The Promise and Perils of COVID-19 Testing on College Campuses

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0:00:11.2 Matt Pellish: From EAB, I’m Matt Pellish and this is Office Hours, the weekly podcast covering higher education. Back in March, as colleges and universities across the country were just beginning to get their heads wrapped around all the ways they needed to respond to COVID-19, a new phrase made its way into our common lexicon, “testing and contact tracing.” Since then, schools have grappled with the many complexities related to testing and tracing that are necessary to the reopening of campuses, but also for society. On this week’s episode, EAB’s Kaitlyn Maloney gets to the heart of the matter with Quest Diagnostics’ Senior Director of Marketing, Stacia Rivello. Quest shifted their focus this year from a range of common health concerns towards supporting COVID-19 testing, and Stacia will talk us through how testing has gone so far. She’ll also answer some important questions like why testing varies so much from state to state, what tests we might start to expect to see in the near future, and maybe most importantly, what’s the most important best practice colleges should adopt for successful testing protocol. Thanks for listening and welcome to Office Hours with EAB.

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0:01:21.5 Kaitlyn Maloney: Hi, everyone. Welcome back to Office Hours with EAB. This is Kaitlyn Maloney joining you again from my home in Washington, D.C. It’s September now, so most of our college and university partners have already started the fall semester. Back when we hosted convenings in our offices, I always loved hearing partners’ fall traditions surrounding their orientation, their move-in, the start of fall sports. It’s something we often use as an ice breaker for our in-person events. But this year, of course, the new semester looks a little different on college campuses. And students, faculty and staff at many schools are experiencing a new ritual of sorts: COVID-19 testing. So to give us a little more context around the testing circumstances on college campuses, I’m joined today by Stacia Rivello, the Senior Director of Marketing at Quest Diagnostics. Hi, Stacia. Thanks for being with us today.

0:02:15.3 Stacia Rivello: Hi, Kaitlyn. Thanks so much for having me.

0:02:17.8 KM: And where are you joining us from today?

0:02:20.3 SR: I am joining you from Cumberland, Rhode Island.

0:02:23.0 KM: Oh wow, okay. I think you’re our first guest from Rhode Island, so, welcome, glad to have you today.

0:02:28.6 SR: Thank you.

0:02:30.2 KM: Before we jump into hearing about the specifics of what’s going on on campus, can you give us a little more context about how Quest is working with colleges and universities?

0:02:42.4 SR: Sure. I think typically in the past, we would normally work with colleges and universities in supporting their student health center for more general health and wellness testing. So we would work with them a lot on testing such as tuberculosis testing, sexually transmitted infections, flu and other viral or respiratory illnesses, but Covid has changed that a little bit. So now we’re partnering with quite a few colleges and universities across the country to help partner with them in developing their pre-arrival, but also their on-campus testing strategy.

0:03:20.4 KM: I’m sure that your organization has been just as disrupted by Covid as many of our college and university partners. But tell us…

0:03:26.5 SR: It’s been a very busy six months. [chuckle]

0:03:30.8 KM: Tell us, what are you seeing and hearing from your college and university partners about how their testing programs are working so far? Maybe some of the challenges that they’ve faced as they’ve repopulated their campuses?

0:03:42.2 SR: I have to say, we’ve seen quite a bit of variability in the way that schools are approaching their testing plans. I think part of that is, is that they’re having to take guidance from a lot of different sources. And then, let’s face it, every college campus is unique. There’s a lot of factors that are gonna change what that testing strategy should look like. So I think one of the first things that we always wanna understand when we’re working with these schools is, number one, what are you trying to accomplish? So are you gonna be testing symptomatic students? Or are you looking to do something that’s broader, where you’re doing more of a screening or surveillance program? The next thing is around really that operational plan. So how are we gonna operationalize that? And that’s really broader than just the testing component. There’s a front-end part of that with making sure requisitions are generated and getting all of the orders created. And then on the back end, it’s managing all of that data that comes from the testing.

0:04:54.3 KM: Yeah, that makes sense. I’m thinking about how my mother is a nursing faculty member at a small college in Pennsylvania, and I think they’re only doing symptomatic testing for students on campus. At the same time, I have a brother who’s starting a master’s program at Northeastern University in Boston. I think they’re required to show the three positive… Three negative tests, excuse me, before they can even arrive on campus, and then maybe testing every two or three days from there. So obviously a lot of variability, like you mentioned. Are institutions, are there federal guidelines that they’re expected to follow when developing their testing strategies? Or are they pretty much to their own devices when coming up with their plans?

0:05:35.2 SR: The CDC did put out some general guidance around what testing protocols could or should look like for the university, but to be honest, in our experience, most colleges and universities are following guidance that’s being put out by the State Department of Health. So the states have been very vocal in helping to shape what that testing strategy is, and many of them have required testing for students even pre-arrival within a certain time frame of the student arriving, and then again once they’re on campus, additional testing just to ensure that there’s no risk of spread once the students are back.

0:06:18.0 KM: Got it, got. Beyond the state guidelines, does Quest recommended factors that your institutional partners should consider when developing or modifying their testing programs?

0:06:30.8 SR: I think the key here is that there’s really no one-size-fits-all approach. So our preference really is to partner with the colleges and universities on the unique dynamics of their college campus, and then partner with them to define what that testing strategy should look like. I think that your testing strategy might be a lot different if you are in a more secluded campus where maybe you have a one way in/one way out, or you’re able to create one of those bubble-type atmospheres, versus some of these universities who are in the middle of a large city and the students are frequently coming on and off campus, going out into the community on a daily basis. I think those are important factors to consider in terms of how frequent you are testing the students.

0:07:24.9 KM: That makes sense. I know I’ve worked with some university leaders as they’ve been considering their re-population plans, particularly in the earlier months of the summer, and there was a lot of confusion, I have to admit. There’s a lot of different types of tests on the market at this point. There was some high-profile incidents that called into question some of the reliability. I think different states and municipalities have released different data and metrics around their testing. It’s very confusing just to the general public. I’m curious for your opinion on how accurate the coronavirus testing is today compared to a few months ago, and have we reached any sort of consensus around which tests are the most reliable or which tests our institutions should be considering using?

0:08:11.0 SR: Well, I can’t speak to some of the other tests on the market. I probably should only comment on the testing that Quest provides. I can say from the Quest perspective, we only work with reputable manufacturers that have extensive data packages that support the accuracy of their tests. We use tests that have received the FDA-EUA approvals, and then even after that, we do perform our own internal verification studies just to make sure that there’s that additional level of quality check being performed.

0:08:48.6 KM: Got it, got it, that makes sense. And for faculty, students, staff that are listening that may be subject to these testing protocols on campus, I know from them that there’s a lot of confusion around what impacts the turnaround time and why maybe they’re hearing some of their classmates getting results in 12 hours versus a week. Could you share a little context for our listeners around what factors determine the turnaround time for obtaining their results back from the lab?

0:09:17.8 SR: There can be so many factors that impact turnaround time, and many of those things could be something that’s out of the control of the faculty, the staff or the students, things like testing capacity, supplies, logistics. Even as we start moving into the winter months, weather can have an impact on turnaround time. Here at Quest, we try to be as transparent as possible about both our turnaround time and capacity, and we do make all of that information public on our website at newsroom.questdiagnostics.com. So anytime anyone is interested in seeing that information, they can just log on there and pull it up.

0:10:00.4 KM: I’m glad that you mentioned all the factors outside of the control of the institution. And that’s one thing that we harped on with our partners when we were helping them through re-population planning, was not just thinking about the state of the PPE and the procurement supply chains, but also how we can’t be thinking about testing and isolation. It has to be orchestrated in relationship with de-densification plan and also contact tracing, something that I think has entered the lingo of a lot of Americans that perhaps they had never considered before, but we know now how important contact tracing is to helping contain the spread of the virus. What are some of the pros and cons to the various approaches to contact tracing that you’ve seen from low-tech interventions, just a contact tracer interviewing the student to ask them where they’ve been, who they’ve been with, all the way up to some of these more high-tech apps that we’re seeing some institutions develop for students to download on their phones that give them access to certain card swipe data and class attendance records and mobile contact tracing?

0:11:09.9 SR: Yeah, so I think first of all, contact tracing is incredibly important in terms of controlling spread across these college and university campuses. The earlier that you can identify positive cases, both symptomatic and asymptomatic, and then isolate those positive cases, that’s where you’re gonna have the best chance of minimizing that spread. Now, with that being said, I think that it can be a double-edged sword because the contact tracing also can give you access to a lot of other data, especially if you’re using some of those technology platforms to help inform your approach. So I think that one element that colleges and universities have to consider is student privacy and any other ethical implications that could come from that contact tracing. But the pro is definitely around being able to identify positive cases and get them into isolation as soon as possible.

0:12:16.8 KM: Yeah, we’ve heard a lot of concerns about data privacy, particularly with regards to the app, but also just with regards to testing itself and who would have access to a student’s testing records or any member of the institutional community. Our institutional partners need to make data-informed decisions about how they’re approaching their testing strategy. I’m curious for your take on how difficult it is for schools to harness and manage all of the data that they’re collecting. What are the sorts of challenges, what sorts of roadblocks are you helping institutions through as they’re managing the volumes of data that they’re amassing?

0:12:55.9 SR: In the conversations that we’ve had with various colleges and universities across the country, I would say data management ranks up in one of the top three concerns. Because to your point, performing one of these broad-based testing programs is going to return a ton of data in itself, and then when you layer on any contact tracing, it just amplifies that level of data you have access to. However, that data is critical in being able to take the data, have that consolidated view, and then being able to manipulate the data so that you can see any trends that are emerging in your student population, and allowing that data to help you quickly identify any risk and then implement those preventative measures. So the data is crucial.

0:13:48.0 SR: There are a lot of different ways that we try to work with the colleges and universities in that aspect. So many of them want to leverage their student health center, the EMR that’s already there. We can work to develop an interface with them so that the results are flowing seamlessly into that platform that they’re already using. We also have our own platforms that they can use to help consolidate and visualize the testing data, as well as we have partners of our own, if they’re interested in a more broader scale data visualization tool, we have partners that we can also bring forward to them to help them, again, manage that data, manipulate it the way that they need to. And then I think the last part of it is the government reporting, because all of these tests you need to be reported to the state so that the state can perform their own tracking and contact tracing. So we will also work with the universities on their strategy to report that data to the state to make sure that everyone’s fulfilling those requirements.

0:14:56.2 KM: That’s interesting. It hadn’t struck me that that would rise to the level of a top three challenge, is the data management. I don’t think it’s something that comes to mind readily when we talk about testing. But I will say that I’m sure our chief information officers and chief data officers on the line, their ears are singing hearing you acknowledge that, so thank you for pointing that out. I think that’s a great point though, that some of the behind-the-scenes elements going into testing are not just even the staff, the healthcare providers needed to actually perform the tests, but all of the people behind the scenes looking at that data, getting the tests from campus to the lab and back, getting the results out to the students. How are schools operationalizing this? Are a lot of institutions hiring new staff? Are they getting support from the local community? What is that looking like on campus?

0:15:49.3 SR: Again, it’s back to there’s been a lot of variability and there’s really no one-size-fits-all approach. So I think that’s where it’s really important to have that conversation and understand what operational capabilities already exist, and then design that testing program based on that. So we have some schools that we’re working with where they just don’t have that on-site staff to help execute a testing program, so instead we might leverage our unobserved self-collection kit where the student can collect the sample themselves and then get it back to us. Or it might be a more broad-scale event where there’s actually testing locations set-up on-site at various different parts of the university, and we’re either assisting in providing staff, or the university already has on-site staff where we work with them to help set up a testing schedule, we can help them with scheduling appointments for the students so that when the student walks up, all of their information is already pre-populated, and then the staff that’s at the event will supervise the student collecting their sample right then and there. So I’ve seen a little bit of everything.

0:17:11.0 KM: Yeah. Wow, quite the enterprise. I’m thinking back to a previous episode of this podcast that I recorded with a research colleague where we were talking about some of the physical space changes that were being made to accommodate COVID-19, and we talked a lot about just all the custodial staff, the registrar, the people just working so much extra behind the scenes to pull off re-populating campus. I think you’re just adding to the list of unsung heroes, staff that are stepping up and really going the extra mile to make this semester work.

0:17:44.3 SR: Absolutely. We’re focusing on the testing aspect, but in all honesty, testing is just one component of a much larger re-population plan that every single one of these colleges and universities have had to put together. So they have done a tremendous amount of work in a very short time in order to bring all of the students back for the fall semester. It’s very impressive.

0:18:08.1 KM: Yeah. And you’ve done a great job painting a picture of what testing looks like on campus right now, and I think for any listener that is joining in from a college campus, one big takeaway is that what they’re seeing and experiencing day-to-day probably looks a lot different than their colleagues or fellow classmates on campuses in other parts of the country. But I think all of our listeners are probably curious about how the rest of the semester will play out, and when it comes to testing, if things will change. Will they just stay the course, or will there be any sorts of new tests on the horizon? Or conversely, any shortages or constraints that they should anticipate or be aware of? I’m curious if you can offer any insights into the months ahead, what some of our viewers might prepare for or might expect to see.

0:18:57.6 SR: [chuckle] That’s a great question. So I would expect that if your school is already… If your school has already implemented a testing program, I would imagine that will likely continue throughout the course of the semester, so I don’t necessarily think that will change. From a Quest Diagnostics perspective, I don’t have any concerns about supplies and things like that, but what I will say is, is that we’re always re-evaluating new testing methodologies, and we have a very robust research and development pipeline, so in the future, what we’re going to be bringing to the colleges and universities is number one, a rapid antigen test to help them get results faster, especially in a surveillance testing perspective, and then also a combination, Flu-covid test, because as you all know, the symptoms overlap quite a bit between flu and COVID-19, so being able to differentiate between the two will be really important as we move into the winter months.

0:20:13.1 KM: That’s really interesting. Yeah, I remember back when the pandemic broke out in March hearing stories about people being tested for all of the various viruses and respiratory agents going around, so hopefully we’ll give listeners comfort that they can be tested once for the multiple viruses that they might be subjected to.

0:20:32.6 SR: Absolutely.

0:20:34.0 KM: Anything else as you look ahead, kind of advice for our university partners around how to make this fall as successful and effective as possible, at least from a testing perspective?

0:20:46.4 SR: From a testing perspective, I would say there’s a few things that I think are really important. And we’ve touched on a lot of them. Number one is that operational aspect, so understanding what you have the capabilities to do, but also where you may have gaps, and being honest with what those things are, I think are helpful for whoever you’re testing partner is not just if it’s Quest, it’s helpful to be able to have those conversations as early as possible so that we can have a successful testing program. Being prepared for the fact that you could have an outbreak on campus and having a plan on how to handle that, whether it’s moving people into isolation, expanding testing protocols, so having a really strong plan in place in case your situation changes and then again, as we mentioned, being able to use the data that you’re collecting to quickly identify any risk and then act on that risk, I think that those are some of the key factors there.

0:21:54.2 KM: Stacia you mentioned earlier, I think as of today, we’re recording on September 9th, we are almost exactly to six months from the day that campus closures occurred back in March, six months living with this pandemic, and like I said, I know it’s been a crazy six months for Quest Diagnostics as well, curious, as you look back at what surprised you most about the past six months, particularly when it comes to working with higher education institutions?

0:22:21.8 SR: The number one thing that surprised me, I think was… On how quickly things changed. The conversations that I had with schools in May were drastically different than the conversations I had with schools in August, and I think that there are a lot of factors that play into that. I think changing guidance from organizations like the CDC or even the American College Health Association, so I think that that was one aspect of it, but then we did see a surge again in some states, which I think changed everyone’s mindset on how they should be approaching testing especially as we were looking at pre-arrival testing. So that I think would be the first thing. The second thing is maybe around the importance of having a strong communication plan when you’re about to implement one of these testing programs. I would say that I saw… The schools that I worked with that had a very direct and concise and almost over-communicated what their plan was with their students, in my perspective, I think that they had… That their testing programs went more smoothly and they saw greater student engagement, whereas in some of the schools that I worked with, where they gave their students a lot of options on how to get their testing done, I think it limited our ability to work together to measure the success of that program.

0:24:08.3 SR: So we weren’t able to say, “You wanted X number of students to get tested and of that number, this percentage of students actually went through and got their test done and here’s their results.” We weren’t able to have that transparent conversation, and I think that that made it more difficult to manage that testing program overall.

0:24:34.4 KM: That makes total sense and I’m sure more difficult to just rally the campus community behind the data. The more cuts of the data that you make, the less it feels like a uniform testing infrastructure. I wanna go back really quick to the point you made about how you were surprised about how much the conversations changed between May and August, can you give a little more specifics about what changed and why in your opinion, you think those changes happened?

0:25:01.7 SR: Sure, so I think one of the areas that I saw the change take place was around the shift… Was a shift from what type of test the colleges and universities were looking for. So in the beginning, there was a lot of interest around using antibody testing, especially from a pre-arrival perspective, but the market was flooded with a lot of tests, and then I think that the sensitivity of those tests went into question, so I think that that ended up changing the perspective of what test made the most sense for these schools moving forward, so there was a definite shift from using an antibody test over to using a PCR test instead.

0:25:50.2 KM: Interesting. Do you get the sense… Were institutional leaders just kind of reacting to what they saw in the news media, or were they being informed by different faculty on campus, what kind of prompted the change in their sentiments?

0:26:05.4 SR: It’s probably both. There was quite a bit of media surrounding it, but I think to a lot of schools involved, various departments on campus to help them in making that decision, some were more pro antibody testing, some were more pro PCR testing, and the President had to make that decision based on… What their committee that felt was best for their student population.

0:26:35.1 KM: Yeah, it goes back to the variability point. One the thing we observed was a lot of our large research university partners do have world class epidemiologists in their faculty who are able to provide a lot of consultation. Smaller schools perhaps are more liberal art focused and have access to those faculty and were relying much more on their own research and consulting with experts like you.

0:27:00.6 SR: That’s a great point. The schools that have either an epidemiology department or a Department of Public Health, I found that they were much more interested in understanding the sero-prevalence of their student population than some of the smaller schools that wouldn’t typically have those departments.

0:27:18.6 KM: And what is sero-prevalence? Just for listeners on the line without that background.

0:27:22.8 SR: I’m sorry. Sero-prevalence would be the percent of your population that tested positive for having antibodies.

0:27:31.7 KM: Got it. Did you give any specific recommendations then to your institutional partners that didn’t have public health schools or epidemiologists on campus, and any advice tailored to some of our smaller institutions?

0:27:47.0 SR: I think it’s more just don’t be afraid to reach out and ask for help from the experts. We have a very large team of scientific and medical experts that are more than happy to work one-on-one with you to understand the needs of your student population and what an appropriate testing protocol would be, so don’t feel like you have to design that all on your own, feel free to tap into our experts to help you do that.

0:28:16.3 KM: Encouraging advice, for sure. I’m encouraged just hearing you say that. [chuckle] Well, Stacia we always love to end on a positive note, and I know that this semester has already been chaotic and perhaps exhausting for students, faculty and staff as they’ve been enduring these testing protocols. Wonder if you could leave our listeners with any glimpses of hope or optimism from the data or the institutions that you’ve worked with, anything that’s gone well that our listeners can cling to.

0:28:47.8 SR: Well, again, as I mentioned, all of these colleges and universities had to put together a very broad comprehensive plan in a short amount of time, so I think, first of all, we should all be incredibly proud of these schools for what they were able to accomplish in such a short amount of time. So in looking at higher education in general, and I think everyone deserves a round of applause for being able to do that and to be able to start re-populating their college campuses. From a Quest perspective, I think one of the things that I find encouraging is number one, the level of partnership that we’ve seen in working with our customers, but number two, in the pre-arrival testing that we’ve done, we actually saw a very low positivity rate, so under 1%, so it’s reassuring to know that as students are coming back to school, the rate of infection is low. So hopefully, we’ll be able to help the schools in managing that positivity rate through the testing programs we’re working with them on.

0:29:52.7 KM: Yeah, that’s really good to hear and I know that the testing, depending on what type of test that you get, it’s not always the most pleasant experience, so I’m sure that the listeners are happy to hear that at least it’s been worth it and we’re seeing good matrix so far. We’re very grateful for having you on the podcast today to share some of your insights behind the scenes into the testing environment with our listeners, so perhaps we’ll have you back once there are more testing developments.

0:30:22.6 SR: Thank you, Kaitlyn, I very much appreciate you all having me today, and of course, if you or anybody else would like more information on how Quest can help, you can visit questbacktoschool.com.

0:30:33.0 KM: Questbacktoschool.com, will do. Thanks Stacia.

0:30:37.6 SR: Thank you.

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0:30:44.5 MP: Thanks again for listening. Join us again next week when we welcome Broward College President, Gregory Adam Haile, to talk about influence, power that our networks have on our lives, and as well as steps Broward has taken to overcome the network gap. Until next week, I’m Matt Pellish with Office Hours from EAB.
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