Indiana University’s mitigation testing strategy has been one of the major reasons why many students, faculty, and staff have been able to return to offices, dorms, and classrooms this fall.  The WISE Indiana team recently sat down with Erika Cheng, PhD, MPA, the Deputy Director of Mitigation Testing for IU’s COVID-19 Medical Response Team to learn about IU’s decision to return to campus this fall, and why the mitigation testing has been so successful.

Indiana University keeps it’s own dashboard which tracks information about on campus positivity rates for symptomatic and mitigation testing.  This page is updated weekly on Wednesdays.

What information did IU use to make decisions about bringing students back to campus? 

I wasn’t on the team when it originated, so I don’t know about the early conversations that happened in the spring. The general sense that I got that there was a desire amongst the administration, the students, and some faculty to open the campuses and have in-person classes and have a college experience in the era of COVID-19.  That’s how the mitigation response team (MRT) was formed – to figure out a way to keep IU open and safe and keep faculty, staff, and students healthy throughout the semester. I think maybe at the time, we thought this would maybe only be in the fall semester, and now it’s extending through the academic year. 

There are three components to this response, a symptomatic testing arm which takes people who have symptoms through an IU virtual hub and gets them testing. There’s a contact tracing team, which if anyone tests positive, they have a robust contact tracing program with a ton of people working on it to figure out how to isolate close contacts. Then there’s the mitigation testing portion, which I’m involved in, and the whole purpose of that is to identify asymptomatic cases and remove them from the community and put them into quarantine so we can stop the asymptomatic spread of COVID-19. We know that asymptomatic spread one of the reasons why this virus is so out-of-control. Those are the three things that the MRT has been trying to this fall.

Can you drill a little bit more into what data resources you are using to influence the decision that the team is making?

Sure! So far, we’ve selected 15,000 faculty, staff, and students each week across all of the campuses – there have been 13 weeks so far in this semester. We have our own labs and tests now, so we are going to increase that amount, hopefully, ideally to do up to 15,000 tests a day at some point, across all the campuses. We make decisions about who is tested and how many people we test based upon the prior weeks’ findings. For example, there was an uptick in cases at some of the regionals one week, so we pulled some tests from other sites and tested more at the regional campuses the following week to make sure that we were properly identifying cases, because we were worried about there being an outbreak there.

People think it’s a completely random selection, it’s not. We focus on people who live in congregant living – residential dorms, Greek housing – people we know from previous weeks tend to be a little bit higher risk, like people who have in-person classes. Those groups are over-sampled, and then within that group, selection is random.  So, you’re twice as likely to be selected if you live in a residential dorm, but who we select within that group of people is a random process. 

Those are really the only data that we have access to – we don’t have access to any demographic data, we don’t have access to any personal information. We just know if you’re taking an in-person class, if you live in residential housing on campus, if you live in a fraternity or sorority, or if you’re affiliated with the Greek system but you live off-campus, because those groups have tended to be a little higher risk as well. From a faculty perspective, we know if you teach in person or if you’re staff who has a job that requires you to be on campus.

What unexpected challenges has IU faced in bringing students to campus? 

I feel like the on-campus arrival group did a phenomenal job. So, what happened coming into fall, anybody prior to moving into a dorm or Greek housing had to be tested. So we did a rapid-test, and they set up these mobile trailer labs that analyzed the results right away, and everyone got their results within 20 – 30 minutes, and if they were positive, they were moved directly into isolation dorms on campus. And if they were negative, they were allowed to move into their dorms.  I think it went unbelievably well, everybody really pulled together and worked as a team, and it was a flawless operation in my opinion. It went really well.

I think we’re facing some challenges coming back in the spring semester, because coming back is a little more staggered. It doesn’t happen as uniformly as in the fall. In the fall, people tend to come to campus by themselves or with a parent, and it’s really easy to tell them no, you can’t move in, you have to turn around and go home. In the spring, people are going to arrive in a car with all of their friends, they’re going to arrive on different days and different times throughout the winter.  So coordinating arrival testing for spring semester has been a little bit more of a challenge. 

How does IU’s response compare to other universities and colleges in Indiana? 

Broadly, I don’t really know what Purdue and Notre Dame are doing to comment on that specifically. But I’m really proud of IU’s response to the COVID-19 epidemic and keeping things in control on our campuses. If you look at the case counts in the community versus on campus, who would have thought that IU Bloomington would be the safest place to be in the state? I just would have never guessed, even being part of this in the beginning. We were nervous about it, but I think it’s what success looks like.

I’m really proud of the university for pulling together the resources to be able to allow people to do this. I think it was executed really well by a ton of very committed people. I’m hoping that it continues on in the spring, even as cases surge. I think it’s a testament to the approach that other places should be taking. We need widespread mitigation testing.  I was reading an interview with Tony Fauci, and he’s just like – think about how nice it would be to be able to take a test for Thanksgiving, on the morning of Thanksgiving and get your results back right away– and have everyone in your family take that test too. There’s no such thing as zero risk, but we could mitigate that risk tremendously by knowing on that day that you want to get together with people what your COVID status is. I think IU is a testament to how things can be – not normal – but things can move and look the way you want it to look with these support structures. If we have a widespread asymptomatic testing program, and a contact tracing team in place, and if we have a symptomatic testing pathway for people who do show symptoms and want to get a test – where they can get testing effectively and efficiently.

If we just knew where we stood, it would decrease a lot of anxiety, and it would make getting together in small groups something that’s achievable, and it’s just something that’s very, very risky right now. For symptomatic testing, wait times are like 5 days right now, and it’s not as helpful as a rapid test or the IU labs having a one-day turn around time – to where you have to tell people that they need to isolate for 5 days while they wait for their test results.

How will IU’s strategy change for spring semester? Based upon your experiences with fall semester, how is IU planning to change for spring semester? 

We’re going to be testing more – assuming that the spread of the virus is still the way it is now. It’s our goal to test more. One of our major accomplishments of this past semester was the establishment of our own labs. IU now has 3 labs and our own saliva-based PCR test. So instead of partnering with a third company (Vault) which I’m sure, Amber, is what you used in your mitigation test..

Amber: We actually did use the IU test.

Great! Vault was a third party vendor that we had to send the test results to and they would send us the results back.  It was a little bit more time consuming and more expensive – it’s nice to have your own processes in place, so we were able to set up our own labs. It will give us the ability to do more tests and have more rapid results.  It’s very exciting, and we’re all hoping that we can test more and test more frequently in the spring.  Otherwise, the plan will still be to focus on high risk groups more frequently using data from previous risks, particularly those people living in congregant living situations and having in-person classes will continue to be our strategy for the spring.

Finally, what do you have to say to worried parents or students to reassure them that these are the right steps to ensure student safety? 

I think that mitigation testing is the best way to control the asymptomatic spread of COVID in our community. If people want to be on campus and they want to be taking classes on campus, this is the best thing that we can do, along with social distancing and mask wearing – it’s certainly not a substitute for the public health safety precautions that we know work really well – this is the best thing that we can be doing to make sure we identify asymptomatic cases and isolate them as quick as possible.

There’s no such thing as completely risk free, but we’re working really hard to minimize the risk for people who want to be here.

WISE Indiana Staff Contributors: Dr. Amber E. Osterholt & Aaron J. Zych, MPH