that and adapt what we’re doing in terms of social distancing and recommendations in order to appropriately respond to that growing threat,” Martin added.
And while the researchers hope their Return to Learn Program could be used to inform other institutions and organizations about their eventual return to in-person collaboration, the cost could be a roadblock.
UC San Diego researchers said the program would cost the university about $2 million a month to test 65,000 people at $30 each. It’s a figure they are actively working to decrease. On top of that, not every organization has its own molecular microbiology lab right on campus.
If in the future, students do get positive results, UC San Diego has plans in place to help them recover and not spread the coronavirus.
“The first thing that happens is we make sure they’re getting the medical care they need,” said Dr. Schooley. “We have housing dedicated for the students who are living on campus in which they can be placed over the next two weeks and safely be able to continue in their classes remotely.”
Students hope to return full-time to campus
For many students, the prospect of returning to full-time campus life is a huge draw to participate in the testing. Test results appear in students’ medical records like any other medical test results, and are accessible right through the university’s app.
“I want to come back,” Grudin said. “So I think that a lot of students are kind of in the same boat: They really want to get back to in person classes or in-person events.”
Grudin is from King County in Washington, the same county where, at the end of February, the United States recorded what was at the time the first known death from Covid-19. (It was later confirmed that the first US death actually happened earlier in California.)
For her, the pandemic was personal early on as she constantly refreshed her computer tabs for news updates from home, worried about her family. Now, she sees Covid-19 as personal for everyone, especially her peers.
“The students have been great,” Dr. Schooley said. “I mean they’ve been very interested in doing this. They’ve been very helpful in helping us improve the process and when they’ve been tested, they’ve been looking up the results. We can see when the results are looked up; they look up the results very quickly.”
Isaac Lara, a second-year clinical psychology and global health double major, couldn’t wait to get his results.
“A day later, I got my test results,” he said. “It provides us all a sense of comfort to know that, like, none of us were carriers of Covid.”
Janie Park, a graduating fourth-year student, said she hopes students still working toward their degrees will be able to enjoy the benefits of being on campus.
“I think that it’s important in terms of the student experience, but that experience shouldn’t be put above anyone’s health or wellness,” the human biology and psychology double major said. “If we can get students back on campus, that would be amazing because a lot of college is what you learn in the classroom but so much of it is also your experiences that you have with your friends – getting to know who you are, experiencing that independence.”
Yet it’s clear all of this testing won’t replace best practices constantly promoted at UC San Diego since Covid-19 arrived in the US.
“All of us are going to have to continue to do the things that we’ve learned,” Dr. Schooley reminded. “About being careful about personal hand hygiene, being careful about masks, being careful about proximity to other people.”