The University of North Carolina abandoned in-person classes at the first sign of infections on campus.
The University of Notre Dame and Michigan State punted even before they got started.
There are dozens of large institutions planning to hold in-person education, while the University of Illinois at Urbana-Champaign is using a hybrid model, mixing in-person and on-line classes. Can the U. of I. succeed where so many others have and will fail?
With their frequent testing plan in place, they have a good chance to succeed.
When students first show up on campus, even a modest positivity rate of 2% will result in 500 to 900 initial infections. The key to success is preventing such infections from spreading unfettered across campus and into the local community, particularly to at-risk people.
Proven public health practices that reduce the spread of the virus are critical on all campuses. These include guidelines requiring face coverings, physical distancing, and hand hygiene, supplemented with isolation and contact tracing as needed.
If 80% or more of the students comply with these practices, the community basic reproduction number — the average number of people to whom an infected person spreads the virus — can fall below one. At that a point, new infection growth will be attenuated, effectively allowing community transmission to be controlled through isolation and contact tracing. Most universities are employing such techniques.
Testing, testing, and more testing is the road to the promised land for in-person education. Testing allows campuses to map the infection landscape, identifying the numerous asymptomatic students who can foment community transmission on campus and into the local community. Rapid turnaround of the test results is critical, particularly with so many asymptomatic infections, since the value of tests fall precipitously within 24 hours.
Many schools are testing students only upon their arrival to campus, and one week later. Then they are waiting for students to show symptoms before they test again. This strategy is a formula for disaster, given that a majority of infected student will be asymptomatic or display only mild symptoms.
The game changer at the University of Illinois is the rapid saliva testing protocol that they developed, similar to the test developed at Yale University and being employed by the NBA. This allows thousands of tests to be administered each day and deliver the results within hours. With such widespread surveillance of campus-wide infections, the university can limit infection outbreaks, with isolation and quarantine of infected and exposed students. Every person on campus must be tested twice per week, or they will be denied access to university buildings based on a university developed app tracking system.
The University of Illinois testing strategy represent 20% of all tests administered in the state of Illinois and 1.5% of all tests administered nationwide. If the 50 largest universities in the country used the saliva test, the number of tests nationwide could double. More importantly, the test would be catching asymptomatic infections, the most deadly virus spreaders.
Like all successful strategies, the devil is in the details. The university must deliver on providing the results of their saliva test within hours. Any delays can spawn community transmission, as infected people may unknowingly spread the virus.
The bigger challenge is student adherence and buy-in to the testing system. With most infected students either asymptomatic or with mild symptoms, a positive test is more of an inconvenience to their education and social activities than a health risk. Students who sidestep the university testing surveillance system undermine its purpose and effectiveness. Such actions will lead to more community transmission, resulting in surges of new cases, potentially forcing the campus to move all classes on-line.
The students will make or break the University of Illinois testing and surveillance system. Students now know that if they circumvent the recommendations, they jeopardize the in-person component of their education, just as was seen at the University of North Carolina. The students carry the responsibility for keeping the University of Illinois in-person component alive. They must make individual choices with community wide implications.
The university hopes that they choose wisely.
Sheldon H. Jacobson, PhD, is a founder professor of Computer Science at the University of Illinois at Urbana-Champaign. He applies his expertise in risk-based assessment to evaluate and inform public policy.
Janet A. Jokela, MD, MPH, is the acting regional dean of the University of Illinois College of Medicine at Urbana-Champaign. She has served as an infectious disease and public health consultant throughout her career.
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