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.
Abstract
On university campuses and in similar congregate environments, surveillance testing
of asymptomatic persons is a critical strategy (1,2) for preventing transmission of
SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). All students
at Duke University, a private research university in Durham, North Carolina, signed
the Duke Compact (3), agreeing to observe mandatory masking, social distancing, and
participation in entry and surveillance testing. The university implemented a five-to-one
pooled testing program for SARS-CoV-2 using a quantitative, in-house, laboratory-developed,
real-time reverse transcription-polymerase chain reaction (RT-PCR) test (4,5). Pooling
of specimens to enable large-scale testing while minimizing use of reagents was pioneered
during the human immunodeficiency virus pandemic (6). A similar methodology was adapted
for Duke University's asymptomatic testing program. The baseline SARS-CoV-2 testing
plan was to distribute tests geospatially and temporally across on- and off-campus
student populations. By September 20, 2020, asymptomatic testing was scaled up to
testing targets, which include testing for residential undergraduates twice weekly,
off-campus undergraduates one to two times per week, and graduate students approximately
once weekly. In addition, in response to newly identified positive test results, testing
was focused in locations or within cohorts where data suggested an increased risk
for transmission. Scale-up over 4 weeks entailed redeploying staff members to prepare
15 campus testing sites for specimen collection, developing information management
tools, and repurposing laboratory automation to establish an asymptomatic surveillance
system. During August 2-October 11, 68,913 specimens from 10,265 graduate and undergraduate
students were tested. Eighty-four specimens were positive for SARS-CoV-2, and 51%
were among persons with no symptoms. Testing as a result of contact tracing identified
27.4% of infections. A combination of risk-reduction strategies and frequent surveillance
testing likely contributed to a prolonged period of low transmission on campus. These
findings highlight the importance of combined testing and contact tracing strategies
beyond symptomatic testing, in association with other preventive measures. Pooled
testing balances resource availability with supply-chain disruptions, high throughput
with high sensitivity, and rapid turnaround with an acceptable workload.
Type
Journal articleSubject
HumansPneumonia, Viral
Coronavirus Infections
Clinical Laboratory Techniques
Viral Load
Universities
Program Development
North Carolina
Asymptomatic Diseases
Pandemics
Public Health Surveillance
Betacoronavirus
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https://hdl.handle.net/10161/21769Published Version (Please cite this version)
10.15585/mmwr.mm6946e1Publication Info
Denny, Thomas N; Andrews, Laura; Bonsignori, Mattia; Cavanaugh, Kyle; Datto, Michael
B; Deckard, Anastasia; ... Wolfe, Cameron R (2020). 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. MMWR. Morbidity and mortality weekly report, 69(46). pp. 1743-1747. 10.15585/mmwr.mm6946e1. Retrieved from https://hdl.handle.net/10161/21769.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Mattia Bonsignori
Associate Professor in Medicine
HIV vaccine development Study of B-cell immune responses in HIV positive individuals
Determination of correlates of protective immunity to HIV Induction of broadly neutralizing
antibodies to HIV Development of multiplex functional assays for the evaluation at
a single-cell level of B-cell responses to vaccinations, infections and in vitro stimulation
Epidemiology and characterization of bacterial resistance determinants (past) </do
This author no longer has a Scholars@Duke profile, so the information shown here reflects
their Duke status at the time this item was deposited.
Michael Bradley Datto
Associate Professor of Pathology
Dr. Datto is an AP/CP/MGP board certified pathologist who specializes in molecular
pathology. He is the Associate Vice President for Duke University Health System Clinical
Laboratories, the Vice Chair for Clinical Pathology and Medical Director for Duke
University Health System Clinical Laboratories. In these roles, he is responsible
for maintaining the standards of the College of American Pathologists and CLIA/CMS
within all Clinical Laboratories at Duke. Speci
Thomas Norton Denny
Professor in Medicine
Thomas N. Denny, MSc, M.Phil, is the Chief Operating Officer of the Duke Human Vaccine
Institute (DHVI), Associate Dean for Duke Research and Discovery @RTP, and a Professor
of Medicine in the Department of Medicine at Duke University Medical Center. He is
also an Affiliate Member of the Duke Global Health Institute. Previously, he served
on the Health Sector Advisory Council of the Duke University Fuquay School of Business.
Prior to joining Duke, he was an Associate Professor of Pathology, Labo
Carol Ann Epling
Assistant Professor in Family Medicine and Community Health
Steven B. Haase
Professor of Biology
Our group is broadly interested in understanding the biological clock mechanisms that
control the timing of events during the cell division cycle. In 2008, the Haase group
proposed a new model in which a complex network of sequentially activated transcription
factors regulates the precise timing of gene expression during the cell-cycle, and
functions as a robust time-keeping oscillator. Greater than a thousand genes are expressed
at distinct phases of the cycle, and the control network itself
John Harer
Professor Emeritus of Mathematics
Professor Harer's primary research is in the use of geometric, combinatorial and computational
techniques to study a variety of problems in data analysis, shape recognition, image
segmentation, tracking, cyber security, ioT, biological networks and gene expression.
Mark Jae Lee
Assistant Professor in Pathology
Michael Anthony Moody
Professor of Pediatrics
Tony Moody, MD is a Professor in the Department of Pediatrics, Division of Infectious
Diseases and Professor in the Department of Immunology at Duke University Medical
Center. Research in the Moody lab is focused on understanding the B cell responses
during infection, vaccination, and disease. The lab has become a resource for human
phenotyping, flow characterization, staining and analysis at the Duke Human Vaccine
Institute (DHVI). The Moody lab is currently funded to study influenza, syphil
Philip Hunter Spotts
Assistant Professor in Family Medicine and Community Health
John Anthony Vaughn
Associate Professor in Family Medicine and Community Health
My major area of scholarly interest is in the field of Narrative Medicine. I am particularly
interested in exploring how this approach to practice can enhance both the care that
clinicians provide to their patients as well as their sense of professional agency
and satisfaction. As Director of Student Health, I am dedicated to maximizing the
health and well-being of every member of the Duke student community through the delivery
of professional, patient-centered
Cameron Robert Wolfe
Associate Professor of Medicine
HIV infection, Transplant-related infectious diseases, general infectious diseases,
Biological and Emergency Preparedness for hospital systems, influenza and respiratory
viral pathogens
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