COVID and Research Universities–so much info, so little evidence

Research Universities have largely failed to amass and communicate evidence of how testing regimes can be used to re-open college campuses. The great college reopening of 2020 is a natural experiment (very different approaches on testing across many schools) on a grand scale, being conducted by institutions who are supposed to exist to do research, teaching and service to society. However, we failed to work together to develop a common protocol for counting and reporting cases, greatly truncating what could be learned from our efforts. Let me say that I share in this failure since I direct a Research Institute at Duke.

The past few months have been very difficult for us all, but we need to be able to learn from what we are doing and we are now largely failing at generating useful evidence. We have much experience studying medical conditions using cross-institutional protocols, but we the Ivy plus institutions have the most resources and are distributed in communities with divergent levels of community spread setting up a very nice natural experiment of how testing and others policies impact spread of COVID19. Why have we not been able to apply our scientific methods to ourselves, for example, by agreeing across University’s how to report cases?

Here is a link to Duke University’s covid19 tracker, and Duke is emerging in media reports as doing about as well as possible in reopening, suggesting that the huge investment in testing done means it is possible to re-open safely. As fewer and fewer schools manage to be open without large amounts of transmission, interest in how Duke has managed this will increase. Folks ask me and I say (1) lots of testing; (2) luck; and (3) I am unsure but quite (pleasantly) surprised.

I teach a graduate health policy seminar this Fall and we are spending quite a bit of time discussing COVID19 and we spent an hour discussing what we could and could not learn from Duke’s tracker during class last night (screen shot below of the cumulative report of the tracker from August 2-28, 2020; link to the notes of Duke’s tracker).

A summary of the class discussion last night.

  • There are 3 types of testing: entry (when students come back to Duke; contact traced or symptomatic; surveyed or surveillance testing). This is an expensive, robust effort.
  • This is an astonishingly low number of positive tests. 24 students had a positive test result upon returning to Duke from Aug 2-28, 2020 out of (24 out of 8,235); all 3 students tested due to symptoms or contact tracing were positive; 2 of 7,471 students who have been tested as a part of sampling or surveillance testing tested positive.
  • The rate of overall positivity (29 divided by 15,709) is astounding for a group of young people who returned to Durham from all over.
  • If there are outbreaks later, such an overall positivity rate is not particularly meaningful, however, since it blends three different rates. You would expect the contact tracing rate to be highest (3 of 3 cannot get any higher, but such a small number); the entry test rate is very low (24 of 8,235); and given that, you expect the survey or surveillance rate to be low (2 of 7,471 is super low)….but this rate is the early warning system.
  • Several of the graduate students in my class reported not being a part of entry testing, since they live off campus in Durham, and were not planning to come to campus for any reason (their Duke card won’t open buildings if they have not been entry tested and complete a daily symptom tracker). It is unclear how many students are living in Durham, but did not receive entry testing.
  • The surveillance or survey testing is a key early warning symptom that will allow the identification and contact tracing of hot spots. One student in the class reported being selected for the survey or surveillance testing but not being testing because s/he was unable to make the testing appointment provided. A key bit of info needed is how many students selected for testing survey testing are not being tested, and why?
  • Another student reported being selected for surveillance testing but feeling that going to one of the campus sites for testing would be the most risky thing s/he had done in a while (fwiw I do not think Duke’s testing locations are risky). The class suggested maybe a drive through, contact-less testing route. There are also a variety of mail testing options.
  • The dashboard should be updated to note how many were selected for surveillance testing but did not receive it. This is not a “gotcha” this is a research university being who we are and trying to build evidence of how to live in a pandemic.
  • Students had a variety of questions about student athletes. This note at the bottom of the tracker was a bit confusing for students in my class

Does not include testing of student athletes who returned to campus in July 2020, before the survey testing program was launched. Duke previously reported that 26 student-athletes tested positive for COVID-19. All went through the required isolation and were cleared to return to their daily activities.

It is clear that Duke’s tracker does not include the 26 student athletes who tested positive in July, 2020, but are they included in the August 2-28, 2020 testing data? Presumably they already had a entry test, but were they a part of the sampling testing? It is unclear.

The ACC has detailed testing guidelines that mandate that athletes in high risk transmission sports, like football, be tested three times each week once competition begins (Duke has a football at Notre Dame scheduled for Saturday, September 12, 2020). Will the athletes “in competition” testing be included in that of the other students? They should not be since they will be tested more often with probability of 1.0 and are living in a “bubble” of sorts in the Washington Duke Inn (other athletes and upper class students are also living there).

I am glad that Duke has put out testing information. It remains a work in progress to be as useful as it might be. It is not too late for Research Universities to work together to try and convert some of the reams of information being collected into meaningful evidence about how testing and other policies can allow the re-opening of large organizations with mobile populations.

Across the board, our country has some much information and so little evidence. If the University cannot lead the way, then who can? It is not too late.

About Don Taylor
Professor of Public Policy (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute), and Chair of the Academic Council at Duke University https://academiccouncil.duke.edu/ . I am one of the founding faculty of the Margolis Center for Health Policy. My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

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