Washington University’s COVID-19 testing strategy for the fall semester will combine mass asymptomatic testing with more targeted diagnostic testing for members of the University community.

Upon arrival to campus, all undergraduate, graduate and professional students will be required to complete a COVID test. Students living in Residential Life housing will receive tests at a facility on West Campus as part of the check-in process before proceeding to their housing. Students living off campus in the St. Louis area will be required to complete a test during the first week of class. Over the course of the semester, only undergraduate students will receive mass asymptomatic testing every two weeks, due to their status as a high risk population.

Diagnostic testing will follow CDC guidelines, meaning that those showing symptoms of COVID-19, as well as those who have been potentially exposed to the virus, will be tested and potentially moved to isolation housing.

Christine Watridge | Student Life

The University’s executive planning committee, which includes over 200 faculty and staff, has been working all summer to develop this plan. Dr. Kevin Hsueh, the medical director of the Antimicrobial Stewardship Program at Barnes-Jewish Hospital and member of the infectious disease unit, described how the nature of COVID-19 presents a particularly difficult challenge for testing programs.

“COVID-19 is not a disease that is super amenable to easy identification,” Hsueh said. “I think the thing that people need to really wrap their head around is that people who actually are shedding the live virus can range in symptoms from no symptoms at all to people who are deathly ill…The second problem is that from the time when you were exposed to COVID until the time when you may or may not present signs of the active virus can range between two and fourteen days, so this is just an extremely challenging position.”

Despite these challenges, the Food and Drug Administration’s emergency authorization of a new PCR saliva test developed by Washington University’s department of genetics in collaboration with biotech company Fluidigm has the potential to strengthen the University’s testing capacity. The new test is less invasive than a nasal swab, which can often be uncomfortable for those being tested. It also requires less effort to process, meaning that more tests can be processed more quickly.

“As with most universities, when we were planning in April, May and June, there were not widely available tests,” Interim Vice Chancellor for Student Affairs Rob Wild said. “Part of [the reasoning for] our delay of the fall semester was to prepare and to make sure that we would have adequate testing capabilities.”

The approval of the saliva PCR test allowed the University to introduce regular asymptomatic testing of undergraduates every two weeks into its testing strategy as announced in an email, Aug. 31.

Dr. Steve Lawrence, one of the University’s top experts in viral infectious diseases, said that the overall effectiveness of asymptomatic testing is still unclear, but it does have a few unique advantages.

“There is certainly a lot more interest in testing asymptomatic people than there are data on its effectiveness, and so we have been waiting [for] data as it becomes available,” Lawrence said. “But I think that any sort of asymptomatic testing program does one thing. It will identify some additional people with infection who you wouldn’t catch through other mechanisms, and so that is a recognized advantage.”

Still, according to both Hsueh and Lawrence, even the most comprehensive testing plan is bound to fail without the cooperation of the University community when it comes to wearing masks and social distancing.

“Because of all those problems with detecting the virus and identifying people with the virus, you have to assume that at any point in time you could be shedding the virus, because you can’t tell based on how you feel, you can’t tell necessarily unless you just got a viral test,” Hsueh said. “You can’t tell based on your previous viral test, so people have to take responsibility and act like they themselves could have the virus at all times.”

According to Lawrence, testing is important, but it is far from the most essential piece of the University’s COVID prevention plan.

“Let’s make sure we all look at testing as what it is, and that it’s one piece of a bigger mitigation strategy,” Lawrence said. “And it’s not even the most important piece. The most important thing is just the masking and the distancing, because quite honestly if there was a way to ensure 95% perfect use of masking and distancing, we wouldn’t even need any testing. But we have it, and so it is something that is one more tool in our toolbox to try to keep this place as safe as possible.”

In fact, Lawrence expressed concern that increased testing could possibly encourage students to behave recklessly after receiving a negative test result.

“Being tested regularly [could] lead to a sense of feeling less vigilant and saying, ‘Hey, I’m good and I don’t have to take as many precautions,’” Lawrence said. “I think we have to guard against that because it’s possible that a widespread interpretation of negative test results could undermine the positive impact it would have. We have to be vigilant. We can’t let our guard down even with a negative test result.”

In order to crack down on this type of reckless behavior, Wild warned that those violating social distancing guidelines will face serious consequences.

“We’ve been proactive and clear that we are going to take violations very seriously,” Wild said. “If we find out about egregious violation of the public health principles, that could lead to suspension or expulsion.”

However, Wild acknowledged the inevitability that some students would test positive for COVID, stating that the Habif Health and Wellness Center is up to the job of handling any potential outbreaks.

“What’s also important is the preparation for when we have cases, that we’re able to identify them quickly, that we have adequate staffing on the contact tracing side as well as on the medical side,” Wild said. “We’ve really ramped up our operations out of Habif Health and Wellness Center so that when students either need to be quarantined or that they do test positive, that we have as a safe, comfortable place where they can recover in isolation housing.”

Although testing is important, Wild maintained that the cooperation of the student body when it comes to masking and social distancing will make or break the semester.

“We know that when these two things [masking and social distancing] happen, the likelihood of spread reduces to nearly zero,” Wild said. “We can see other universities that have opened that have had challenges with this, and when we have cases at Washington University this fall, which we will, I predict the cases will be also the result of people not following those two key principles.”