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Colleges in Virginia should do more COVID-19 testing to stop transmission, experts say

Colleges in Virginia should do more COVID-19 testing to stop transmission, experts say

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Colleges in Virginia should consider ramping up their COVID-19 testing from the fall semester, some public health experts say, if campuses even reopen at all in the coming months.

Across Virginia’s 10 largest universities, more than 7,100 students and about 850 employees tested positive for COVID-19 this fall, according to an analysis by The Roanoke Times of school data. On average, four in every 100 undergraduate students became infected, and at least one in every 100 employees, though many more tests were not logged by the colleges themselves.

Radford University had one of the highest rates, with an estimated 7.7% of undergraduates contracting COVID-19. Virginia Tech, which tested more students, had a rate of 5.7%. James Madison University in Harrisonburg was the only university whose case count also included tests self-reported by students. Those additional 910 cases, to 769 cases logged by JMU, brought the university’s rate to 8.4%, though without them it stood at 3.9% of undergraduates.

In September, a week after classes began, an outbreak forced JMU to shut down campus for a month.

Counties with large colleges that held in-person classes saw a 56% increase in COVID-19 cases, compared to an 18% decrease in counties with colleges that held all-online classes by the time fall semester ended, according to a study published Friday by the U.S. Centers for Disease Control and Prevention.

“‘Should they bring students back at all?’ is a legitimate question,” said Dr. John Voss, a professor of medicine at the University of Virginia, when asked what colleges might do differently in the spring. “To that extent, it depends on the school’s ability to do testing and contact tracing to effectively isolate students from vulnerable, high-risk populations.”

Some universities in Virginia plan to increase their testing capacity this spring, but it may still not be enough to prevent coronavirus outbreaks. Some schools — including JMU, as well as Old Dominion University in Norfolk — already have announced delays to the start of in-person classes because of coronavirus conditions.

“We’re in a completely different place than we were in August,” Voss said. “The infection rate is way higher, is likely to be way higher, in mid-January, February, when colleges start. That’s still an open question in my mind.”

Tech and Radford are sticking with plans to bring students back to campus starting this week. Move-in at both schools will be staggered over multiple days, and the first few days of classes at Tech will be online-only. At both schools, in-person classes begin Jan. 19.

Dr. Noelle Bissell, director of the New River Health District, said Wednesday that she does not expect the return of classes to spark outbreaks.

“If we do get a bump, I don’t think it will be anywhere near what we had in the fall,” Bissell said. “We don’t expect to see the surges like we saw before because most of those who are more social and maybe didn’t abide by the precautions already had COVID.”

She said widespread community viral transmission exists nearly everywhere; transmission in classrooms and from the university to the community was not measurable; and that students overall did a good job of adhering to public health guidelines.

“I do want to get away from this blaming our students from bringing it or exacerbating it,” Bissell said.

‘We still can’t adequately test’

There’s no consensus around how much testing a college should do.

But six out of nine universities analyzed by The Roanoke Times conducted fewer than one test per undergraduate student, a rate that some public health experts found concerning.

Amber D’Souza, a professor who studies infectious diseases and epidemiology at Johns Hopkins University, suggested at least 20% of students should be tested each week.

“If testing less than that, it would serve to monitor and detect a large outbreak once it’s occurring in campus,” D’Souza said in an email, “but may be too late to prevent the outbreak.”

Over the course of a 15-week semester, D’Souza’s suggested testing regimen would amount to 300 tests for every 100 students.

Last fall, only the University of Virginia achieved such a testing capacity among the state’s 10 largest colleges. Tech came second, conducting 126 tests per 100 students, while Radford administered 76 tests per 100 students, according to the analysis of school data.

While school testing has largely focused on a much smaller subset of on-campus students, more off-campus students tested positive for COVID-19 for each of the five universities that broke out testing by student classification.

“It’s sort of crazy, really, we’re a year into this pandemic and we still can’t adequately test like we need to, to interrupt transmission,” Dr. William Petri, a professor of medicine at the University of Virginia, said.

The CDC gave colleges wide latitude in how to test. Particularly early on in the pandemic, the agency emphasized the need only to test those with symptoms, even though studies have found people without symptoms spread the virus in about half of cases.

“I think their guidance was tempered by what they felt colleges and schools could do,” Voss said. “So it brings into play all kinds of questions about how advice coming out of the CDC was provided, given the political environment at that time.”

Voss said universities could think of the guidance as a “minimum,” but that, to him, “more testing may be more useful than they were willing to acknowledge at that time.”

He also cautioned that an overview of testing across an entire semester can hide nuance about its value, and a college’s particular situation.

“Just doing testing without carefully thinking about how the testing will be used is not a fruitful way to use one’s resources,” Voss said.

Comparing data about COVID-19 cases and testing across schools can be a challenge because each college can record counts slightly differently. And specific town-gown dynamics can determine how much testing a university may need to provide on its own.

George Mason University in Fairfax County, for example, had the lowest testing rate among colleges studied — 37 tests per 100 students. But with the smallest percentage of its undergraduates living on campus, more off-campus students may have sought tests elsewhere in the Washington suburbs.

“I cannot confirm if the rate you cite is the lowest in the state, as each university has a different approach and not all universities in the Commonwealth are conducting surveillance testing,” Michael Sandler, a GMU spokesman, said in a statement. “What I do know is that our approach is thorough and continues to evolve. All universities are constantly learning about COVID, and we continue to make adjustments and improve our efforts, in real time.”

JMU said its relatively low testing rate — 46 tests per 100 students — did not take into account an additional 5,446 tests it facilitated through the Virginia Department of Health.

Unlike Tech, UVa and other schools, JMU did not ask students to secure a negative test before arriving on campus or to be tested upon arrival.

Tim Miller, vice president for student affairs at JMU, said that in the fall “the test option we had was two days to get a result.” He said, “you can’t really do much with that positive result.”

This semester, thanks to the state, JMU plans to conduct 6,400 rapid tests — with a 15-minute turnaround — as on-campus students arrive.

“It’s hard to know if any one thing or two things or 12 things would have made the fall different,” Miller said. “I’m proud ... we did come back, and it was successful. I didn’t want to just throw in the towel and say, ‘That was really hard. Let’s stop.’”

‘They handled it really well’

Nicolette Gaff said she is looking forward to the spring semester on Tech’s campus. Even though all her classes are online, it has been a challenge to meet new people, and, to save money, her roommate dropped out to attend community college.

“I was actually very close to staying home this semester, but I knew that all my hometown friends were going to school, and going away, and my sister, of course, was going to still be [at Tech],” said Gaff, an 18-year-old freshman. “I still wanted to grow as an individual, and I thought it may be difficult, but it definitely will be some self-growth.”

In September, Gaff tested positive for COVID-19 after one of her hallmates fell sick. Gaff opted to drive back to her home in Richmond, where she stayed holed up in her room. Her parents left meals outside her door.

“I thought they handled it really well,” Gaff said of the university. “The only thing I was kind of stunned by was how I was notified” that she had been exposed. Her hallmate told Gaff about testing positive, but nobody from Tech or the health department contacted her, she said.

Virginia Tech’s 43-page plan for the spring semester notes the university “identified challenges” in managing cases or suspected cases of COVID-19. In response, the university hired three full-time staff members to help with contact tracing and assisting students who test positive, a spokesman said.

Many campus residents who tested positive stayed in one of the university’s isolation dorms. Over the fall, Tech increased space from 430 beds to 513 beds, a capacity it plans to keep for the spring.

Some students identified wrinkles with the quarantine dorms early on in the semester, but acknowledged conditions may have improved later. One student came out of the dorm to find campus police had ticketed her car, which she was unable to move during isolation. Other students realized only after quarantine that they had spent far more than usual on food, because staff delivered meals from a nearby, and more costly, dining hall.

Charlotte Haber, a Tech sophomore from San Francisco, recalls standing in a dining hall line one day with a friend who had just gotten out of isolation.

The friend remarked, “‘I don’t know if I have any dining dollars left,’ because at that point we kind of realized nobody knew how much they were spending in quarantine or isolation,” Haber, 19, said. She said students could check that information in an online portal, but that “that is the furthest thing from some people’s minds while they have COVID, especially if they’re having symptoms.”

Haber tested positive for COVID-19 in the fall. She found out 15 minutes before an in-person English class, through an online health center portal. Later, she got a phone call from the housing office, and moved into a university isolation dorm for 10 days.

She felt fortunate to have no symptoms. While many cases are mild in young people, Haber said students still need to stay vigilant.

“I really hope that people continue to take COVID seriously,” she said. “Actually, that people take COVID more seriously, because not everybody really was.”

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