COVID-19 screening strategies that permit the safe re-opening of college campuses

ABSTRACT

ImportanceThe COVID-19 pandemic poses an existential threat to many US residential colleges either they open their doors to students in September or they risk serious financial consequences. ObjectiveTo define SARS-CoV-2 screening performance standards that would permit the safe return of students to campus for the Fall 2020 semester. DesignDecision and cost-effectiveness analysis linked to a compartmental epidemic model to evaluate campus screening using tests of varying frequency (daily-weekly), sensitivity (70%-99%), specificity (98%-99.7%), and cost ($10-$50/test). Reproductive numbers Rt = {1.5, 2.5, 3.5} defined three epidemic scenarios, with additional infections imported via exogenous shocks. We generally adhered to US government guidance for parameterization data. ParticipantsA hypothetical cohort of 5000 college-age, uninfected students. Main Outcome(s) and Measure(s)Cumulative tests, infections, and costs; daily isolation dormitory census; incremental cost-effectiveness; and budget impact. All measured over an 80-day, abbreviated semester. ResultsWith Rt = 2.5, daily screening with a 70% sensitive, 98% specific test produces 85 cumulative student infections and isolation dormitory daily census averaging 108 (88% false positives). Screening every 2 (7) days nets 135 (3662) cumulative infections and daily isolation census 66 (252) with 73% (4%) false positives. Across all scenarios, test frequency exerts more influence on outcomes than test sensitivity. Cost-effectiveness analysis selects screening every {2, 1, 7} days with a 70% sensitive test as the preferred strategy for Rt = {2.5, 3.5, 1.5}, implying a screening cost of {$470, $920, $120} per student per semester. Conclusions & RelevanceRapid, inexpensive and frequently conducted screening - even if only 70% sensitive - would be cost-effective and produce a modest number of COVID-19 infections. While the optimal screening frequency hinges on the success of behavioral interventions to reduce the base severity of transmission (Rt), this could permit the safe return of student to campus. KEY POINTSO_ST_ABSQuestionC_ST_ABSWhat SARS-CoV-2 screening and isolation program will keep U.S. residential college students safe and permit the reopening of campuses? FindingsFrequent screening (every 2 or 3 days) of all students with a low-sensitivity, high-specificity test will control outbreaks with manageable isolation dormitory utilization at a justifiable cost. MeaningCampuses can safely reopen in the Fall 2020 but success hinges on frequent screening and uncompromising, continuous attention to basic prevention and behavioral interventions to reduce the baseline severity of transmission.