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A targeted coronavirus testing strategy that Rutgers University has found to be effective (opinion)

Over the last year, higher education leaders across the nation have grappled with a question many had never encountered: How open should my campus remain during a pandemic?

While the specter of COVID-19 seems to color every decision we make these days, each institution’s distinct situation makes this question difficult to answer uniformly. At Rutgers University, in part because New Jersey was hit so hard by the first wave of this pandemic, we were among the first higher education institutions to decide that most of our instruction would be remote this fall.

We were disappointed, but it has turned out to be the correct decision. We used this time to fine-tune our coronavirus testing strategy, which may ultimately be one of our most potent tools assisting us in remaining functional across all missions while planning on reopening campus further this coming spring or summer. As the pandemic in New Jersey is appropriately mitigated to allow a more proactive repopulation plan, we believe our targeted approach to coronavirus testing will continue to assist us in keeping our current community safe.

Even now — as a second wave of the pandemic has engulfed New Jersey (third wave for the nation at large) — this strategy has continued to assist campus leadership in suppressing outbreaks on our campus. Our novel approach to targeted testing has produced a finely balanced success across all missions for the university: remote and in-person mission areas are functioning well, while the world sprints to vaccines and therapies. And now that we have a semester’s worth of experience in this new normal, we have begun to examine what has worked.

Our university’s daily testing positivity rate has been and remains well below the state’s overall rate. On Oct. 31, for instance, our test positivity rate was 0.63 percent across Rutgers campuses, while the state’s climbed above 7 percent. As the state’s rate climbed to more than 13 percent by December, we have continued to maintain a positivity rate on campus below 1.5 percent to 2 percent. In general, we have been able to keep our rate at roughly around one-10th of that of the state around us.

This is even more impressive when you consider our major geographical locations in urban environments between the Philadelphia and New York City metro areas. Rutgers New Brunswick, the university’s Big Ten campus, is a locus for research and economic activity that is entwined with our entire state. Our Newark and Camden campuses are truly of their home cities, fundamentally connected culturally and physically with their urban communities. Our health-care enterprise, Rutgers Health, educates and heals almost everywhere in between.

Because of the dense population of New Jersey, we were originally concerned about a potential viral spread outward from our campuses, especially due to national trends and reports from other colleges and universities of superspreading events occurring due to students’ discipline — or, more accurately, a lack of it. But to date, that has not occurred in New Jersey.

Why?

We acknowledged early on a truism of pandemic management: “You can’t test everybody all the time.” Indeed, we felt that could be harmful, by providing false reassurance and enabling less responsible behaviors. Instead, here at Rutgers, our response hasn’t been a one-size-fits-all approach, but rather one that targets faculty members, administrators and students according to their current and evolving epidemiologic exposure risk. We emphasize that testing is not perfect, is not armor and does not protect the person tested but rather those around them.

We asked groups to apply to be tested and created an expert multidisciplinary committee to review those applications. Our a priori criteria to help assess risk cohorts for subsequent coronavirus testing have been:

  • Is the requested group able to maintain physical distancing while completing activities on campus?
  • Is the requested group working and/or learning in a patient care environment?
  • Does the requested group reside in a congregate living environment (e.g., residence halls)?
  • Is the requested group working and/or learning in an environment where they may expose individuals from another group who are at risk for severe illness (i.e., a vulnerable population)?
  • Are there other factors that may increase the requested group’s risk based on the evolving science and public health data?

Using those criteria, we created testing cohorts, such as research teams grouped by principal investigator, students grouped by year or by campus residence or athletics teams.

Our targeted strategy’s risk assessment focus means that testing is not required or recommended for all employees or students. Instead, it focuses on these predefined cohorts that are returning to learning and work environments that may interrupt their ability to mitigate effectively throughout their entire time on campus. Everyone in the Rutgers community accepts some social responsibility for behavior in keeping each other safe. And it’s working.

Tracking the Results

Since adopting this testing strategy in May, daily positivity rates have been low, mostly staying below 1 percent. Of course, our rates climb along with the state’s. But at the time of this writing in mid-December, more than 86,000 tests have been performed for coronavirus with an overall positivity rate of 1.20 percent across our community.

We discovered additional benefits to targeted testing, too. Mass testing can be time-consuming and expensive, and it only allows a snapshot of our community for one day. However, targeted testing has allowed us to use our resources wisely without sacrificing safety and to concentrate our other important containment interventions where the risk is greatest.

For example, contact tracing is also more manageable with targeted cohorts, and conducting daily or weekly sweeps of data has allowed us to track outbreaks and their responsiveness to our interventions. It also avoids false reassurance of people that they are negative, leading to reckless follow-up behavior.

Rutgers also has been fortunate to have a built-in advantage in our COVID-19 response. In April, we adapted pre-existing high throughput testing technology to receive the first emergency use approval from the Food and Drug Administration for saliva-based testing. New Jersey governor Phil Murphy and his administration eagerly adopted our test, and the technology has been deployed around the country. Our innovation has allowed us to maintain a reserve capacity of saliva-based, coronavirus PCR SARS-CoV-2 testing for our use as part of our targeted testing regimen.

As Rutgers moves through the winter and cases continue to increase, and the spring semester arrives and we hopefully increase our on-campus population, we will be testing in real time to see how our model responds. So far, this approach, working in concert with our state health department, has effectively helped to limit transmission on our campus and off. Ultimately, the availability of a vaccine will be very helpful, but we will likely need to learn to live with this virus. This methodology may be useful for other colleges and universities to understand, too.

In the meantime, we will continue to combine our approach to repopulating our campus with a strategic targeted approach to testing. We’ll make adjustments as warranted and refine our ability to assess risk. And we’ll continue to prioritize the health and well-being of our on-campus population while understanding that the secret lies not in how many people you test but whom you test and when.

Vicente Gracias is senior vice chancellor for clinical affairs at Rutgers Biomedical and Health Sciences and vice president for health affairs at Rutgers University. Brian L. Strom is chancellor of Rutgers Biomedical and Health Sciences and executive vice president for health affairs at Rutgers University.

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