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Implementation of a Pooled Surveillance Testing Program for Asymptomatic SARS-CoV-2 Infections on a College Campus – Duke University, Durham, North Carolina, August 2-October 11, 2020

Our take —

Pooled COVID-19 testing reduced the number of total tests performed—improving efficient use of resources—and allowed large-scale, frequent screening in a population with low disease incidence.

Study design

Other

Study population and setting

Between August 2 and October 11, 2020, 10,265 graduate and undergraduate students at Duke University, a private university in Durham, North Carolina underwent frequent pooled, nasal-swab based SARS-CoV-2 polymerase chain reaction testing. Residential undergraduates were tested twice per week, off-campus undergraduates were tested one to two times per week, and graduate students were tested once a week. Testing was combined with social distancing measures including universal masking, single occupancy of dorms, packaged meals, and social distancing in classrooms.

Summary of Main Findings

This study described the implementation of a university campus-based surveillance testing program which relied on pooled sample testing for resource-efficient and early detection of COVID-19 outbreaks in a low-incidence (~0.08%) population. From 68,913 collected specimens, 84 cases were diagnosed as a part of the large scale screening, 51% of which were of asymptomatic. Of these cases, 17 were diagnosed as a part of the entry screening, 29 by pooled testing of students who were asymptomatic, 23 by contact tracing (18 symptomatic and 5 asymptomatic), and 15 via symptoms monitoring application. Pooled testing was a highly sensitive and high throughput method which allowed for the efficient use of resources and early identification of COVID-19 cases.

Study Strengths

The report was based on the real-world performance of a pooled testing-based surveillance program on a college campus, demonstrating the effectiveness of a multi-approach strategy (including frequent testing, contact tracing, masking, social distancing, etc.) for timely identification of SARS-CoV-2 transmission in a college campus.

Limitations

The main limitation in the generalizability of this study was that the pooling strategy was specific to the local and academic setting where it was developed. Thus, this surveillance strategy likely has to be customized to other settings based on the disease prevalence and the positivity rate of other target populations. Additionally, differentiation of symptomatic from asymptomatic cases were based on self-reported symptoms, potentially decreasing the accuracy of the reported asymptomatic detection rate from this surveillance program.

Value added

This is a proof of concept study describing the implementation of a university campus-based surveillance testing program which relied on pooled sample testing Between August 2 and October 11, 2020, among graduate and undergraduate students at Duke University, a private university in Durham, North Carolina. The study demonstrates the value of frequent pooled surveillance testing combined with symptomatic screening and contact tracing for early diagnosis of not only symptomatic but also asymptomatic COVID-19 cases in an academic setting. The program proposed here will likely need to be customized to specific settings based on the disease prevalence and the positivity rate of other target populations.

This review was posted on: 22 January 2021