Testing and compliance are key for a safe semester, health experts say

Health experts from around the country weigh in on what needs to be done for ASU to safely reopen during the COVID-19 pandemic

While health experts acknowledge that ASU's plan to mitigate the spread of COVID-19 on-campus is strong, the issue lies within what happens off campus, something that the University may struggle to control, they said. 

A safe semester will depend on the action students take on and off campus, where students are coming from and how quickly the University responds when – not if – an infection spreads, said Emily Gurley, an infectious disease epidemiologist and associate scientist at Johns Hopkins University. 

"If you have people interacting with each other, there's going to be some transmission, there's just no way around it," Gurley said. "I think the bigger question for campuses is, as a community, what level of risk is everyone willing to accept? What do you do once you hit that threshold of risk? 

"It's not an empirical question, it's more of a values question for that community," Gurley said.

A. David Paltiel, a public health professor at Yale University, said he is most worried about students "heading down the road to take Jell-O shots in an overcrowded, non-ventilated basement frat house" and attending similar events.

What is ASU’s plan?

The University has laid out a wide range of protocols to ensure the school can open and operate safely. These protocols range from broader guidelines, such as the Community of Care plan students must abide by, to a daily health check students must complete before coming onto campus

ASU has also provided students with three different learning modalities, allowing students to either attend classes in person, through ASU Sync or through ASU Online. 

ASU President Michael Crow expressed confidence in the plan when he spoke to The State Press last week

“If everyone follows the guidelines in our Community of Care plan, wears a mask, social distances, (completes the) health check, testing if you're showing symptoms, we're not going to have any problems,” Crow said. 

But despite multiple universities devising plans to continue with in-person learning like ASU, some have dealt with the ramifications of doing so firsthand and are now falling back.

The University of North Carolina at Chapel Hill moved all of its classes to online learning after 130 students tested positive for the coronavirus within a week of opening in-person classes. Michigan State University moved to online learning two weeks before its classes would start.

Some universities moved to fully online instruction well before their semesters began, despite drafting potential plans. Harvard University planned to test students at least once a week but moved to fully online instruction in early July. Johns Hopkins University planned to test students twice a week before following Harvard's footsteps.

When Crow was asked how his confidence in the University’s plan was so strong considering the actions of other higher education institutions, he said that it was unfair to compare ASU’s situation with those at other universities.

"They're basically declaring that they don’t believe that their undergraduate programs are essential," Crow said in an Aug. 12 interview.

Crow specifically noted how each state has varying degrees of trouble with the coronavirus. New daily coronavirus cases in the state of Arizona have dropped from around 3,500 a day in early July to under 1,000 a day currently, according to the ASU Biodesign Institute critical COVID-19 trends page.

Crow said that compliance would be enforced by University staff and the daily health check. Students who see classmates not following the guidelines are advised to inform their instructors.

The University stressed that compliance is vital to safely starting and continuing the semester in person and avoiding a potential outbreak similar to UNC's.

“If all of us – ASU students, employees and the broader community – follow the protocols and modify behavior, we are confident that we can successfully re-engage in person, on campus,” a University spokesperson said.

Will Humble, executive director of the Arizona Public Health Association and former director of the Arizona Department of Health Services, said the plan ASU has put forth is well thought out and mitigates as much risk as possible.

What Humble and most health experts fear, however, is whether compliance will transfer off campus.

'The weak underbelly': Off-campus activities

Much of the traditional college experience on campus has been adjusted to limit the spread of the coronavirus, but the University can only control the choices students make off campus to a certain degree.

"The weakness in the plan is really what happens in the city of Tempe," Humble said. "ASU has done a good job controlling what they can control. But what they can't control is the off-campus behavior, and that's the weak underbelly."

READ MORE: COVID-19 and ASU: Here's what you need to know

Humble said activities like parties and frequenting bars when they reopen could result in superspreader events, where just one infection within the venue can result in a dozen or more infections.

Paltiel said that while a university's goal should not be to stop students from having social interactions, it should look to prevent superspreader events from happening through developing “safe, low-risk” activities on campus for students to attend.

A University spokesperson said it plans to punish partying on and off campus if officials are made aware of it.

ASU also plans to work with the city of Tempe and local businesses to promote the same safety protocols off campus and educate students on the disease, according to a University spokesperson. 

Neal Woodbury, the interim executive vice president of ASU Knowledge Enterprise, said the community must continue its efforts of promoting mask-wearing and practicing social distancing until there is an effective vaccine or herd immunity is developed.

"It's tiresome, I get it," Woodbury said. "But it is critical, and it will save our lives."

And even if students continue their efforts, some health experts believe the amount of testing ASU is requiring for all of its students and staff may not be enough to stay ahead of the coronavirus. 

Frequent testing is essential for returning 

Paltiel praised ASU's Biodesign Institute for developing a saliva-based test that is free to all students and employees. He said ASU's tests make collecting samples easier, cut down on supply-chain costs and provide quick turnaround times for results.

However, Paltiel said the modeling he and others have produced suggests that university-wide testing needs to occur every two or three days when reopening a university. ASU requires students who are moving into on-campus housing be tested before arriving. Most other students and employees are only expected to get tested if they feel ill.

 "It shouldn't be voluntary," Paltiel said. "It should be mandatory and it should be frequent." 

Woodbury said the University is planning to test roughly 7% of the community weekly, but reaching that goal will require cooperation from students and employees across the four largest campuses.

Joshua LaBaer, the director of the Biodesign Institute, said the University has upgraded its labs to ensure they can process the tests needed. 

LaBaer added that any student who feels they need to get tested often because of exposure to high-risk scenarios should do so. 

"Err on the side of more testing would be my bias," LaBaer said. "The quicker we find these cases, the quicker we get them in isolation, the quicker we prevent the spread."

Crow told The State Press last week that the positivity rate of those within the community who were tested was around 1%. 

Woodbury would not comment on the specific number Monday, but said it is "still very low." He added that the University does not want to focus on specific numbers but rather on the bigger trends within the community and outside of it. 

"So, if we look at those trends and we see the trends going up or the trends going down, that tells us something," Woodbury said. "The absolute number (of infections within ASU) is very hard to interpret."

The University previously stated it doesn't intend to publish campus-wide COVID-19 data. Crow said last week the University is working on a dashboard to display data by zip code. 

Humble added that not being transparent isn't a fatal flaw in ASU's plan, but "transparency builds trust, and trust builds compliance."

"Folks need to know what is happening, what is expected of them, and the rationale behind it," Gurley said.

All of the experts who spoke said there will be cases within the ASU community. The decision to return is risky, "but having students stay home to live under the supervision of their parents with less structure is also risky," Paltiel said.

It is paramount that the University helps minimize the spread and keep people safe, Paltiel said. Testing and enforcing compliance throughout the ASU community should do that, the health experts said.

"You do the best you can with compliance, and you follow the test results over time to see what's actually happening," Humble said. "You will get enough warning, this virus can expand exponentially, but if you have enough testing in place you can see it before it explodes into a full-blown exponential threat."


Reach the reporter at wmyskow@asu.edu and follow @wmyskow on Twitter. 

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