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By the numbers, COVID-19 cases at the University of Missouri are down, and that looks good on paper.
But it may not reflect reality.
MU and other area universities are not testing students and staff regularly, so officials can’t know how many of them are walking around spreading the coronavirus on campus, and in the surrounding community, infectious disease experts say.
And at MU, only those who show symptoms are told to get a test.
“We should not be reducing testing on college campuses,” said Anthony Fehr, an assistant professor of molecular biosciences at the University of Kansas. “It is clear that they are a hotbed for infections, though few students actually exhibit symptoms.”
Fehr, who has been researching coronaviruses since 2012, said “continued random, regular testing of students on campuses is the only way that these schools will know the true prevalence rate of the virus and be able to contain it such that it does not spread exhaustively out into the larger community, where there are likely to be more at-risk individuals.”
Yet some experts say that wide-scale testing on campuses just isn’t worth the cost.
“Testing does not stop the spread of the disease,” said John Middleton, an MU professor of veterinary medicine and infectious disease. “The problem with mass testing is it uses a lot of resources. It uses a lot of testing capability and with the supply chain the way it is and logistics the way they are, we are better to focus on those people that really need a test because it is medically indicated.”
MU maintains that its limited testing works, and it boasts that case numbers are trending down. Yet a White House report released Sept. 20 said Missouri had the fifth highest rate of cases per capita in the country and called for the state’s universities to “dramatically increase testing.”
The report said Missouri is in a “red zone” for COVID-19, with 117,000 confirmed cases and about 1,950 deaths.
“The less you test, the less you know,” said Bill Schaffner, a professor of preventive medicine at Vanderbilt University, where all students and staff are tested weekly.
He said even schools testing frequently may not be able to say for certain how many cases they have because “there is nothing completely accurate about any of this.
“And even we don’t know exact numbers because we are not testing every day. But Vanderbilt is doing a good job.”
KU began the school year testing every student and staff member, using a saliva test with rapid results, and then scaled back.
But MU has never done a mass testing of students, or random testing, for that matter. Tests are only requested for students showing symptoms. And to get a test, a student needs a doctor’s or nurse’s note. University officials say that policy appears to be working for them, since they are reporting fewer cases.
MU boasted their COVID-19 cases are down 86% this month, from 683 the first week of September to under 100 on Sept. 23. No students have been hospitalized with the virus. And, the number of new cases has been dropping “consistently for two weeks,” said Christian Basi, MU spokesman.
“There is a misunderstanding that we are limiting the number of tests so we can reduce the number of cases, and that is absolutely not true,” said Chancellor Mun Choi.
The data the university reports, Basi said, “indicates there are fewer active cases on campus. Our theory is that everybody has it, so practice the safety guidelines. And If I’m asymptomatic and practice the guidelines I am not likely to spread the virus. Why should we do massive testing and waste those resources if we are assuming everyone has it?”
All over the map
Since there is no national guidance for how schools should handle coronavirus testing, colleges are left to come up with their own testing protocols. “And they vary significantly,” Schaffner said.
They vary even among campuses within the same state system. The Georgia Institute of Technology, for example offers free testing for anyone with symptoms and tests up to 1,500 asymptomatic students, staff and faculty a day, reports Inside Higher Education. Elsewhere in the Georgia system, meanwhile, Georgia Gwinnett College doesn’t offer testing on campus. Students are told free tests are available at the Georgia Department of Public Health, maybe at their primary doctor’s office or the local pharmacy.
University of Illinois at Urbana-Champaign tests its 45,000 students as often as twice a week, using a saliva-based test that produces results within hours. According to campus news reports, researchers there had projected they would see about 700 cases by the end of the semester. On Sept. 21, they were up to about 2,000. Now they are restricting student movement to curb spread. But university officials there say most schools are not testing as much, so those numbers only show the tip of the iceberg.
Many universities opened this fall with a mix of in-person and online classes. Dorms and some dining halls opened too, with mandates for masks and physical distancing. They put sick and exposed students in isolation and quarantine rooms. Several weeks into the semester, some colleges have already closed campuses and reverted to online classes only. Others have said that as long as the case numbers stay low, they will stay open with at least some face-to-face teaching. Colleges lost millions of dollars in housing, dining and student fee refunds in the spring when campuses closed.
After the mass testing at the start of school, KU shifted to random testing, as well as testing people with symptoms and those who came in close contact with a positive case. A KU dashboard, showing the number of cases every seven days, indicates they too are seeing a downward trend. It shows 91 positive cases found on Aug. 21, down to 11 on Sept. 7 the most recent data available.
University of Missouri-Kansas City required students living on campus to get tested on their own and prove the result was negative before moving in, and all international students were quarantined for 14 days after their arrival in the U.S.
“Universal testing of all members of our community was neither recommended by health authorities, nor logistically feasible given testing resources available in this community, given how often it would have to be repeated to be of value,” said John Martellaro, UMKC spokesman. “We anticipate that our campus safety guidelines, which include self-monitoring for temperature and symptoms, wearing a face covering, social distancing and practicing good hand hygiene and enhanced cleaning of facilities, as well as a transparent notification policy, should provide effective control.”
“These decisions were not made without a lot of planning,” Basi said. “We made a lot of adjustments,” before settling on how MU would test.
“Are we right on the money on this? We don’t know that, but we are doing what is best for our situation. There has not been a proven strategy out there. If there were, everyone would be doing it.”
At a University of Missouri System board of curators’ meeting on Thursday, Choi said he’s confident there are fewer virus cases on campus because “more people are taking it seriously that this is a pandemic that can be mitigated by wearing a mask and social distancing and we have been more forceful in our enforcement,” of penalties for violating safety rules. In the five weeks since students returned to campus, MU has acted on 542 cases in which students are accused of violating the rules. So far two students have been expelled and three suspended.
Huge house parties near the KU campus in Lawrence also led to disciplinary action against students. A public health ban was issued to students living at two off-campus houses after a video surfaced showing crowded weekend parties.
A culture of community where students and faculty who want the campus to stay open are following the rules, wearing masks, social distancing and hand washing, is what keeps the numbers down, Choi said.
Experts say that young people with the virus are more likely to be asymptomatic. They could be contagious, but without a test, no one would know.
Still, Basi says the drop in cases is a good indication “we are managing COVID well in Columbia. We are not seeing signs that the disease is spreading among faculty and staff.”
He said, “more students are recovering than are coming down with the virus.” And among the 2,000 faculty on the campus, MU has only seen 11 cases in five weeks. Boone County numbers, he said, “also are falling as the college’s numbers fall.”
MU only counts cases reported by the county health department. So if a student from, say, Overland Park or Lee’s Summit makes the two-hour trip home for a weekend visit and gets tested there, a positive result would not show up in the university’s numbers.
“We don’t have an accurate number of students being tested and cannot calculate a positivity rate just for students,” Basi said.
COVID-19 testing is expensive
Testing, along with other safety measures, including retrofitting buildings, signs promoting social distancing, temperature taking technology and more, can be expensive. Some schools report spending more than $50 million a semester on those measures.
Choi said MU hasn’t yet calculated exact figures but estimated it will be in the millions. KU officials also did not have an exact amount, but said that number is best represented by the roughly $3.1 million in state funding received for testing, contact tracing and infection prevention.
Other schools report spending far more.
The Washington Post reports that Illinois is paying about $10 to $14 per test. Testing every student twice a week could run nearly a million dollars a week, or more. Northeastern and Purdue universities are spending about $50 million on testing alone, according to the College Crisis Initiative, which has been tracking the U. S. college response to the coronavirus.
But there is also an equity issue to all of this, said Madeline Buitendorp, a data and policy research analyst with the crisis initiative at Davidson College. “Smaller and minority-serving institutions can’t afford that same level of testing, and some schools can only afford to do symptomatic testing.”
Some MU students said their school could do more.
“I know testing everyone would cost a lot of money,” said Joy Mazur, an MU sophomore from suburban Chicago. “But they have been spending so much money on other things that I don’t think are relevant, like $10,000 on a social media campus influencers campaign. And $20,000 to put an acrylic case around the Thomas Jefferson headstone on campus.”
The influencer campaign, which cost $10,300 and ended Sept. 25, was part of a university effort to spread the word about how it is fighting COVID-19. The acrylic case was installed to protect Jefferson’s original headstone — a gift to the university — from vandalism.
“I think they could find the money to do more testing.”
It’s not just about the money though, said Julie Brncic, who chairs the UM System’s board of curators.
“The community we are testing is different. With this population, what we are finding is that if you test everyone it decreases the compliance, it presents people with a false sense of confidence and safety.”
“There may be some truth to that,” said Mazur, who lives on campus and said she doesn’t trust that the university’s numbers give a true picture of infection on the campus. “I would still like for them to test more.”
Jack Soble, a sophomore from Chicago, agrees. “I think that they have made it clear that they really don’t care about keeping us safe,” said Soble, who hasn’t been tested since arriving on the campus. “Knock on wood, I haven’t shown any symptoms yet. But I very much don’t feel safe. I just want to feel like I am safe.”
Being completely safe from the virus exposure may be unrealistic, said Schaffner, the professor from Vanderbilt. The only way to be sure, he said, “is to stay at home, lock your doors, don’t let anyone in, and wrap yourself in plastic.”