Returning to Campus
COVID-19 Virus Testing, Contact Tracing & Surveillance
Scientists around the world are working tirelessly to develop medications and vaccinations to treat and prevent COVID-19 but until then students, faculty and staff will need to adopt the US Centers for Disease Control and Prevention’s (CDC) prevention and mitigation strategies in order to minimize the transmission of the COVID-19 virus. These include wearing face coverings, frequent hand hygiene practices, social distancing at least 6 feet, physical barriers when social distancing is not possible and staying home when feeling ill. [1] In order to measure the consistency of the University community adopting these changes, it is essential to implement a surveillance system to evaluate the prevalence of transmission of the virus within the USF community.
The University surveillance system will be composed of three elements: symptom tracking surveys, viral testing and environmental sampling. Viral tests are performed by using nasopharyngeal or nasal swabs to collect samples from the respiratory tract and using polymerase chain reaction (PCR) to determine if SARS-CoV-2, the virus responsible for COVID-19, is present. Some viral tests have been developed that can be processed at the time a patient is being evaluated but the availability of rapid testing supplies remains unreliable. Other test kits are sent out to laboratories which adds several days for results to be received.[2] Serological testing is also being developed to evaluate previous infection by the detection of IgG antibodies. These tests are becoming available as point of care testing as well as traditional serological testing. However, the results of these tests have come under scrutiny as the results have been too inaccurate to be reliable. The FDA has increased evaluations of these tests in an effort to enhance the reliability of COVID-19 serological testing.[3] Other testing under investigation is serological detection of viral antigens, which would indicate active infection. Once approved by the FDA, such a test would expedite the detection of active viral transmission and could replace PCR as the main test for the detection of COVID-19.
USF will utilize patient self-collected anterior nares swabbing for PCR testing for the detection of SARS-CoV-2 virus. The testing protocol was approved for Quest Diagnostic Laboratories through the Food and Drug Administration’s (FDA) emergency use authorization program in late May 2020. In the event that viral antigen detection technology becomes commercially available, utilization of this technology will be assessed for implementation for SARS-CoV-2 viral detection.
Prior to the first day of classes for the fall 2020 semester, all students, faculty and staff will receive and be required to complete a Baseline Symptom Tracker Survey (see Appendix C) (LINK TO PDF) to evaluate their exposure to COVID-19, current state of COVID-19 symptoms, and whether they will be physically returning to any of the USF campuses for the fall semester. Any faculty or staff reporting symptoms of COVID-19 will be asked to have a medical evaluation and refrain from returning to campus until medically cleared. All students returning to campus for programs such as athletics prior to start of the fall 2020 semester will be asked to complete COVID-19 testing prior to their return. Any student reporting symptoms of COVID-19 will be asked to have a medical evaluation and to refrain from returning to campus until medically cleared. Students responding that they will be returning to USF campuses from international locations, from out of state locations and from Florida counties with COVID-19 positivity rates >7% (based on the Florida Department of Health COVID-19 Data and Surveillance Dashboard) will need to complete COVID-19 testing prior to returning. In addition, to respond to parental concerns of roommate assignments, students living in University residential housing and a random sampling of 10% of students who report living in off campus housing with 1 or more non related roommates will need to complete COVID-19 testing prior to returning in the fall. Isolation will not be required while awaiting tests results.
Any student, faculty and staff whose COVID-19 test comes back positive will be notified of their test results; we will notify their county health department who will conduct contact tracing and the individual will be instructed to self-isolate away from any USF campus until medically cleared to return.
After completing the initial survey and test, if required, all students, faculty and staff present on the campuses will be surveyed with a Modified Symptoms Tracker Survey, which will be mandatory and occur on a daily basis. This survey will inquire about an individual’s physical symptoms and will take less than a minute to complete.
Active monitoring of viral transmission across the University community on each of the campuses will occur through weekly random sampling of students, faculty and staff who complete the modified symptoms tracker survey. Random sampling rates are usually set at 5% or 10% for surveillance purposes; the higher level of 10% sampling will be chosen for the first 3 weeks of the semester, to allow the campuses to capture the variability of prevalence due to the geographic diversity of the returning USF population. The sampling rate will then be adjusted to whatever the prevalence rate is in Hillsborough County, such as a current rate of 3% to allow for the smallest possible bias between prevalence and sampling. The number of people sampled will also be adjusted after the initial survey is sent out in late June/early July, when the accurate number of returning students, faculty and staff will be determined.
The frequency of the symptom tracker survey will be routinely evaluated and adjusted according to the prevalence rate in the University community and its respective county. As the prevalence rate decreases, the University community will be surveyed on a less frequent basis as determined by epidemiologists in the College of Public Health and medical leadership in the Morsani College of Medicine.
Those students, faculty and staff responding positively to the modified symptom tracker will be contacted by nursing staff from Student Health Services (SHS) to seek medical attention from SHS, USF Health or a community provider to have their symptoms evaluated. If during the course of the evaluation, COVID-19 testing is initiated, students, faculty and staff will be required to isolate for 10 days from the onset of symptoms and have resolution of symptoms for 72 hours before being released from isolation. [4]
Those students, faculty and staff who seek medical attention on their own and are found to have influenza like illness (ILI) symptoms with negative rapid testing for streptococcus group A, influenza or mononucleosis will need to be tested for COVID-19. Students, faculty and staff will be required to isolate for 10 days from the onset of symptoms and have resolution of symptoms for 72 hours before being released from isolation. [4]
Those students, faculty, and staff randomly selected to be tested for COVID-19, will be notified on a weekly basis that they have been selected. They will receive through University email a requisition and a location to receive and drop off the self-administered COVID-19 test kit. All results will be communicated to the tested party. Isolation will not be necessary while awaiting test results. Anyone testing positive and who is asymptomatic will have a telehealth medical evaluation and will be required to be isolated for 14 days from test date. [4]
Any student, faculty, and staff required to be isolated will need to complete an isolation survey every 12 hours for 10 days. The isolation survey and frequent telehealth visits will monitor the progression of symptoms to assist in determining if a higher level of medical care is necessary. This survey will also be screening for mental health and will assist medical providers in making referrals to a mental health specialist as necessary.
All students in isolation will be assigned a Care Manager through the Dean of Students office. The Care Manager will assist students with referrals for all non-medical concerns such as meals, financial assistance and academic assistance.
Students, faculty, and staff who are symptomatic for COVID-19 and those who have tested positive are required to be separated from the community at large. The University is encouraging people to isolate at their home; however, for many students this option may not be viable. In order to prepare for students who may need to be isolated while they recover from illness or while they await a test result, it is recommended that Housing and Residential Education reserve 250 beds between the Tampa and St Petersburg campuses. This estimation is based on a SHS five-year average for the fall semester of influenza like illnesses (ILI). The Tampa peak weekly average is 175 ILI and the St. Petersburg peak weekly average is 69 ILI.
All members of the USF community who test positive will have their test results reported to the health department in the county in which they were tested. As part of the reporting system, a physician from SHS will communicate with a health department official to communicate any information that is available regarding other persons they may have come into contact with while infectious. The health department will contact the individual with the positive test result to discuss the contacts and travel history. The health department will communicate with the contacts to evaluate their risk and advise on isolation and testing for COVID-19.
The COVID-19 crisis has placed a huge strain on public health departments across the country to meet the demand for contact tracing as the number of COVID-19 cases increase. In response to a call from the FDOH in March, nearly 70 College of Public Health faculty, staff and students were hired on a temporary basis to assist the state in contact tracing. In addition, students from all the Colleges of USF Health, the School of Social Work, and the Genshaft Honors College have volunteered and are being trained to assist in contact tracing should the number of positive cases increase in the counties surrounding USF.
The essential element of containing an outbreak of COVID-19 is identification of contacts to a positive individual. Contact tracing through the health department can identify people who are in close proximity to each other, which would indicate there is a potential for more people who may be infected in a particular site. This would be called a “hotspot”. In order to determine if there is active virus within the confines of a particular building environmental sampling for COVID-19 could take place. Environmental sampling uses samples collected from surfaces such as floors, door handles, telephones, computer keyboards and desk surfaces to determine if viral RNA specific to COVID-19 is present by using polymerase chain reaction (PCR). If COVID-19 RNA is found, this would trigger a broader investigation among those who were present in a particular location during a particular time period. The testing in these circumstances would use batches of pooled specimens from numerous patients’ swabs to determine if virus is present. If viral activity is found in a particular batch, only those individuals whose swabs were pooled for that batch, would be individually tested. This testing mechanism allows for large volumes of people to be tested in a very short period of time. Pooled specimens is an effective tool as long as the prevalence of the disease in the population is low.[5]
USF will be collaborating with its SUS neighbor in Sarasota, New College of Florida to provide the same access to surveillance and testing. USF will be assisting with medical consultation and guidance for any positive cases that may develop on their campus. A flow chart depicting this entire process is provided in Appendix C.
References and Additional Sources
- National Center for Immunization and Respiratory Diseases (NCIRD), D.o.V.D., Coronavirus Disease 2019 (COVID-19): How to Protect Yourself and Others. Centers for Disease Control and Prevention, 2020.
- National Center for Immunization and Respiratory Diseases (NCIRD), D.o.V.D., Testing for COVID-19. Centers for Disease Control and Prevention, 2020.
- National Center for Immunization and Respiratory Diseases (NCIRD), D.o.V.D., Using Antibody Tests for COVID-19. Centers for Disease Control and Prevention, 2020.
- National Center for Immunization and Respiratory Diseases (NCIRD), D.o.V.D., Discontinuation of Isolation for Persons with COVID -19 Not in Healthcare Settings. Centers for Disease Control and Prevention, 2020.
- Yelin I, A.N., Shaer Tamar E, et al, Evaluation of COVID-19 RT-qPCR test in multi-sample pools. Clin Infect Dis, 2020