As COVID cases soar among Cal Poly students, what can the university do to stop the spread?
Cal Poly saw its largest single-day spike in COVID-19 cases on Wednesday. The next day, the same thing happened. On Friday, a third record.
Since Tuesday, the university has added 130 student cases, raising its total number of positive tests from 280 to 410. As of Friday, a total of 596 students are in quarantine, while 66 are isolating, according to the university.
And those are just the cases Cal Poly is reporting.
Dozens of other young adults tested positive in San Luis Obispo over the past few days, according to the county Public Health Department, leaving some health experts to wonder how accurate either agency’s data are relating to college-age residents. At the same time, university officials raise fears that higher case counts could threaten students’ ability to attend limited in-person classes and live on campus.
That’s led the university to renew calls for its student body to follow safe practices that can limit spread of the virus as it identified pockets of troublesome behavior, including multiple sororities not following guidelines and students holding social gatherings in the on-campus Poly Canyon Village community.
“We want to reiterate how critically important it is that each member of our campus community exercise personal responsibility in helping to slow the spread of COVID-19 in our community,” President Jeffrey Armstrong wrote to the campus community in an email Thursday evening. “What you do matters, and can make things better or worse for everyone.”
The entreaty coincided with a news release sent out by county Public Health sounding the alarm about the recent uptick in cases that could push San Luis Obispo County back into the highest purple tier of restrictions.
In Thursday’s release, the county noted that almost three-quarters of the 74 cases reported countywide on Thursday were in the 18-to-29 age group, and 44 of them were in SLO or on Cal Poly’s campus.
The situation was worse on Friday, when another 72 new SLO County cases included 55 between SLO and Cal Poly alone.
“We want to move forward, not backward and we can turn this around before it negatively impacts the entire county,” Public Health Officer Dr. Penny Borenstein said. “Young adults: You know what you need to do. Wear your face covering, avoid social gatherings with people outside of your social bubble, stay home if you’re sick, and get tested.”
In response, Armstrong said Cal Poly is ratcheting up its testing, which some experts believe is overdue.
However, they also believe that COVID-19 testing and pressuring young adults is not the only answer, and that more should be done to provide safe outlets for socialization.
What is COVID-19 surveillance testing?
In September, when about 4,500 students came to Cal Poly to live on campus and more arrived to attend a total of 560 classes in person, the university told students to get COVID-19 tests before coming to campus and announced a myriad of rules designed to prevent outbreaks.
Like other universities across California and the nation, Cal Poly has worked to ensure it provides a “robust” and “multi-level approach” to its COVID-19 surveillance testing program, which aims to identify and tamp down outbreaks before they can grow.
Surveillance testing for the novel coronavirus creates a complete picture of the virus on and off a college campus, showing how widespread it is, where outbreaks may be occurring or about to occur, and the demographics of those infected. Without such a program, universities would only have limited knowledge of the virus’ spread in the community, University of Illinois epidemiologist Rebecca Lee Smith told The Tribune.
Cal Poly university officials and scientists have — to the extent some university officials say is possible — built a comprehensive COVID-19 testing program. The university’s lab has performed an average of 205 tests every weekday over the past four weeks, and another average of 408 per day over the same time period were conducted through an outside contractor, Avellino Labs.
Avellino Labs began testing asymptomatic students and employees on Oct. 3.
Students living on or visiting campus for any reason are required to get tested once every other week through Nov. 20, or a total of three times if they do not test positive.
Employees who work in Campus Dining had to get tested once, between Oct. 26 to 28, and others are “strongly recommended” to get tested if they are on campus for any reason, according to the university’s testing website.
In total, the university and Avellino Labs had performed more than 21,400 tests as of Friday.
“Compared to other colleges nationwide, even the heavy hitters, Cal Poly is among the top tier when it comes to our surveillance and testing programs, not to mention our mitigation efforts and COVID-19 management capacity,” Cal Poly epidemiology professor Dr. Aydin Nazmi wrote in an email to The Tribune. “We are doing quite well, and I’m very proud of the work we have done.”
Through those efforts, Cal Poly is performing roughly 3,000 to 4,000 COVID-19 tests per week as of Nov. 5.
But experts say that in order to follow the “gold standard” of university surveillance testing levels — testing students living on campus twice a week and employees once a week — Cal Poly would need to perform nearly 9,500 tests per week, plus tests for individuals wanting to go to campus for in-person classes or other activities.
Surveillance testing, however, is just one part of a complex puzzle that protects the community from coronavirus outbreaks, Smith said.
“Testing on its own doesn’t actually protect anybody,” she said. “But testing combined with contact tracing, isolation and quarantine is what works.”
At Cal Poly, a student who tests positive for coronavirus is sent to one of roughly 150 isolation rooms in on-campus housing facilities, according to the university.
Contact tracing, and enforcement of quarantine and isolation measures, are done in consultation with the San Luis Obispo County Public Health Department.
Coupling these COVID-19 prevention measures with mental health care and safe social opportunities for students is key, said Julia Marcus, an infectious disease epidemiologist at Harvard Medical School whose research focuses on HIV prevention.
“We know from other areas of public health that shaming and punishment actually drive people away from engaging in public health efforts rather than deterring the behavior that we’re hoping they can avoid,” Marcus said. “What works better is a more compassionate approach that recognizes the challenges students are facing — which include potential mental health impacts of having limited social and physical contact — and helping students find ways that they can stay socially connected while keeping the risk of transmission low.”
How many coronavirus cases does Cal Poly have?
Cal Poly has seen a sharp rise in coronavirus cases since it brought students on campus in mid-September, capped by the most recent surge.
According to the university, this new increase in cases is tied students on campus and in off-campus sororities holding unsafe events, and a number of students ignoring isolation and quarantine measures.
Data shows that, on average, 11 students at Cal Poly have tested positive for COVID-19 every weekday over the past month. Cal Poly doesn’t report testing data over the weekends.
That means that 267 students have tested positive for the virus since Oct. 6 — 159 of whom live off campus.
The university now has a total of 410 students who have tested positive for the virus since March.
But those numbers do not include two key demographics: employees, and students who have been tested by means other than through the university.
The San Luis Obispo County Public Health Department tracks how many people with a “higher education” occupation have tested positive for COVID-19 — 617 since March.
But that “includes students, staff and faculty at Cal Poly San Luis Obispo, Cuesta College, vocational post-graduate settings, and those living in SLO County while taking part in distance learning at colleges or universities outside the county,” according to the Public Health Department.
Nazmi, one of the Cal Poly faculty members leading the university’s response to the pandemic, wrote that there “will always be a chance that some tests do not appear on our data. The discrepancy, if there is one, would likely be minimal.”
Cal Poly originally said six employees had self-reported to the university that they had tested positive for the virus. Since then, no more employee cases have been reported, and it’s not a number that the university has kept track of, according to Matt Lazier, Cal Poly’s director of media relations.
How other universities have conducted surveillance testing
Some schools, such as the University of Illinois, test everyone for COVID-19.
“Testing faculty and staff has been partly for peace of mind, but also for them to help protect themselves and their family,” said Smith, an epidemiology professor at the University of Illinois. “And one of the things that the models told us early on was that if we were only testing students who are on campus, we would have an uncontrolled outbreak.”
The University of Illinois, which has a student population of around 49,000, has performed nearly 730,000 COVID-19 tests since July 6, according to the university’s testing dashboard. On average, the university tests about 9,000 to 10,000 people on weekdays, Smith said.
Every undergraduate student is required to get tested twice a week, and all staff and graduate students are tested once a week, Smith said. If a residence — including residence halls, fraternities and apartment complexes — has an outbreak of the virus, all those living in that residence must get tested three times a week, Smith added.
The University of Illinois has reported more than 3,200 coronavirus cases so far, one of the highest case counts in the country, according to The New York Times — and Smith said that’s largely because of the numbers of asymptomatic students who test positive.
“These are people who would never have gone to get tested if it was left up to them,” she said.
Cornell University, a private university in New York with about 19,000 students, requires undergraduate students to get tested for the coronavirus twice weekly, graduate students once weekly and teachers up to twice weekly. The university tests about 5,000 to 6,000 people on weekdays, according to its testing dashboard.
So far, the university has reported just over 180 positive COVID-19 cases, according to the Times.
UC Santa Barbara tests the 2,000 students living on or coming to its campus on a weekly basis, according to university spokeswoman Andrea Estrada.
The university has had about 30 COVID-19 cases, according to the Times, but that number does not include the large outbreaks that have occurred off-campus in the Isla Vista area. Like Cal Poly, UCSB does not track those off-campus case numbers.
San Diego State University, the California State University system’s largest campus, is testing students at least once every two weeks.
San Diego State has reported 1,301 cases out of about 2,200 attending in-person classes and 2,100 living on campus, out of a total enrollment of about 35,600, according to the Times.
Building testing program requires money and time, experts say
It’s relatively rare for universities to conduct regular, widespread testing, according to an analysis by National Public Radio.
NPR found that more than two out of three colleges with in-person classes either have no clear testing plan or are testing only students who are at risk, meaning those with possible close contact with a coronavirus patient or those who feel sick.
California’s public health guidance does not require colleges to conduct regular systematic testing of staff or students. It only encourages it.
In a virtual town hall hosted by the nonprofit journalism consortium CalMatters on Aug. 20, Luoluo Hong, CSU vice chancellor for student affairs, said “if campuses have the resources, we certainly encourage them” to test everyone, regardless of symptoms or whether they live on or off campus.
To date, Cal Poly has spent $6.5 million on COVID-19-related efforts and supplies, Lazier said, and it’s looking to face a large budget deficit as the state takes a hit in funding due to the coronavirus pandemic.
Money aside, building a surveillance testing program takes time, and a lot of it.
“It’s like planning a daily massive event for thousands of people,” Nazmi said. “Imagine communicating with thousands of people, getting them to come stand in line on specific days, have them pre-register in advance, check them in and provide information and materials when they arrive, get their nasal swabs done, find a way to transport thousands of vials to the lab safely, dispose of all the biohazards at the testing site, and by the way, you need two dozen nurses and logistical staff to get any of that done.”
The data then has to be accurately tracked and monitored, and then the whole process repeats every weekday, Nazmi said.
He and other Cal Poly Emergency Operations Center staff are working to streamline the testing process to make it more efficient. This includes working to possibly switch the testing method from nasal swabs to saliva and possibly testing the sewage at the university to detect early signs of an outbreak.
Some university faculty and staff members and experts familiar with the matter told The Tribune that they believe Cal Poly should have responded faster by launching a surveillance testing program in March and April.
Pat Fidopidasis, a microbiology professor at Cal Poly, said that when he and other scientists at the university first tried gathering supplies for testing in March, they hit the same kinds of massive bottlenecks seen elsewhere as the medical community struggled to launch a massive COVID response in the early days of the pandemic.
“We started trying to order supplies, and everything was either sold out or, ‘Sorry, you can’t have this because we need to conserve it for hospitals,’ and so we couldn’t get our hands on anything,” he said.
Later, over the summer, Cal Poly’s administration was “planning very intensively” as it worked toward the university’s reopening, Nazmi said.
In August, Fidopidasis said, Cal Poly came back to him and other university scientists to urge them to start creating a surveillance testing program.
At that time, many of the professors with the expertise to create the testing program were teaching summer classes full time, or prepping for their fall classes, Fidopidasis said.
“There’s a lot of challenges being a predominantly undergraduate institution, with modest supplies and with high teaching loads,” he said. “That’s one of the reasons why we were a little delayed behind some of the other institutions.”
At the University of Illinois, Smith, the epidemiologist, said she is not teaching any classes this fall and is instead focusing solely on the university’s surveillance testing program.
“From the time that I joined the team, which was like late April, early May, the majority of my time has been spent on this,” she said. “Our students are not getting the support they need — I canceled my fall class because I couldn’t teach and do this work.”
How else can universities prevent COVID-19 spread?
Surveillance testing isn’t the only way to mitigate the spread of the coronavirus, according to public health experts.
Prevention efforts “also need to include ways that the university can message to students about behavioral changes that they may need to make. And I think, provision of safer alternatives for students to socialize, including outdoors and in social bubbles, with a recognition that abstaining from social contact isn’t an option,” said Marcus, the Harvard Medical School epidemiologist.
Cal Poly advises students to physically distance at all times when possible, wear masks and avoid social gatherings. The university has also created an online system where students and community members can report instances of students violating COVID-19 rules.
Any violation of those COVID-19 guidelines may land a student with a suspension or possible expulsion from the university, Cal Poly has warned.
Marcus believes this approach is misguided, and she, along with more than 100 health experts, recently authored an open letter calling for universities to “embrace a more humane approach to students during the coronavirus pandemic.”
In that letter, Marcus writes that “This abstinence-only approach to social contact is inhumane, unrealistic and likely to backfire.”
Marcus relates it to her work in HIV prevention.
“If we’re trying to prevent HIV and we tell people to just stop having sex, that doesn’t work, right? I think we can probably all agree on that,” she told The Tribune. “So instead, we tell them, ‘Here are safer ways for you to have sex, and they’re not zero-risk, but they’re safer.’ And that becomes a much more sustainable and pragmatic approach.”
Columbia University social and behavioral health scientist Morgan Philbin, a native of San Luis Obispo who’s tracked Cal Poly’s response, said students are in a precarious place mentally right now.
“If students have to make the calculus of: ‘I am by myself in my dorm room, going on for a month, my mental health is tanking, I’ve been told I’m not as much at risk for this virus and if I get it, the outcome is, statistically speaking, probably not going to be terrible or won’t die from it,’ ” she said, “’and this new friend that I just made says they’re going to a party,’ what do you think the student’s going to do?”
One healthy way to mitigate the spread of COVID-19 would be to promote safe gatherings, Marcus said. Students are bound to gather and throw parties, she said, so the university should be helping them do so in the safest way possible.
For example, at the University of Notre Dame’s Library Lawn — a central gathering place for students — the school has set up physically distanced fire pits with chairs for students. The University of Illinois is hosting movies and concerts in its football stadium.
Marcus and Philbin said that promoting safe, outdoor gatherings will not only help students prevent the spread of COVID-19, but also keep them mentally healthy and able to connect with friends.
“If they’re testing students twice a week, or they’re testing the sewage, and they’re able to detect outbreaks really quickly or before they happen, that can give students more wiggle room,” Philbin said. “Yes, students should still be careful. But with really frequent surveillance testing, that’s going to make students, and hopefully the community as a whole, feel a little bit more comfortable having that balance of a social life.”
Cal Poly currently hosts several virtual events for students to attend, which include things like a moderated discussion led by Anna Drezen, one of the co-head writers of Saturday Night Live with Michael Che, a comedian, writer, actor and co-anchor of the show’s “Weekend Update” segment. Other events have included virtual concerts, trivia nights, museum tours and more.
