Message on reopening the University: Expanding testing, daily health check updates

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Dear Notre Dame Community Members,
 
The first week of classes helped to remind all of us of Notre Dame’s important educational mission. We are grateful to be back together in community.

When we began our efforts to reopen the University, we knew we faced many challenges, and that we would all have to work incredibly hard to reach our collective goal. We have emphasized the importance of being agile, flexible, and responsive. We have received feedback and questions directly from you, as well as through social media. We write today to clarify a few areas and to share some new information.

Turnaround Time on Tests

The turnaround time on PCR tests, the gold standard for COVID-19 diagnostic testing, done at the Stadium Testing Center over the past three weeks has been 1-2 days, and we expect this to continue going forward. We are communicating this from University Health Services, the Wellness Center, and the COVID-19 Response Unit. We hope you will all help us get this message out to the Notre Dame community. 

LabCorp, whose local facility is processing our tests, has assured us that it has the capacity we need. Further, we have confirmed that processing tests from Notre Dame is not hindering the timely processing of tests for the larger St. Joseph County community. We understand that some health facilities have chosen a different test and are using a different company, which may have a longer return time on tests.

Timing/Cooperation with Contact Tracing

Those who have tested positive have been forthcoming with our contact tracing team regarding those with whom they have been in close contact. Those who have been named as close contacts have been equally responsive to our outreach and requests to come in and get tested. Reports that students are dodging our calls are inconsistent with the data we have collected on the contract tracing efforts. Contact tracing is critical to containing the spread of COVID-19, so please help us continue to reinforce the importance of cooperating fully and promptly with this process.

Availability of Tests

We have a deep inventory of both rapid antigen and PCR test kits. We have never run out of tests, and decisions around who and when to test are driven by our medical team. The University has not and would not deny a medically recommended test because of cost. In addition, we are expanding testing, as described below.

Getting Tested Elsewhere

The University is working collaboratively with the St. Joseph County Health Department on contact tracing to help keep the University community safe. If you are tested outside of the University, please let us know. If you tested positive, we will pick you up in Notre Dame contact tracing. Anyone can directly provide us with a copy of the results from a COVID-19 test taken elsewhere.

What Happens with Close Contacts

Those who are identified as close contacts through our contact tracing program will be required to quarantine either at home (for off-campus students, faculty, and staff) or in Notre Dame quarantine facilities (for on-campus students). We do not test people immediately because the tests are highly unlikely to reveal anything due to the time required to build a detectable viral load. Those in quarantine are tested via PCR on Day 4, with results available in 1-2 days. If the test is positive, they move into isolation. If the test is negative, they continue to quarantine. Those still in quarantine are tested again on Day 7 via rapid antigen. If this second test is positive, they move into isolation. If the second test is negative, they are released from quarantine.

Daily Health Check and Expanded Testing

We realize that the daily health check has not been operating as effectively as we had hoped, and we thank you for your good feedback. Starting on Monday, you will receive a GREEN, YELLOW, or RED pass.

Student - Red Pass A:

Those who indicate they are exhibiting one of the big three symptoms (fever >100.4, shortness of breath, or loss of sense of taste or smell)

  • Thanks to system enhancements, these individuals will be scheduled automatically for testing at the stadium site without need for a telehealth consultation.
  • These individuals will receive a rapid antigen test. If that is positive, they will go directly into isolation. If it is negative, they will receive a follow up PCR test during the same visit to the stadium testing center and go directly into quarantine until that test result is received.

Student - Red Pass B:

Those who believe they may have had direct, sustained contact with someone diagnosed with COVID-19 in the last 14 days (except of course for those who are already in quarantine)

  • These individuals will also now be scheduled automatically for testing at the stadium site without need for a telehealth consultation.
  • These individuals will receive a rapid antigen test as a precautionary measure, but will not be required to isolate unless the test result comes back positive.

Faculty/Staff - Red Pass:

Those who indicate they are exhibiting one of the big three symptoms (fever >100.4, shortness of breath, loss of sense of taste or smell) or believe they may have had direct, sustained contact with someone diagnosed with COVID-19 in the last 14 days.

  • These individuals should contact either the Wellness Center or their private healthcare provider for clinical assessment.
  • These individuals can be tested at the stadium site, but may instead choose to be tested elsewhere.
  • These individuals should quarantine at home until test results are received and they are cleared to return to work by the Wellness Center or their private provider.

Student - Yellow Pass:

Those who exhibit secondary symptoms (e.g., unexplained new sore throat, headache, body aches, etc.)

  • Those individuals with secondary symptoms for two or more days should call UHS to be scheduled for testing at the stadium site. They will receive an antigen test. If that is positive, they will go directly into isolation. If it is negative, they will receive a follow up PCR test and go directly into quarantine until that test result is received.
  • While individuals with only one day of secondary symptoms should monitor their symptoms, immediate testing is not medically recommended. If, however, these individuals prefer to be assessed earlier for testing, they may call UHS. They will be scheduled for an antigen test as a precautionary measure, but will not be required to isolate unless the test comes back positive. 

Faculty/Staff - Yellow Pass:

Those who exhibit secondary symptoms (e.g., unexplained new sore throat, headache, body aches, etc.)

  • These individuals should stay home and monitor symptoms, though they may report to work if the symptoms checked are mild and of known origin. They should exercise their best judgment about coming to campus in person.
  • If symptoms worsen or persist for two or more consecutive days, or if these individuals want to discuss their symptoms, they may contact the Notre Dame Wellness Center or their private healthcare provider for a clinical assessment.
  • These individuals can be tested at the stadium site per clinical recommendations, but may also choose to be tested elsewhere.

Green Pass:

Those who do not exhibit any symptoms and who have not been in close contact with someone who has been diagnosed with COVID; no testing required.

Surveillance Testing

The University has been working on a surveillance testing plan in consultation with the St. Joseph County Department of Health. Based on their input, we developed a plan that has subsequently been endorsed by the health department. This reassures us that we are being appropriately attentive to the needs of the broader community, while still ensuring a plan that will serve the Notre Dame community.

Please remember that pre-matriculation testing was a form of surveillance testing. Going forward, the county health department has encouraged us to take a statistical sampling approach. We agreed that such an approach would likely get us better information more quickly, and so we followed their advice. For those who want to geek out on the details, see the text pasted below our signatures.

We will begin our next round of surveillance testing this week. If you are selected to participate in surveillance testing, you are obligated to make yourself available for testing. Anyone found to be positive through our surveillance testing will enter our isolation protocols, and we will begin the contact tracing process. We thank Dr. Fang Liu, Professor of Applied and Computational Mathematics and Statistics, for her help in developing our surveillance strategy.

We are also building the capacity to do saliva-based pooled surveillance testing with thanks to Professor Michael Pfrender. This approach follows the work being done at the University of Illinois Urbana- Champaign, which has been much in the news. We signed a non-disclosure agreement with UIUC, which allowed us to obtain the full details on the methods for saliva-based pooled sampling. When this capacity comes online, we will test wide swaths of the campus community as a supplement to our initial surveillance testing approach.  

A Lot Is at Stake

As you learned in the August 13 message from Mike Seamon and Erin Hoffmann Harding, the vast majority of our initial cases were linked to an off-campus party that was held August 6. Yesterday, another set of positive cases was linked to an off-campus party held August 9. In public health, we sometimes talk about the rings that surround an initial infection. Our contact tracing reveals that there is a ring clearly associated with those who attended each of these off-campus events. Secondary rings have now occurred among those in close contact with those in the first ring. We should all be exercising every precaution possible to prevent the spread to a third ring.

We have done an enormous amount of work to come back together as a community. Please be careful today – and every day going forward. All of our choices all of the time are critical to our being able to stay together.

Please:

  • Wear your mask
  • Practice physical distancing
  • Wash your hands regularly
  • Complete your daily health check

And be kind – but remember that being kind to our community includes holding people accountable.

Yours in Notre Dame,

Marie Lynn Miranda, Provost

Shannon Cullinan, Executive Vice President

Erin Hoffmann Harding, Vice President for Student Affairs 


Surveillance Testing Approach

We are following a Bayesian stratified and staggered-entry rotating cohort design. Let’s unpack that a bit.

  • Bayesian means that we will use what we learned this week to shape how we will proceed next week. We will have the opportunity to learn from at least two streams of information: 1) the most recent surveillance testing; 2) results and patterns from the diagnostic testing ongoing at the stadium site.
  • Stratify means that we will put all community members into a group and use the groups to help shape our testing strategy. For example, all residents of a particular dorm would form a group, or everyone who works in a particular building would form a group.
  • Staggered-entry rotating means that we will rotate through testing all members of a given group staggered throughout the coming weeks.
  • Cohort means that in order to accomplish the staggered-entry rotating approach, each group will be subdivided into cohorts. Thus, in any given round of surveillance testing, we will be collecting samples from selected cohorts in each group. 
  • Design means that we are being intentional about whom we test and why.

In any given round of testing, if we discover with confidence that the prevalence rate is low, we will wait for the next round of testing. If we alternatively discover with confidence that the prevalence rate is high, we will evaluate the need to implement slowing rules. If we do not have sufficient confidence in our estimate of the prevalence rate, we will do additional testing in the same round. The strategy for the next round is informed by what we learn in the previous round and by what we learn through the onsite testing center. 

Originally published by Andy Fuller at here.nd.edu on August 16, 2020.