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College students would need to be tested for COVID-19 infection every two to three days for campuses to safely reopen this fall, a new analysis concludes.
Otherwise, colleges are very likely to fall prey to outbreaks that will place vulnerable people on campus and in the surrounding community at risk for serious illness and death, said lead researcher David Paltiel, a professor of health policy at the Yale School of Public Health in New Haven, Conn.
"I know that many schools are following [U.S. Centers for Disease Control and Prevention] guidelines and considering the option of just carefully monitoring students for symptoms and using signs of illness to trigger isolation and testing and contact tracing and quarantine," Paltiel said. "We explored thousands of scenarios, and we didn't find a single plausible circumstance under which that kind of strategy would be sufficient to contain an outbreak."
For the study, Paltiel and his colleagues used epidemic modeling to test different monitoring programs that would minimize COVID-19 cases and also maintain a college's ability to isolate and quarantine infected students.
The research team found that every infection prevention strategy on the table will be crucial to preventing campus outbreaks -- including frequent hand-washing, wearing masks, social distancing in classrooms and dorms, elimination of buffet dining and limited bathroom sharing.
But without regular testing of students for COVID-19 infection, all of these measures will be for naught, according to results published July 31 in the journal JAMA Network Open.
"The reason is clear -- this virus can be transmitted by highly infectious asymptomatic silent spreaders," Paltiel said.
"It's just not possible to move swiftly enough to contain an outbreak using nothing more than symptom-based monitoring. You can't play catch-up with this virus, and any school that thinks it can test and respond only when symptoms have been observed, it's like a fire department that only responds to calls when the house is already known to have burned down," he said.
It won't be cheap, either. Each semester, colleges would pay:
- $120 per student under a best-case scenario that assumes weekly screening,
- $470 per student if conditions require screening every two days,
- $910 per student under a worst-case scenario requiring daily screening.
However, Paltiel expects that the cost will soon decrease as cheaper rapid COVID-19 tests come onto the market.
"I don't want to downplay the cost or the logistics. It's a lot. But it's not beyond reach," Paltiel said.
The frequency of screening is much more important than the accuracy of the test a college uses, researchers were surprised to learn.
Testing students every two days with a low-quality test that correctly detects infection 70% of the time and has a 98% chance of avoiding a false positive actually avoided more infections than testing once a week with a higher-quality alternative that correctly detects infection 90% of the time, their model showed.
Beyond regular screening, colleges also will need to create reasonable but effective infection prevention guidelines and standards that students will be able to follow, Paltiel added.
"It's not just a financial nightmare. It's a logistical problem, it's a psychological and behavioral problem," Paltiel said. "We can't just hand out masks and a bottle of hand sanitizer and say to students, come in to be tested every couple of days and go be safe. That's setting them for failure and it's setting them up later to be blamed later for that failure, to be scapegoated for things that go wrong."
Not every college administrator is on board with Paltiel's findings.
"Their conclusions point to one specific strategy that is very resource-intensive and logistically very difficult to do, and neglect other strategies that one could use and be equally as safe," said Elizabeth Bradley, president of Vassar College in Poughkeepsie, N.Y. "Although they show one strategy that could work, there are many others."
Colleges that are more isolated from their surrounding community, like Vassar, could maintain student health without regular testing if you "keep the students on the campus, almost like an island," and test them before they arrive for the semester, said Bradley, who co-authored an editorial accompanying the study.
"You're going to count on them using masking and social distancing, but if that fails now and again, you have them all on a campus and all negative," Bradley said. "They're unlikely to spread the virus."
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