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Chronicle of Higher Education
The CDC Is Wrong
Testing is essential for colleges to reopen safely
By Carl T. Bergstrom July 14, 2020 PREMIUM
Last month, the Centers for Disease Control and Prevention released
updated guidance for institutions of higher education in dealing with
the Covid-19 crisis. In that report, the CDC failed to recommend testing
for students returning to campus, and went one step further: It issued
an explicit statement of nonrecommendation.
"Testing of all students, faculty and staff for Covid-19 before allowing
campus entry (entry testing) has not been systematically studied. It is
unknown if entry testing in IHEs provides any additional reduction in
person-to-person transmission of the virus beyond what would be expected
with implementation of other infection preventive measures (e.g., social
distancing, cloth face covering, hand washing, enhanced cleaning and
disinfection). Therefore, CDC does not recommend entry testing of all
returning students, faculty, and staff."
The aim of such testing is to identify infected individuals with no or
mild symptoms, and to isolate them to prevent them from transmitting
disease to others. This is a proven means of disease control, and is
being used everywhere from workplaces to our armed forces to the NBA to
the White House.
The CDC’s decision not to recommend such testing for higher education is
inexplicable and irresponsible, particularly given that colleges are
environments where Covid-19 spreads easily, and large outbreaks are likely.
For example, a major cluster in fraternity housing at the University of
Washington last week has infected more than 130 students, the University
of Mississippi suffered an outbreak of over 160 cases associated with
fraternity parties, the University of California at Berkeley had a large
fraternity party cluster, and several college football teams have
suffered sizable outbreaks already this summer.
If we cannot contain outbreaks during the minimal campus activity of
summer, we cannot expect to fare better in autumn.
The language of the CDC statement makes a disingenuous appeal to an
absence of evidence. It is true that we have never had students return
to college amidst a Covid-19 pandemic, so we have no direct experience
with the effects of testing in that specific scenario. But we know
exactly what to expect. We have overwhelming evidence from numerous
other settings that testing is effective above and beyond other measures
at identifying infected individuals, and that by isolating such
individuals we can reduce the spread of disease. The CDC’s rationale for
inaction is akin to observing that seatbelts save lives in Cleveland but
refusing to recommend them in Cincinnati because that’s a different city
and “you never know."
We lack direct insight into the CDC’s motivations. But the
nonrecommendation poses serious cause for concern. The White House has
discouraged widespread Covid-19 testing. The CDC has already capitulated
to the White House on other aspects of its coronavirus guidance. In May,
at the request of the West Wing, the agency walked back its meek
suggestion that religious organizations "consider suspending or at least
decreasing use of a choir/musical ensembles and congregant singing … if
appropriate within the faith tradition.” Last week, in response to
criticism from Vice President Pence and President Trump, Director Robert
Redfield of the CDC stressed that his agency’s K-12 school guidelines
were not binding and expressed a desire that they not be used to justify
school closures.
.
Another possibility — not mutually exclusive — is that the CDC is
concerned about the feasibility of entry testing, given the nationwide
testing shortages. Rather than recommending against testing, the
appropriate response would have been to issue a statement like: “The CDC
recommends entry testing as a best practice for Covid-19 control on
campuses. We recognize that this may not be feasible in some locations,
but urge colleges to make every effort to implement such a program.”
Unclear as the motives may be, the consequences of this decision are
easy to anticipate. The CDC has provided considerable cover to colleges
that do not wish to deal with the expense and logistical challenges of
entry testing or continuing testing throughout the semester. Already we
are seeing institutions justify their planned inaction by appealing to
the CDC guidelines.
As college students return to campuses around the country next month,
they will bring coronavirus infections with them. Failing to take
obvious precautions and carry out effective control measures puts
students at risk. It puts university faculty and staff at risk. And it
puts at risk the broader communities in which institutions of higher
education are embedded.
While college students may be less likely to suffer severe outcomes from
Covid-19, college outbreaks do not stay on campus. They incubate disease
and amplify transmission chains that reach and kill members of more
vulnerable populations. To allow universities to open without testing is
to replicate the error at the root of the feckless and incoherent
federal response: ignoring the available evidence, hoping for the best,
and planning accordingly.
So what should colleges be doing in the absence of guidance from the
nation’s health-protection agency? First, they need to recognize that
the CDC’s direction is inadequate at best and may be politically
compromised as well.
Second, administrators need to acknowledge that they cannot open for
in-person instruction in the fall without realistic plans to prevent
large outbreaks on campuses. Such plans are not going to come from the
CDC, and so the responsibility for crafting them falls upon individual
institutions. Doing little, hoping for the best, and planning to suspend
operations when that fails? Such an approach is irresponsible, will
cause unfair disruption for the student body, and puts the larger
community in harm’s way.
Entry testing is essential to start the semester from the best possible
position. Continuing testing, isolation of positive cases, and at least
basic contract tracing will temper the spread of disease on campus.
These measures are expensive and pose logistical challenges. But the
challenges can be overcome. Batch testing offers a way to stretch
capacity considerably while reducing expenses. The cost of an ambitious
testing program needs to be considered in light of the alternative:
converting to online instruction entirely, or terminating in-person
instruction midway through the semester as outbreaks spiral out of control.
Third, colleges need to plan ahead for what happens if an outbreak does
get out of hand. Rather than trying to make decisions amid the fog of
war, reopening plans need to clearly state the criteria that will
trigger increased prevention measures, up to and including complete
cessation of in-person instruction and any associated dormitory closures.
The CDC has failed to provide the necessary guidance for a safe
reopening. Institutions of higher education must see this failure for
what it is and rise to the challenge of protecting their communities,
rather than exploiting this failure as an excuse to do less than is
required.
Carl T. Bergstrom is a professor of biology at the University of
Washington and the author of Calling Bullshit: The Art of Skepticism in
a Data-Driven World, coming in August from Penguin Random House. He
consults for Color Genomics, Inc., on Covid-19 testing logistics.
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