To help reopen America’s K-12 schools, the Biden administration recently announced it will invest $10 billion to support COVID-19 testing for young people and their teachers. While this is a step in the right direction, students enrolled in higher education institutions must not be forgotten. As a population that is young and relatively healthy, most college students will continue waiting to be vaccinated, underscoring the continuing need for them to know their status and take steps to isolate if they’ve been infected by the virus.
In the meantime, higher education institutions cannot remain shuttered. We must continue to cultivate the rich academic and social environments for which America’s world-class campuses are renowned. But how can we get students back in classrooms without sacrificing health and safety?
The answer, science suggests, is to leverage all available public health tools at our disposal, including vaccines, social distancing, mask wearing and, importantly, the enormous capabilities of high-throughput antigen testing.
Online classes have been a stopgap measure for colleges and universities. When the pandemic began, scientific and medical communities had little understanding about the virus, so many campuses rightfully took a cautious approach that balanced public health with continued education delivery. But now, student satisfaction with the academic experience has dropped sharply, a malaise further compounded at some institutions by the lack of collegiate sporting events, public lectures, clubs, concerts, graduation ceremonies and other campus traditions that are integral to the college experience.
As a result, many students have taken leaves of absence, transferred or withdrawn altogether -- leaving higher education institutions in a financial bind as their reputations suffer. Keeping campuses closed will result in enduring damage to our students, communities and the future of the American economy. While some campuses reopened for in-person instruction in a limited capacity this spring, many still remained at least mostly closed, with courses still being conducted online.
Testing Is Vital for Reviving Campus Life
Testing remains essential to ensuring a smooth transition to in-person instruction. While campuses such as Duke University, the University of Illinois and the University of Massachusetts at Amherst have showed that frequent testing can go a long way toward returning to normality, it still remains a rather underutilized tool. In fact, despite the American College Health Association recommendation for twice-weekly testing of students and staff, it was recently reported that just over 20 percent of colleges and universities test asymptomatic individuals at least twice per week, and a shocking 16 percent don’t do any COVID-19 testing at all.
With the latest guidance from the Centers for Disease Control and Prevention suggesting that a strategy of entry screening at the start of each term combined with serial screening testing can help prevent or slow the spread of COVID-19 in higher education settings, campus leaders must better utilize mass testing tools in order to safely revitalize campus life.
The Promise of High-Throughput Antigen Testing
Since the first lockdowns went into place, the scientific and medical communities have made amazing progress in developing fast and accurate tests that diagnose actively infected individuals. High-throughput (or high-volume) antigen assays, which specifically detect the SARS-CoV-2 virus, offer accuracy, speed and scale that can help higher education institutions to safely revive campus life. By analyzing tests in bulk, this type of antigen test can return thousands of results per day, empowering campuses with access to laboratory analyzers to meet the surging demand for COVID-19 tests.
The advantage of the high-throughput approach is good news for campus leaders who are dissatisfied with the disadvantages of both molecular (sometimes called polymerase chain reaction, or PCR) testing and rapid antigen testing.
While PCR tests are known for high levels of clinical specificity and sensitivity, evidence suggests that roughly one-third of individuals who underwent a molecular test waited more than four days for a result. And the longer it takes to get results, the less relevant such tests become from a public health perspective, raising the potential of community spread on our campuses.
Rapid antigen tests, which do not use laboratory resources, have emerged as a faster alternative to PCR, but their validity varies. Despite the hype, off-label use of rapid antigen tests to screen asymptomatic Americans has sometimes run into accuracy issues -- leading the Food and Drug Administration to issue warnings about the potential for false positives. False positives can be highly disruptive for campuses, requiring otherwise healthy students to isolate alone.
Unfortunately, the fact that personnel who are not experts in diagnostic testing are often those analyzing the samples has exacerbated such issues. To properly run a rapid antigen test, each sample must be tested individually according to the manufacturer’s specific technical instructions. But if run improperly, accuracy of each test suffers and the possibility of a false positive climbs. Moreover, the nature of nonexpert personnel running manual methods for analyzing and processing results increases the likelihood that an error will occur somewhere along the chain.
Consequently, the need for high human touch on each individual sample, the low throughput process and the narrow time window necessary to read the results undercuts the 15-minute guarantee promised by some rapid antigen test makers. If you are at the end of a very long line, as many students currently are, it could take hours or even days for anyone to even analyze your sample. Back to the same problem rapid tests were supposed to solve.
To reopen colleges safely, we need a “Goldilocks” solution that is fast, accurate and scalable. High-throughput lab-based antigen tests, which have concordance rates with PCR test accuracy and can return thousands of results per day, strike the ideal balance between these three key factors. While each campus will need to develop its own policies and procedures, higher education leaders should discuss how a mass-scale testing strategy might work.
For example, campuses may consider collecting samples from students and staff members on at least a weekly basis. They could do that at a centralized location like a university health center or in a decentralized manner in student dorms. Whatever approach is taken, campuses with access to high-throughput antigen analyzers -- either on campus or through laboratory partners -- would be well equipped to turn around hundreds of results per hour, quickly identify positive cases, launch contact tracing and alert the community about the need to implement additional safety procedures like quarantining. While PCR and rapid antigen assays will continue to be useful in certain situations, high-volume lab-based antigen tests are integral to the mass-scale testing strategy that officials recommend.
America’s campuses cannot remain shuttered. For the sake of student experience, institutional sustainability and community economic impact, most colleges and universities must reopen for on-campus activities as soon and as safely as possible. Doing so will require implementing public health directives like social distancing and wearing masks in coordination with a rigorous testing strategy. High-throughput lab-based tests will empower educational leaders to closely monitor the health situation on their campuses and confidently act to keep their world-class classrooms open.