Tuesday, May 26, 2020

Audacious vs. Universal Testing

An earlier post on this blog noted that at the Regents meeting last week, universal testing was ruled out because of the cost.* The cost of each test was put at $40 and it was said that weekly testing of 600,000 UC students and employees (including faculty) would therefore cost $24 million. When you multiply the weekly expense by the number of weeks in an academic year - even just the part of the year in which courses and exams occur - you get a figure that is out of the question.

We also posted earlier about UC-San Diego's plan for testing to allow reopening with some version of in-person instruction in the fall.** The UC-San Diego chancellor's plan - as described in that post - called for testing 65,000 students and employees each MONTH, i.e., only about one fourth of the weekly testing discussed at the Regents. If we take the $40/test figure presented to the Regents as correct, you are talking about $2.6 million per month. You'd be spending about approximately $7 million a quarter for that one campus.

A news article from a couple of days ago now describes the UC-San Diego plan as testing about 1,500 folks a day. That would be 45,000 tests per month, not 65,000. (We reproduce the article below.) At $40/test, the cost would be $1.8 million per month and approximately $5 million per quarter. This level of planned testing is described in the article as "audacious." If you use the audacious testing ratio from UC-San Diego (45,000/65,000) and multiply it by the Regents' 600,000, you get around 415,000 tests to be done each month (not per week) for the entire UC. On a weekly basis, that's about $4.2 million, not $24 million, for "audacious" testing throughout UC.

So now the question is what is what level of testing is adequate? The latest version from UC-San Diego tests about 70% of the base of students and employees per month rather than 100% per week. Is the definition of adequate testing everyone each week or just 70% of everyone each month? Do you really need the universal testing every week as described to the Regents? Or is audacious testing on a monthly basis OK? Another question implicitly raised by the article is whether campuses without medical centers can achieve audacious testing. Presumably, UCLA - with its medical center - could achieve audaciousness. Could Santa Barbara or Santa Cruz?
UC San Diego begins ‘audacious’ coronavirus testing program in hopes of resuming in-person classes in fall

Ron Kroichick, May 24, 2020, San Francisco Chronicle

UCSD launched its “Return to Learn” program May 11, an effort to broadly test students, faculty and staff on the picturesque campus along the Pacific Ocean. School officials started with 100 tests per day the first week, doubled that total last week and hope to conduct 400 tests daily this week. If the project works as planned, they would expand to 1,500 daily tests in the fall, potentially allowing the campus to reopen for in-person classes and activities.

Natasha Martin — project lead, associate professor of medicine, infection disease modeler and Stanford alum — acknowledged the volume of testing is ambitious and brings logistical challenges. She remains hopeful because UCSD has an on-campus laboratory to process the tests, and because the goal is clear. “This is not a research study,” Martin said. “It’s a public health intervention.”

UCSD is believed to be one of the first colleges in the country to attempt a program on this scale. Martin and her colleagues, Dr. Robert Schooley (who oversees the testing element) and Dr. Cheryl Anderson (contact tracing), already have fielded calls from several schools interested in adopting some of UCSD’s methods. The project leaped to life, in part, because of Schooley’s distinctive job description. He has been involved in infectious disease research most of his career, and now divides his time developing viral drugs in a laboratory and running a research and education program in Mozambique.

Three years ago, he also was asked to coordinate the school’s international collaborations. That landed him an office about 50 feet from the office of UCSD Chancellor Pradeep K. Khosla, and a quick connection to the boss. “The current structure of my job gave us a head start,” Schooley said.

Khosla asked Schooley and Martin to develop a plan for UCSD. They already knew the urgency of identifying infections early, after what Schooley called the nation’s “failed experiment” to find the virus after people began getting sick. He found more evidence in a Chronicle graphic showing the strikingly divergent caseload curves of California and New York. The two states were close through about March 15 — and then New York’s suddenly soared, while California (and especially the Bay Area) stayed relatively flat after early shelter-in-place orders.

Martin put together models and discovered UCSD needed to test 75% of the campus population to catch an outbreak before there were 10 cases. “We know the campus is not an island,” she said. “We’ll likely get viral introduction from the community, so we want to be able to detect outbreaks early enough that we can isolate and do contact tracing before they spread to the campus community.”

The program requires participants to pick up a clean nasal swab in a specimen collection container; scan the bar code onto a smartphone app, linking their cell phone number to the specimen; swab the inside of their own nose; and then drop the swab in the container and leave it in a collection box. Schooley said students proved “quite capable of self-testing” during the project’s first two weeks. (Nearly 5,000 students, many of them graduate and/or international students, stayed on campus after classes moved online in mid-March, according to a UCSD spokeswoman.) Schooley also said the project will move toward salivary testing in the fall, which would be faster and more comfortable. Also worth noting: None of the first 1,000 students to participate tested positive.

UCSD officials were determined to make the tests efficient — the opposite of visiting a doctor’s office, in Schooley’s words. No search for parking, no long forms to complete, no prolonged wait for results (the goal is within 24 hours). “We want this to be easier than brushing your teeth,” he said. Or, as Martin put it, “If we’re really going to test this many people, it has to be a simple process that’s self-administered. We can’t have clinicians out there” in personal protective equipment. It helps to have the Center for Advanced Laboratory Medicine, a state-of-the-art, 90,000-square-foot facility that opened more than eight years ago. The lab has the capacity to run 2,000 to 2,500 tests per day, Schooley said.


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