🚨If university students aren't tested every 2-3 days, "colleges are very likely to fall prey to outbreaks that will place vulnerable people on campus & in the surrounding community at risk for serious illness and death." 1/
https://consumer.healthday.com/infectious-disease-information-21/coronavirus-1008/college-students-will-need-covid-tests-every-2-3-days-for-campus-safety-study-760002.html
This according to @ADPaltiel, a Professor of health policy at @YaleSPH, in comments on epidemological modelling, for which he was lead investigator, published today in JAMA👇. 2/ https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2768923
SARS-CoV-2 Screening Strategies to Permit the Safe Reopening of College Campuses in the United...

This analytic modeling study defines the screening performance standards for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests that would permit the safe return of students to US...

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2768923
See further comments👇by @ADPaltiel in above-linked press account. ("school" = "university") 3/
These findings are especially problematic, given these remarks of England's chief medical officer👇. If @UniversitiesUK re-open to in-person teaching without 2-3 day testing, other things will need to close to keep the pandemic under control. 4/4
https://www.theguardian.com/world/2020/jul/31/coronavirus-boris-johnson-postpones-latest-round-of-lockdown-easing
PS: The study published in JAMA is co-authored by 2 Harvard scientists & has informed the university's decision to test students every 3 days as a condition of opening their halls of residence to reduced capacity re-opening. See thread👇. 1/ https://twitter.com/MikeOtsuka/status/1280568912573333504
Note that Harvard Arts & Sciences doesn't even regard testing every 3 days as sufficient to ensure the safety of in-person teaching & will be conducting their teaching entirely online in 2020-21. 2/
One further comment on Harvard's approach👇. 3/3 https://twitter.com/MikeOtsuka/status/1269362108422029317
Further comment by @ADPaltiel: Acknowledges challenge & expense of testing every 3 days but says that, given risks to faculty & staff, any university unwilling to test so frequently "has to ask itself if it has any business reopening". 1/
https://news.yale.edu/2020/07/31/students-need-be-tested-every-2-3-days-colleges-safely-reopen
Disappointing that @UniversitiesUK employers have not explained why, in spite of these findings, they nevertheless think it possible safely to re-open campuses to in-person teaching in the absence of such frequent testing. They simply ignore this challenge. @jim_dickinson 2/2
Here I go a bit into the weeds of @ADPaltiel's modelling. JAMA paper says "This model did not identify symptom-based screening alone as sufficient to contain an outbreak under any of the scenarios we considered." See also👇linked comments to the press. 1/
https://consumer.healthday.com/infectious-disease-information-21/coronavirus-1008/college-students-will-need-covid-tests-every-2-3-days-for-campus-safety-study-760002.html
As @ADPaltiel also notes👆: "The reason [why testing of only those with symptoms is insufficient] is clear -- this virus can be transmitted by highly infectious asymptomatic silent spreaders". 2/
On the basis of a number of cited papers, the model assumes "a 30% probability that infection would eventually lead to observable COVID-19–defining symptoms in this young cohort" -- i.e., 70% of those 18-30 years old who have Covid-19 infection never develop symptoms. 3/
JAMA also includes a response👇to this paper, co-authored by @ehbvassar, a health economist who is President of Vassar College & past founder & Director of Yale Global Health Leadership Institute. 4/ https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2768917
Reopening Colleges During the COVID-19 Pandemic

In the midst of the deadliest pandemic since 1918, the question of how to reopen colleges safely after months of lockdown is of great concern. First and foremost, the strategy cannot be a one-size-...

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2768917
. @ehbvassar doesn't dispute @ADPaltiel's assertion that symptomatic testing is insufficient. But she argues that, for a small residential liberal arts college such as Vassar in a college town, testing all students (including asymptomatic) only every 4 weeks might be enough. 5/
What accounts for this difference? I think it's mainly that @ehbvassar believes Vassar College could improve on even the most optimistic of @ADPaltiel's three modelled scenarios (base, worst case, & best case). 6/
. @ADPaltiel's best case scenario assumes 10 new infections per week (from outside the student community) per 10,000 students. It also assumes an Rt of 1.5 (i.e., each infected student transmits to 1.5 others on average). 7/
By contrast, @ehbvassar assumes 4 new infections per week per 10,000 students "given that [Vassar students mainly live in halls of residence on campus and] we will limit student movement off campus and significantly reduce student interactions with faculty and employees". 8/
. @ehbvassar also assumes an Rt of 1.25 "given that we will have extensive social distancing, masking, and other measures". These measures are spelled out in more detail👇. Note that they don't much address transmission among students in halls of residence & while socialising. 9/
Presumably, students will be allowed to venture off campus in the evening. Assuming that the local bars are allowed to remain open, the risks of super-spreader events such as this👇will remain, even w social distancing. 10/ https://twitter.com/MikeOtsuka/status/1284758183521726464
Even if the bars of Poughkeepsie, New York, are all shut down, student will mix & socialise. There will be house parties👇. It's also possible that some will sleep with one another. @ehbvassar will not be able to impose & enforce monastic vows. 11/ https://twitter.com/MikeOtsuka/status/1285814841169584133
For the reasons spelled out👆, & in this thread👇, an Rt as low as 1.25 for students in residence stretches credulity. @ADPaltiel's best case scenario of Rt of 1.5 is more credible. (Note that "dorm" is American for UK "hall of residence".) 12/ https://twitter.com/gregggonsalves/status/1278368955044782081
What about @ehbvassar's assumption of only 4 new infections per 10k per week from outside the student community, rather than @ADPaltiel's best case of 10 per week? 13/
. @ADPaltiel calls these new infections "exogenous shocks" & describes how they might arise👇. 14/
The above-mentioned super-spreader event in the East Lansing bar is one good example of an "exogenous shock". It's not clear how @ehbvassar will manage to "limit student movement off campus" to prevent this. 15/
The number of new infections per week from outside the student population will also crucially depend on the general rate of infections in the surrounding community. 16/
In England, this has been rising in recent weeks as things have re-opened. We can infer from the latest ONS figures that the general rate in England is now about 5.5 new infections per week per 10,000 people. 17/
https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/coronaviruscovid19infectionsurveypilot/31july2020
This rate has also been almost twice as high among those 18-49 years old, in comparison with other age groups. 18/
Absent, therefore, significant reduction in general rate of infection in England this autumn -- contrary to prediction colder weather & school re-openings will lead to a rise -- it's unrealistic to assume better than @ADPaltiel's best case 10 per 10k weekly new infections. 19/
Upshot: What @ADPaltiel say here👇, in the very first tweet of this thread, applies to universities in England & not just the US. 20/ https://twitter.com/MikeOtsuka/status/1289243511414558721
. @UniversitiesUK @UCEA1 @RussellGroup @AlistairJarvis
& other university leaders in this nation: This modelling merits a response. Please stop pretending it doesn't exist. As @gregggonsalves said of an earlier draft of the JAMA paper👇. 21/ https://twitter.com/gregggonsalves/status/1280560141952331777
You owe it to your students, your staff & the residents of the communities in which you're located to explain how you've established the safety of re-opening universities in the autumn in the absence of regular & frequent testing of students, asymptomatic & symptomatic. 22/22
PS: In early July I asked these questions👇re pre-print of the @ADPaltiel et al study. No explanation for why this isn't necessary here. I hope @markmleach @jim_dickinson @jgro_the @RichardA @sweale or @branwenjeffreys might be able to elicit explanation. https://twitter.com/MikeOtsuka/status/1280568912573333504
Shockingly weak @UniversitiesUK statement of Covid safety measures all unis will adopt, in linked piece by @AnnaFazack1. No mention of testing, ventilation or face masks. Only hand sanitisers, cleaning & 1-way & 2m markings. @AlistairJarvis, is that it!?
https://www.theguardian.com/education/2020/aug/01/uk-universities-putting-finances-above-student-safety-expert-warns
For evidence relevant to above modelling assumptions regarding rate of infection among university-aged, see this graph👇of prevalence of confirmed infections in Spain among ages 15-29, since easing of lockdown.
https://www.bloomberg.com/opinion/articles/2020-07-28/what-spain-is-telling-us-about-second-wave-of-coronavirus
In a plan 'typical' of large US state universities, UC Berkeley will test all residential students on arrival, followed by 7-10 day quarantine in single dorm room, then re-test to confirm Covid-negative status. Separate dorm for those who test positive. 1/
https://www.nytimes.com/2020/08/02/us/covid-college-reopening.html
Followed by planned testing 2x month of all students in halls of residence. Are any @UniversitiesUK employers planning such initial testing & quarantine for ALL students in residence? Regular testing later? Single rooms for all? Separate hall for quarantine? If not, why not? 2/2
Significant UK developments regarding testing described in this government press release 'Roll-out of 2 new rapid coronavirus tests ahead of winter'. 1/ https://www.gov.uk/government/news/roll-out-of-2-new-rapid-coronavirus-tests-ahead-of-winter
Roll-out of 2 new rapid coronavirus tests ahead of winter

Millions of new rapid coronavirus tests will be rolled out across NHS hospitals, care homes and labs from next week.

https://www.gov.uk/government/news/roll-out-of-2-new-rapid-coronavirus-tests-ahead-of-winter
Further information on today's @BBCr4today:
--Interview w John Bell, Oxford’s Regius Professor of Medicine, starting at 7:13 am.
--Piece starting at 6:10 am.
--Interview with a government minister from 8:22 am. 2/
In a few hours, and for the next month, these will be available to listen to here👇. 3/ https://www.bbc.co.uk/programmes/b006qj9z/episodes/player
BBC Radio 4 - Today - Available now

Available episodes of Today

https://www.bbc.co.uk/programmes/b006qj9z/episodes/player
Information gleaned from the above:
✅The test can be based on saliva (either throat swab or spit into a cup) rather than somewhat intrusive & unpleasant nasal swab.
✅It can test for the flu as well as Covid-19. 4/
✅Results within 90 minutes, by use of either a desktop machine or a palm-sized device which doesn't require technical expertise to use. So any university can set up rapid testing sites for students & staff. 5/5
See this piece by @ashishkjha, Professor of Global Health at @HarvardHSPH, on why frequency of testing & rapidity of results is much more important than accuracy of result per test. 1/ https://time.com/5873444/radically-rethink-covid-19-testing-approach/
America Needs to Radically Rethink Our COVID-19 Testing Approach

At this critical moment, it is time to radically rethink our approach to testing by focusing on tests that offer rapid results.

https://time.com/5873444/radically-rethink-covid-19-testing-approach/
See also this paper by @michaelmina_lab (et al), to whom @ashishkjha refers, whose title says it all: "Test sensitivity is secondary to frequency and turnaround time for COVID-19 surveillance". 2/2 https://www.medrxiv.org/content/10.1101/2020.06.22.20136309v2
Test sensitivity is secondary to frequency and turnaround time for COVID-19 surveillance

The COVID-19 pandemic has created a public health crisis. Because SARS-CoV-2 can spread from individuals with pre-symptomatic, symptomatic, and asymptomatic infections, the re-opening of societies...

https://www.medrxiv.org/content/10.1101/2020.06.22.20136309v2
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