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Duke University is sometimes referred to as a very good imitation of fancier schools further north. But while these ivy-clad universities with smart students, prestigious medical schools, and large endowments remained closed this fall, Duke invited his freshmen, sophomores, some upper-class students and all of its students graduate at its Durham, NC campus for largely in-person classes.
Now he’s teaching those sniffer schools how to reopen safely.
From August 2 and through this week, when the Duke campus made a pre-planned return to online courses for the remainder of the semester, the university implemented a rigorous program of testing, monitoring and monitoring for more than 10,000 students. And he has implemented, on a large scale, an innovative program – called cluster testing – that can stretch limited testing resources without losing precision or resolution.
For returning students from Duke, the result has been a relatively safe and almost normal return to learning, at a time when other colleges and universities have closed their campuses or started epidemics in the community as they reopened. with few measures in place to detect or isolate infected students.
At Duke, students lived together on and off campus, mingled in dorms, and attended classes and labs. There were football matches (Duke athletes were tested and followed in a separate program). The fraternities and sororities continued to function. And a few times, the students celebrated like in 1999.
When there were epidemics, they were nipped in the bud. The surrounding community of Raleigh-Durham, North Carolina, was protected from 17 infected students – nine of whom were entirely symptom-free – arriving among them from distant homes. And extensive contact tracing found that class attendance was not linked to a single case of coronavirus transmission.
“Duke has done an exceptional job compared to other institutions, and has been very low-key about it,” Christopher Marsicano, director of the College Crisis Initiative at Davidson College, told Davidson NC. “This is one of the few institutions that we Ivy Plus that has decided to have classes in person. He deserves to be commended for stepping up his efforts and being an innovator here, and for reducing his arguments. “
As the United States enters a deadly new phase of the pandemic, colleges and universities are caught in a whirlwind. Even as they approach decisions on whether and how to reopen for the spring semester, many are responding to the new peak in the pandemic by closing campuses and sending students home earlier than expected.
Just as students turned many college towns into coronavirus hotspots in the fall, there are fears that students sent home untested will accelerate outbreaks as they are summarily sent home to their families.
If universities nationwide want to know what Duke did right, they can turn to a detailed report released this week by the Centers for Disease Control and Prevention.
The university developed and implemented a smartphone app that monitored students for symptoms and communicated their test schedules and results. He organized teams of contact tracers and trackers who quarantined the infected students, found the students exposed and asked them to self-isolate, investigated disturbing clusters and identified some students for surveillance. and additional testing.
There was “the Duke Compact,” a pandemic version of an honor code entered by every student who came to campus. The students have promised to wear a mask when in public, to wash their hands frequently and at a social distance, of course. They also agreed to avoid large gatherings, to self-isolate for the prescribed period of time if asked, to be vaccinated against the flu and to allow the use of certain personal data for the purposes of tracing and testing of potentially exposed contacts.
“We are, more than ever, individually and collectively responsible for the health and safety of our comrades, teachers, staff, families and neighbors,” the pact reads.
The tests were a crucial part of the school’s success. Duke has established 15 campus testing sites and a central laboratory based in the Institute for Human Vaccines at his medical school. He implemented the cluster testing program, which relayed very accurate results in 18 to 30 hours. By pooling samples, Duke’s program extended the reach of its testing efforts without sacrificing speed or precision.
As of mid-September, Duke’s lab was working three shifts a day and processing 11,390 samples a week. Students who were not feeling well had their samples tested immediately and got their results within a day. But with or without symptoms, every Duke student who lived on campus was tested at least twice a week.
Off-campus students were tested once or twice a week. And graduate students took an average of one test per week.
The pooling program was first designed to test U.S. soldiers for syphilis during World War II, when the number of servicemen deployed to Europe exposed to the sexually transmitted disease threatened to overwhelm available labs.
At Duke, lab technicians first bundled some of the specimens from five students into one sample and tested it. If the pooled sample was negative, all five students were well pronounced – based on a single test.
In the rare event that a trace of coronavirus was found, lab technicians immediately returned to specimens from the five students and tested each one individually to find out which of the five belonged to an infected donor. In populations where infections remain rare, pooling can help save on testing and reagents and further stretch scarce supplies. But keeping a backup sample from each student on the ice also sped up the process of follow-up testing. Students did not need to be called back to provide another sample.
For the most part, the fall semester has been healthy, but not entirely normal. The dorm did not include roommates. Meals were delivered to the students in their dormitories.
Between August 2 and October 11, 68,913 specimens from 10,265 students were tested. During this period, only 84 students were infected with coronavirus. Just over half of them – 43 students – were identified before any symptoms of COVID-19 appeared.
If these asymptomatic students had been left to mix freely with other students, university workers and members of the community, they would almost certainly have triggered epidemics: additional tests found that “quite a few” ‘Asymptomatic students had very high viral loads, a measurement widely seen as a good surrogate for infectivity, said Thomas Denny, a Duke vaccinologist and a key architect of the school’s program.
There is no reason why a program like Duke’s cannot be exported to other universities, said Denny, the lead author of the report, which appeared in the Weekly Morbidity and Disease Report. CDC mortality.
“I think a lot of other places could do it,” he said. “They just need to engage and mobilize their faculty to use innovative approaches.”
Depending on their resources and the capacities of the laboratories with which they partner, colleges and universities could adopt a wide range of approaches to surveillance testing. But he said Duke’s experience, in which more than half of all positive tests were from asymptomatic students, clearly shows that delaying testing until a student is visibly ill is not enough. .
College administrators “just need to make a commitment to think it’s important” that students and faculty are together on campus, Denny said. “Many programs have innovative talents and ideas. It is leadership that makes this possible. “
It is also faith in the practical applications of models and experiences that are the cornerstone of higher education, said Peter Frazier of Cornell University.
A data scientist and operations research professor, Frazier helped design a program for students to return to the Ivy League campus in Ithaca, NY, closely monitoring infections through comprehensive testing and monitoring.
Over the summer, Cornell administrators began to recognize that students would return whether the university was open or not, and that dropping them and the community of Ithaca was not an option, Frazier said. . So the school turned to faculty experts, “and we developed mathematical models that helped us predict it would work,” he said.
These models fleshed out the contours of an effective pooled testing program and showed that Cornell’s veterinary labs – which were skilled at testing dairy cow herds – could do it.
“There was a lot of uncertainty, and it was just fundamental,” Frazier said. “But we did it because we thought it would work. At the end of the day, you have to have courage. “
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