Many Texas universities are not doing widespread testing to catch students who may be silent spreaders of the coronavirus, a gamble that experts say increases the risk of massive outbreaks.
The Dallas Morning News surveyed seven universities in North Texas, along with the University of Texas in Austin and Texas A&M. Only one — the University of Dallas — tested all students when they arrived on campus, and plans to continue broad testing throughout the fall.
Outbreaks at several universities across the country have forced a switch to fully remote learning and dorm closures within weeks after classes started. In Texas, universities have just begun to welcome students back to campus. New cases are already popping up: Texas Christian University reported 330 new cases last week, up from 110 the week before; Southern Methodist University reported 35 last week.
Not testing students when they return nearly guarantees starting the academic year with an outbreak already underway, experts told The News. And calculations by disease experts suggest that testing mainly students with symptoms, as most schools told The News they would, is unlikely to contain an outbreak, putting the health of other students, faculty and staff at risk.
Not everyone agrees with the need to test asymptomatic students, however, and there’s no proven way to safely open a college campus in this country.
As schools start the fall semester, some have a limited capacity to test students. Others said the decision against mass testing follows advice from the U.S. Centers for Disease Control and Prevention, something experts told The News is faulty and a White House adviser recently contradicted. One university’s adviser said that because heavy testing would show most students are negative, they might have a false sense of security and become less careful.
Much will depend on how cautiously students conduct themselves, disease experts said.
“We should try to hold 18-to-20-year-olds accountable for their behavior, but we should also be realistic,” said Dr. Ashish Jha, director of the Harvard Global Health Institute. “If your entire strategy is built on a perfect behavior of 18-to-20-year-olds, it’s not not a very good strategy.”
Conflicting federal advice
As the pandemic has unfolded across the globe, areas with the ability to do widespread, rapid testing have controlled the virus. Because people without symptoms can spread the disease, many advocate testing widely and isolating anyone who’s infected. In the U.S., however, rapid and accurate testing has been in short supply.
Against that backdrop, universities across the state had to design strategies to operate safe campuses. Planning had to be done in just a few months and required adjustments to classrooms, dorms and dining halls. University officials didn’t know how prevalent the disease would be in the fall.
Some schools told The News they had looked to the CDC for guidance.
The agency notes that if resources allow, schools may consider ongoing testing of people without symptoms or a known exposure. That would help universities to find people, such as students living in dorms, who may be infected and isolate them from others.
The agency does not recommend testing all students, faculty and staff when they return to campus. That’s because the approach hasn’t been studied, the agency says, and it’s unknown whether it would help beyond wearing masks, social distancing, and better hygiene.
But experts said the CDC’s reasoning is unsound.
An entry testing strategy hasn’t been studied, Jha said, because campuses have just begun to reopen.
“I think for a lot of colleges and universities, it’s been an excuse not to do it,”he said.
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White House Coronavirus Task Force member Dr. Deborah Birx recently contradicted the CDC’s advice, saying each university “has to do entrance testing.”
Her remarks were made on an Aug. 19 call with state and local health officials, according to The Center for Public Integrity, a nonprofit newsroom in Washington, D.C.
A spokesman said in an email the White House had no comment on the conflicting statements. The CDC also did not offer a response.
Testing strategies
Over the summer, some universities enlisted their own scientists to evaluate strategies for containing outbreaks. Lacking real-world examples to go on, scientists tried to assess how much testing would be needed to pick up cases before an outbreak could run out of control.
The calculations estimated various levels of the disease prevalence in the community, the pace of the spread on campus, and the accuracy of the tests.
Another unknown: How many students might show up infected on the first day.
“This is a mass migration event,” said Sharon Bewick, a mathematical biologist at Clemson University in South Carolina who studies disease transmission. “It’s like taking a big spoon and stirring up the whole country.”
Bewick set up an online calculator that, based on disease levels in their students’ home states, schools could use to predict how many students might be infected when the school year starts.
Other researchers showed how even a small number of students on Day One could start an outbreak.
In a study published in an online journal run by the American Medical Association, Yale School of Public Health professor David Paltiel described what could happen on a hypothetical campus of 5,000 students. On the first day of school, 10 showed up infected.
Paltiel varied how fast the disease spread, how good the tests were, how often students were tested, and whether everyone or just students with symptoms were tested.
Under the scenario with the least spread of the virus, testing every student once a week was needed to prevent a major outbreak, he found. The worst option: testing students only when they show symptoms.
“We explored thousands of scenarios and failed to find even one plausible circumstance under which that strategy would be sufficient to contain an outbreak,” Paltiel said.
Another team of scientists at Clemson University found that no testing resulted in a strong surge of cases early in the semester. Testing within a week of arrival delayed the surge; a second test to pick up false negatives delayed it even further. Additional testing of all students throughout the semester would help even further, said Lior Rennert, the biostatistician who led the study.
Researchers at the University of California San Diego, led by infectious disease scientist Natasha Martin, looked at the problem another way, calculating how much testing it would need to catch an outbreak before a single case could spawn 10 other infections. Martin found that would require testing 70% of the campus population every month.
“That’s why we are starting with a plan to catch those students on entry,” she said. “Because we don’t want to be starting with hundreds of infections.”
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At Emory University in Atlanta, researchers found that monthly testing of all students could cut the total number of cases during the semester by 30%. Testing weekly instead could cut the total number by 80%.
All of the studies indicated that testing students at the beginning of the school year, and then doing regular testing to check for hidden cases throughout the semester could go a long way to preventing outbreaks. Still, the researchers said requirements for masks and social distancing, as well as tracing and isolating exposed students, are also essential.
Some schools — including Brown University in Providence, R.I, Northeastern University in Boston, and the University of Illinois Urbana-Champaign — are testing students on arrival, and then several times a week.
Texas universities
Of the nine Texas schools The News surveyed, all have comprehensive plans that offer tests to those with symptoms and people who came in contact with them. They all require face masks, plan to spread people out on campus, and promote good hygiene.
They also have space to house sick students, and designated staff to track down contacts of anyone known to be sick. Many say they can also target tests to specific groups, such as dormitories, if necessary. Some schools are testing athletes on arrival and during the semester.
Only one school — the University of Dallas — decided to test all students when school started, followed by random testing during the semester to pick up hidden cases. Every week, the school plans to test about 200 of its 700 students who live in dorms.
Texas Christian University opted against regular testing of students who aren’t showing symptoms. The university’s public health plan relies on the CDC’s recommendations and also cites a June document from the American College Health Association that states “screening large numbers (thousands) of students will likely produce no substantial public health benefit.”
UCSD’s Martin disagrees.
“No testing is the worst plan, given what we know about asymptomatic transmission,” she said.
The ACHA’s current document, updated after TCU published its plan, no longer contains that assertion and cites a study that suggests such testing could help. TCU did not respond to a request for comment. In a statement to The News, the ACHA said its initial document was consistent with CDC recommendations.
Southern Methodist University also opted against testing all students on entry and during the semester. The school cited the CDC’s recommendation against it, as well as advice from UT Southwestern epidemiologist Dr. Robert Haley.
Some faculty had asked for entry testing, but Haley said it would backfire for the students who had negative tests.
“You’ll never convince them that you have to be careful because they’ve all got a piece of paper in their hand saying they were negative,” he said.
A better approach, he said, would be to send the message that “there’s a bunch of you who are infected and could infect others. And you don’t know who they are, and we don’t know who they are. So you all better wear a mask and be careful because as soon as you let down your guard, this whole semester is over.”
SMU has encouraged students to lead the effort to be careful, Haley said.
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The University of Texas at Dallas also opted for no screening of students without symptoms, except for athletes when the semester starts. The school said it did so because cost and capacity were an issue. The University of Texas at Arlington asked students to limit their exposure before coming to campus, and will do regular checks on some students, such as athletes, the marching band and those in Greek houses.
Texas Woman’s University also said it didn’t have the resources, but said it would treat anyone with symptoms as positive, even before the test result was available. The University of North Texas isn’t testing students on entry but aims to do some random testing during the semester.
UT Austin, home to some of the state’s top disease specialists, also opted against testing at the start of the semester. So many students already live in Austin that the university decided it wouldn’t gain that much by testing them, said Dr. Amy Young, a vice dean at UT’s Dell Medical School. The school predicted that between 82 and 183 students would be infected before arriving in Austin. Based on its own projections, she said, the school decided to test 5,000 students a week.
The school is able to increase its testing capacity if needed; early results have shown few students without symptoms testing positive.
Dr. David Lakey, vice chancellor for Health Affairs at the University of Texas System, said even if campuses wanted to test heavily all semester, it’s not feasible. The UT System has 240,000 students, and trying to test them all could quickly overwhelm the state.
“On a good day the state of Texas maybe tests 60,000 to 65,000 individuals,” he said.
At A&M, school officials were aiming to test 5,000 students selected at random last week, with more to come as the semester progresses to figure out the prevalence on campus.
But with a typical enrollment of more than 60,000 students, the school didn’t have the capacity to test them all when the semester started. Would they have if they could?
“Maybe,” said Dr. Martha Tannenbaum, A&M’s director of health services. “I think it’s something that you would have to weigh all of the circumstances at the time before making a decision.”
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