A Learning Curve: What COVID-19 Testing Looks Like on College Campuses Today

Last August, as universities began tentatively allowing students back to campus, Kim* received an email from the University of Pennsylvania, where she is a second year. Amid a surge in coronavirus cases across the state and especially in Philadelphia, the city where UPenn is located, the university said it did not have the testing capacity necessary to allow students on campus.

Kim, along with many other students, returned to Philadelphia to live off-campus for the year. These students filled out a symptom tracker every day, but no testing was required unless they reported symptoms. It wasn't until the start of the spring semester, that students were allowed back on campus and the school started administering saliva tests twice per week.

“Now, it’s definitely like we're on their radar—we get tested regularly and followed up on,” Kim tells Verywell. “It was probably a bit of a learning curve here, but I guess it probably was everywhere.”

UPenn is one of many schools that has had to adjust its testing and other COVID-19 response measures since last spring. As of December 11, there were more than 397,000 cases at more than 1,800 college campuses. That’s a 75,000-case increase from early November.

As schools grapple with fluctuating infection rates, changing state and county ordinances, and traveling students, many have had to reconsider how they track cases and respond to outbreaks to keep their communities safe.

Testing the Student Population

Mikaela Burkgren left her job as a snowboarding instructor in Utah to go home to New York shortly before states started imposing lockdowns last spring. After losing a friend and fellow snowboarder to COVID-19, she wanted to find a way to help people through the pandemic. So, she applied to work for the Cornell University testing system. 

“When I was doing the testing, people would thank me or thank us for doing this to allow them to come to school and be as normal,” Burkgren says. “It was like putting myself out there enough to go help make sure that these individuals can get an education, because I know how important that is.”

Burkgren says that when she started in August, she encountered students who struggled to navigate the university’s test appointment system. To complicate matters, there weren’t enough testing sites to accommodate the students who required testing each day.

“They didn't have enough testing sites open, and so there were really long lines, like you’d wait for an hour or maybe more,” Burkgren says.

Soon after, she says, the school opened up several more testing sites to help people get access to tests faster. “There’s almost no lines when you go through now,” Burkgren says.

In the months since the start of this academic year, many school administrators and health systems have focused on developing more effective testing plans. Anita Barkin, co-chair of the COVID-19 Task Force at the American College Health Association, says testing coupled with other safety measures is key. Without effective testing strategies, colleges risk missing new cases, potentially leading to outbreaks and leaving some infected students unaware that they should self-isolate.

“One of one of the major lessons learned was that robust testing strategies really assisted schools in having a measure of success regarding containment of outbreaks on campus,” Barkin tells Verywell.

Barkin says the ideal schedule includes testing students twice a week, with a result turnaround of less than 24 to 48 hours. Using a multi-layered approach is also key for consistently keeping infections down, per CDC recommendations. This means requiring students to quarantine or provide a negative COVID-19 test result upon return to campus, offering testing and contact tracing for students with symptoms or known exposure, and using ongoing surveillance testing for people without symptoms. 

Building Capacity

For schools with established labs on campus before the pandemic, there was some existing capacity for the large-scale testing they needed. Some schools devoted resources to building new or additional labs on campus. Others chose to send test samples to commercial labs operated through companies like Quest Diagnostics, LabCorp, and the Broad Institute.

Student health centers send samples once or twice per day and the results are transmitted back to the school, often electronically. Barkin says many schools have pre-existing relationships with commercial labs for testing other kinds of health samples, but the volume of tests was drastically increased.

“What was different was the volume of the laboratory work,” Burkin says. “If you're testing students who are symptomatic, students who report that they've had a positive contact, and you're also doing surveillance testing, that ramps up the volume considerably from what you were traditionally sending a laboratory pre-pandemic.”

In a survey of 500 colleges and universities from August, only 27% of schools planned to test students upon returning to campus and 20% said they would test their community “regularly to some extent,” according to the preprint study. Additionally, those schools with larger endowments and higher academic rankings were more likely to plan to test, compared with lower-ranked and lesser-resourced schools.

Barkin says that many schools which did not use surveillance testing measures in the fall have adopted them for the spring term.

Keeping Students in Check

Testing can give schools and health officials a look into infection rates, but it should be coupled with other response measures. For instance, at the University of Illinois, every on-campus student has been tested twice per week with a rapid saliva test since campus re-opened in the fall.

In the first few days of the semester, the positivity rate spiked to 3% after the school detected 320 new cases in a day. Administrators responded by locking down the campus for two weeks, instructing students to leave the campus only for essential activities like going to class, buying groceries, and getting tested. The positivity rate quickly dropped and has remained at less than 1% since September.

Kim says that just prior to the Super Bowl, UPenn saw an uptick in coronavirus cases. The university sent students an email warning against attending gatherings and parties.

“That was very clearly, saying we have to get under control or else there’s gonna be some real consequences,” she says.

In general, though, she says she’s glad to have a sense of control over her exposure level, especially because she isn’t living on campus, where she might have interacted with more people.

“All things considered, for someone living in the middle of a big city, I really do feel pretty safe, which I think is good," Kim says. "And I think that has a lot to do with my personal choices. I hope that students on campus feel the same way.” 

Learning Through Experience

Barkin says she’s seen people at all levels of college education and health leadership share their strategies and knowledge with others. Especially for schools with relatively limited access to resources, designing solutions for testing, isolation housing, and more can pose a challenge.

“This has been an opportunity for all of us in our different areas of specialization to share information so that we are all moving toward that common goal of being able to provide an excellent experience for college students,” Barkin says.

As colleges look ahead to the rest of the spring term and the next school year, the greatest challenge may be to mediate vaccine administration. 

Barkin says that a single-dose vaccine, such as a candidate from Johnson & Johnson which is undergoing review by the Food and Drug Administration for authorization, would be ideal for colleges who may otherwise struggle to administer two doses of vaccine to each student before the end of the academic year.

*In order to respect their privacy, Kim's last name has been omitted.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.