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.

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Description

Provenance

Citation

Published Version (Please cite this version)

10.15585/mmwr.mm6946e1

Publication Info

Denny, Thomas N, Laura Andrews, Mattia Bonsignori, Kyle Cavanaugh, Michael B Datto, Anastasia Deckard, C Todd DeMarco, Nicole DeNaeyer, et al. (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.

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Scholars@Duke

Datto

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.  Specifically, Dr. Datto oversees clinical testing and reporting, develops quality management systems and proficiency testing programs, provides consultation with ordering physicians, ensures educational programs, develops strategic plans that are in line with the needs of our patient population, physicians and health system leadership, coordinates research and development, ensures adequate and appropriately trained personnel, and provides profession interpretation for molecular diagnostic testing including the wide range of PCR, quantitative PCR, sequencing and FISH based tests for inherited genetic diseases, hematologic malignancies, solid tumors and infectious diseases.

Dr. Datto also serves as the chair of the Accreditation Committee (AC) for the College of American Pathologists (CAP).  The CAP is the largest accreditor of hospital based laboratories in the US and serves as a ‘deemed entity’ by the Center for Medicare Services. In his role of chair of the AC, Dr. Datto oversees the committee that makes clinical accreditation decisions for approximately 7,000 clinical domestic and international laboratories.

Finally, Dr. Datto has an active academic program developing data system to aggregate, normalize and utilize high complexity and high volume laboratory data.  Dr. Datto and his team have developed the Molecular Registry of Tumors (Mr.T); a software solution that supports clinical trials matching, engagement with the AACR GENIE Project and the Molecular Tumor Board for Duke University Health System.  The ultimate goal of this work is to ensure that the vast amount of laboratory data generated on our Duke patients can be put to use, driving better patient care, research and education.

Epling

Carol Ann Epling

Assistant Professor in Family Medicine and Community Health
Haase

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 consists of ~20 components, so this dynamical system is far too complex to understand simply by biological intuition. We rely heavily on the expertise of the Harer group (Dept. of Mathematics, Duke University) for the analysis of complex data, and their understanding of dynamical systems.  Using a collection of tools, including molecular genetics, genomics, mathematical models, and statistical inference, our groups aim to understand how the cell division clock works, how it might be perturbed in proliferative diseases such as cancer, and how the clock components might be targeted for new anti-tumor therapies.  Qualitatively, the clock networks that control the yeast cell cycle look much like the networks controlling circadian rhythms in a variety of organisms. More recently, we have been using our experimental and quantitative approaches to investigate the function of circadian clocks, as well as clocks that control the division and development of pathogenic organisms such as P. falciparum and P. vivax, the causative agents of malaria.

Harer

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.

Lee

Mark Jae Lee

Assistant Professor of Pathology
Spotts

Philip Hunter Spotts

Assistant Professor in Family Medicine and Community Health
Vaughn

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 and innovative health care.


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