Against the Grain

Last semester Auburn University asked students to get tested for COVID-19 before or upon arrival to campus. The public university in Alabama sent out home testing kits for students, offered on-campus sites and allowed students to demonstrate results they got elsewhere.

This semester, the university chose not to repeat that practice.

The move was criticized by some observers and faculty members. But university officials say there are good reasons to not do it again.

For one, it didn’t work.

“I hate to say it, but it clearly did not prevent a spike at the start of the fall,” said Dr. Fred Kam, clinical medical director at Auburn. The university struggled, like others in the state, Kam said, to get 90 to 100 percent compliance with the protocol. And in the first few weeks of the term, the university saw more than 1,300 cases. “It clearly did not stop a spike at University of Alabama, or Auburn, or some other schools. It still happened,” he said.

The situation at Auburn illustrates some of the ambiguity facing colleges and universities this term. With such a new virus, public health protocols are still being developed, tested and perfected. The public health and medical experts advising colleges are experienced professionals. But with research still being done, many institutions and their experts have had to rely on anecdotal evidence from their peers and others even outside higher education to make decisions about how to contain the disease on campus.

The Centers for Disease Control and Prevention, for example, do not specifically recommend that institutions test students upon or before arrival. Neither does the American College Health Association.

Both bodies, however, have acknowledged that the practice may have some value for colleges and universities. When re-entry testing is paired with immediate isolation or measures that prevent COVID-positive students from coming to campus, it can prevent spread early on in the semester. Research has demonstrated that many universities see COVID-19 peaks within the first two weeks of the term as students return from across a state or region.

Many institutions have used entry testing as part of a suite of measures designed to keep infections low. The University of Vermont, the University of North Carolina at Chapel Hill and Washington State University, for example, are all planning to use the measure this spring. A recent ACHA survey of members suggested about 37 percent of respondents conducted upon-arrival testing in the fall, and 22 percent conducted prearrival testing. Officials from the organization have said it’s something colleges and universities should consider.

Other measures such as twice-weekly testing of the entire student body -- which ACHA has recommended and a number of colleges are planning for the spring -- can prevent transmission but also make specific re-entry testing less imperative. Auburn has indeed expanded a sentinel testing program for the spring, though not to the frequency that ACHA has recommended. The program selects a random sample of students and employees weekly to participate, though taking the test after being selected is optional, not mandatory. Test turnaround has been improved from two to three days in the fall to less than 24 hours this term.

But with re-entry testing and other measures, colleges and universities are also weighing the potential benefits against the potential costs. Kam said that Auburn’s fall re-entry testing was paid for with CARES Act money.

“If we had spring re-entry testing, more than likely that would have had to be covered by each individual student,” Kam said.

Asking 20,000 undergraduates to get tested would also put a strain on state resources, he said.

“The use of the resources for relatively healthy asymptomatic people versus people who have been exposed or people who are having symptoms,” he said, “you are putting pressure on those testing centers for something that is optional.”

Kam acknowledged that more testing is likely not useless and more testing from the start of the pandemic would have been helpful. But the dynamics at Auburn have changed since last semester, he said, making re-entry testing less imperative. The fall semester, when students typically arrive at campus for the first time, is characterized by a flurry of socializing and events. Students want to make friends, get involved in Greek life and hang out at pools. In the spring, students have already gotten to know people in their residences and classes.

The cold weather, while it may push people inside, where the risk of transmission is greater, also broadly discourages socializing, Kam said.

Not everyone is happy with Auburn’s decision. One senior faculty member, who wished to remain anonymous, said he had serious concerns about doing away with the re-entry testing. His perspective, contrary to Kam’s, is that re-entry testing worked well in the fall. About 500 infected students were caught by the measure.

“Almost immediately as we started doing the total number of counts and also the surveillance testing, the numbers got quite low quite quickly. Less than 100 per week,” he said. “There was certainly not rampant COVID on campus, and that’s in spite of our students going out to bars unmasked.”

The COVID-19 situation in Alabama and across the country is also currently much worse than it was late last summer, which could potentially result in more students coming to campus infected than last term, he said.

“If we want to create a bubble where we have all the people that we’re concerned about -- and that would be faculty, staff and students -- within a self-contained system and we’re trying to control the infection within that system, it seems to me a whole lot smarter to start out with less infection,” the professor said. “If we let everyone in the bubble who’s infected, we contaminate the bubble.” Controlling that early infection is possible without re-entry testing, but more difficult.

On the subject of the sentinel testing expansion, the professor, who works in a medicine-related field, said that while sentinel testing is helpful, it is more useful to see trends, rather than find cases to trace and isolate. Re-entry testing and mass testing of a campus population are measures that can do the latter.

Kam said that he still believes the campus will face “hiccups” in its coronavirus situation this term. More classes will be face-to-face this semester, and there will be more students on campus. “It’s going to be a bit more dysfunctional,” he said.

But on the subject of re-entry testing, Kam emphasized that classes at Auburn began Jan. 11. If university officials were likely to see a spike, he said, they would have seen it already.