10K COVID-19 tests a day: Indiana University’s reopening plan to include diagnostic and surveillance testing

cropped covid presser carroll Screen Shot 2020-07-31 at 1.17.05 PM
Screenshot of Friday July 31, 2020 press conference of local Bloomington leaders. It was conducted on the Zoom videoconferencing platform.

As part of its campus re-opening plan, Indiana University is planning to use a combination of diagnostic and surveillance testing, in a program that will see up to 10,000 COVID-19 tests done in a single day.

That was Friday’s news from Aaron Carroll, associate dean of the Indiana University School of Medicine.

Besides diagnostic testing (of people who are showing symptoms) and surveillance testing (of people who are not showing symptoms), the third pillar of the plan is contact tracing.

The university is planning to set up its own system for identifying people who might have come in contact with someone who tests positive for COVID-19. For quarantine and isolation, the university is setting aside 564 dorm rooms.

The massive scale of the surveillance testing will be provided by Vault Health, Inc., which uses a saliva-based test, developed by RUCDR Infinite Biologics at Rutgers University

In contrast to saliva-based surveillance tests, diagnostic tests use specimens that are taken with a nasopharyngeal swab.

Carroll’s announcement came at the weekly Friday press conference of community leaders on COVID-19 response.

Last Friday, the university’s assistant vice president for strategic partnerships, Kirk White, had announced the university was working on a plan that would test every student when they arrive—if they were not able to be tested in a 10-day window before showing up in Bloomington.

The testing program outline by Carroll this Friday sticks with the university’s previously-announced goal of getting as many students as possible to have themselves tested before arriving on campus.

Carroll said the basic idea is to prevent infected people from coming to Bloomington. But after that, the university wants to catch the people who might be infected as quickly as possible—when they arrive.

After that, the university wants to move to a system of constant monitoring. Students who are infected will be pulled out and kept separate from the rest of the community, Carroll said.

The university will be using Vault, Inc. for the surveillance testing, Carroll said. But the university will also be establishing two labs in Indianapolis and one in Bloomington, which will have the sole purpose of running asymptomatic surveillance testing for IU students, faculty and staff.

The goal is to ramp up those labs to where they’re doing 10,000 tests a day, Carroll said—he hopes within eight weeks, maybe sooner.

“If those numbers sound huge, that’s because they are,” Carroll said. He said it’s more tests than are done in many states.

It’s also close to the largest number of tests done on a single day in the entire state of Indiana—12,278 on July 20, according to the state’s COVID-19 dashboard.

The eventual goal is to test all students one or two times a week, and all faculty and staff “very regularly,” Carroll said.

Asked if the university’s testing numbers would feed into the Indiana State Department of Health’s COVID-19 dashboard, Carroll confirmed that the university will report its testing results to the state.

Carroll said the state’s department of health might choose to separate out the university’s surveillance results, because they might distort the overall state picture. That’s because most of the COVID-19 tests that are being done in the state of Indiana are diagnostic, not surveillance tests. How that data is handled will be up to the state, Carroll said.

Carroll said the university’s contact tracing program is being developed with help from faculty at the IU Center for Global Health. Carroll described some of the faculty at the center as having a lot of experience working in resource resource-limited settings, like Kenya, to do contact-tracing work for HIV. The COVID-19 contact tracing is led by Adrian Gardner and Megan Miller, director and associate director of the center.

Gardner served for seven years as executive field director of the Academic Model Providing Access to Healthcare Consortium and was based in Eldoret, Kenya, during that time.

The intensive COVID-19 surveillance testing, along with constant monitoring of the data, will allow the university to make swift, informed decisions about converting to online-only instruction for a period of time, if that’s necessary, Carroll said.

A media question fielded by Carroll after his presentation: Do you have any concern that the aggressive surveillance testing program might lead to complacency about about maintaining good physical distancing and hygiene practice? “That’s why we need education, education, education,” Carroll said. He added, “A negative surveillance test does not mean you’re not infected, and you can go off and do willy-nilly whatever you like.”

Carroll clarified what a negative surveillance test means: “A negative test means we haven’t found infection, yet.”

According to Carroll, the “constant drumbeat” needs to be: practice social distancing; wear a mask; and practice good hygiene like hand washing. “All of those things have got to become second nature, and occur in addition to all the surveillance testing we’re doing,” Carroll said.

The goal of surveillance testing is not to find every infection, Carroll said. Surveillance testing will never have the quality of diagnostic testing. The point of surveillance testing, according to Carroll, is “to find more infected people than we otherwise would, get them out, and keep the rate of infection lower.”

Carroll said, “Let’s be clear, infections are going to happen. We can’t get to zero. Our goal is to minimize them. So we need to be prepared and not panic as they occur, and know exactly what we’re supposed to do, when we’re supposed to do it, to keep everyone else as safe as possible.”

The amount of ongoing campus diagnostic testing is planned to be substantial, even if not on the kind of scale as surveillance testing. The initial short-term goal is to be able to test 0.1 percent of the university’s constituents on any given day, Carroll said. That works out to about 122 tests per day, across the state, Carroll said.

The eventual goal for the diagnostic program, Carroll said, is to test 0.5 percent of the university’s constituent population. That’s because respiratory flu season is approaching, and a lot of people are going to have symptoms—so they’ll need to get diagnostic tests, Carroll said.

[Updated at 6:21 p.m on July 31, 2020. The state’s dashboard breaks down data by county, defined by the “county of residents” for those infected with COVID-19. How will college students who have recently moved to campus be integrated into this scheme? Responding to a question from The Square Beacon, a spokesperson for the Indiana State Department of Health said, “College students will be counted based on the address they list on the testing form. Contact tracers will also ask if the patient is in school and gather information to inform close contacts.”]

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