Update on UGA’s Surveillance and Testing Plan for COVID-19
On August 3, UGA launched a pilot COVID-19 surveillance testing program for faculty, staff, and students. The tests are offered for free in a convenient central location at Legion Field, in close proximity to the first-year residence halls. Although initial testing occurred prior to the return of students to campus, nearly two-thirds of those tested last week were students. This percentage has continued to increase upon the advent of classes, with an even larger majority of test subjects now being students.
Surveillance testing is provided to those who are not reporting symptoms of the virus. Students who are symptomatic should contact the University Health Center (UHC) for COVID-19 testing, while faculty and staff should contact their local health care provider, go to one of the many testing sites offered by the Georgia Department of Public Health (GDPH), or seek a test at a commercial site (e.g., pharmacy, urgent care center, etc.). Any positive COVID-19 test must be reported to the University through the DawgCheck notification tool.
The pilot period for UGA’s testing program has concluded. The pilot achieved the goals that we proposed several weeks ago: to assess the operational and logistical aspects of COVID-19 testing at Legion Field, to assess the capabilities of the Veterinary Diagnostic Lab’s analysis and reporting, and to complete the implementation of the DawgCheck survey tool.
Next steps will include inviting students, faculty, and staff who are selected through randomized sampling to participate in the ongoing surveillance program to determine the prevalence of COVID-19 cases on the campus; identify individuals infected with COVID-19; and identify potential hotspots of COVID-19 on or off-campus. Each weekday, there also will be slots available for testing faculty, staff, and students who do not have symptoms of COVID-19 and were not invited in the randomization protocol. Participation remains entirely voluntary.
Method of Testing
The method used in the surveillance testing program is an FDA-approved nasopharyngeal swab technique using PCR methodology—one of the most reliable forms of testing available. The technique requires medical personnel to obtain the sample.
Through collaboration between the University Health Center to collect the samples and the Veterinary Diagnostic Lab to perform the analysis, we are able to manage the entire process in-house and provide accurate test results to test participants in 24 – 72 hours. This efficient turnaround—far superior to the 7 – 21 days common for external labs—has enabled us to quickly isolate those identified with COVID-19 at the University of Georgia.
Capacity of Testing is Evolving
During the pilot program, sampling ramped up quickly, rising from 90 samples per day to 300 tests per day (3% of the 50,000 individuals/week) by the end of Week 2. By Friday, August 21, the lab was capable of processing 360 tests per day. The VDL is currently seeking FDA approval for analysis of pooled samples, which will increase UGA’s capacity considerably more.
UGA also has purchased 10,000 Vault Medical Saliva Test Kits: these will be available for the University Health Center to use in identified hotspots or in another capacity as needed to assist in mitigating COVID-19. This FDA-approved test is expected to return results within 72 hours. While widespread adoption of alternative approaches such as saliva testing would significantly increase UGA’s testing capacity, the tests are not widely available at present. About 720 such test kits have been made available to UGA extended campuses.
Reporting of UGA Results
UGA is reporting test results on a weekly basis on the UHC website. Results from the prior week are reported each Wednesday. The website displays the COVID-19 positive test results from three sources: the UGA surveillance program, tests performed at the UHC, and those reported in DawgCheck by employees and students. Analysis of the swabs sampled on Friday are not completed by the VDL until the following Tuesday—thus, the reason why results are reported on Wednesdays.
How We Got Here
We consider the work of the staff at the UHC and VDL to operationalize such an efficient and effective program in such a short amount of time nothing short of extraordinary. The UGA VDL, both Athens and Tifton locations, gained CLIA certification on June 17, 2020—just one month after filing the application. We are grateful to Dr. Jesse Hostetter, the executive director of the VDL, who worked with the faculty in both labs to obtain CLIA certification. This certification is critical because it is required to conduct testing on human specimens. Also, Dr. Ravinda Kohle, a pathologist at the Augusta University Medical College, serves as the CLIA director for the UGA labs, and was crucial to the effort to obtain CLIA certification. Together, Dr. Hostetter and Dr. Kohle support supervision of the human testing accomplished in both the Athens and Tifton labs.
The sample size for the pilot testing program was determined based on several considerations:
- Realistic supply chain issues (ability to obtain swabs, reagents, disposable plastics, buffers for PCR testing).
- Current capability of the Athens VDL lab including personnel, space, and equipment.
- Individuals (faculty, staff and students) willing to participate in the plan.
- Logistics of nasopharyngeal swab sample collection by a health professional.
- Desire not to compete for essential medical and testing supplies with clinical and public health facilities in the local community.
Supply chain issues are very real, and plans that look good in theory do not always work. For example, if we were to dramatically scale up our testing of asymptomatic individuals, we would be consuming medical-grade PPE and swabs that are needed to treat sick patients. We would also slow down our ability to run the tests quickly, thereby reducing their effectiveness in mitigating COVID-19 spread. We are operating in a very delicate balance: by managing the number of tests that we can perform effectively at UGA, we are minimizing strain on other providers, and we are maximizing the effectiveness of the tests we conduct.
Now that we have completed a successful pilot of the program, the UGA COVID-19 surveillance program will employ a stratified, random sampling procedure.
Strata will include on and off-campus students, faculty and staff, and employees with more frequent face-to-face interactions. The goal is to sample randomly from the strata and include more students in order to more appropriately reflect the UGA community.
Contact tracing remains a challenge in Georgia, particularly with the longer wait times to receive test results from external labs. We have a very close working relationship with the Georgia Department of Public Health (GDPH) and have a designated UGA liaison to work directly with them. GDPH has assured us they can handle contact tracing in Northeast District 10, where UGA is located. GDPH hired several of our students over the summer as contact tracers, and many are continuing to work in District 10 through this academic year. Should GDPH find that more contact tracers are needed, we are prepared to work with them to train and hire additional staff. We are further aiding GDPH by sharing the contact information provided in DawgCheck by those who are reporting positive cases; this information gives GDPH’s contact tracers a head start in performing their work. It is critical that each member of the UGA community enroll and participate daily in DawgCheck, record positive tests, and list close contacts to help us control the spread of the virus on campus and in our community.
Knowledge about COVID-19 prevention, mitigation, and testing is changing rapidly. The Medical Oversight Task Force is reading the latest research and monitoring the different approaches that other universities and schools are taking. Likewise, the CDC and GDPH continue to offer guidance to institutions of higher education. We will continue to translate this knowledge and provide counsel to senior administrators that will inform decision making on policies and practices that will work best at UGA to protect the health of our community.