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Friday, Aug 12, 2022

Following entry testing, Middlebury to test 750 people per week for Covid-19 this fall

With more than 3,000 Middlebury students, faculty and staff set to return to campus in late August, the college is planning to test 750 of them — on top of those who develop viral symptoms — for Covid-19 each week over the course of the fall semester, in a “targeted” testing approach directed towards higher-contact parts of the community. 

Director of Health Services Mark Peluso described the testing plan in a July 28 meeting between college administrators and the Town of Middlebury Selectboard (the plan is also described in the college’s Return to Campus Guide.) Students will receive an initial test when they arrive on campus and another test seven days later, both in Virtue Field House. Following those two tests, students will be included with faculty and staff working “high-contact” jobs in “Targeted Dynamic Testing” (TDT), which will consist of 750 tests per week. 

Acquired from the Broad Institute based in Cambridge, Mass., tests will be diagnostic PCR anterior nares swabs, which are more sensitive than antigen tests, the other common type of Covid-19 test. Broad claims it can return results in 24 hours

Any student who develops Covid-19 symptoms will also be tested, and the college has reserve tests for symptomatic students so as not to draw from the weekly 750-test allocation for TDT, Peluso said. Students will receive an email when they have been selected for TDT, and tests will likely continue to be held in Virtue Field House.  

Testing 750 community members weekly means less than one-fifth of the roughly 2,300 students, 300 faculty members and 1,200 staff occupying campus this fall could receive a test from the college every seven days, not including symptomatic individuals. And although both the Return to Campus Guide and administrators in town halls have said that the plan is to randomly test everyone at the college throughout the semester, TDT will be targeted towards some parts of the community more than others. 

“TDT is intentionally dynamic” and “will focus on students living in congregate housing, and the staff and faculty members who work directly with them,” Peluso wrote in an email to the Campus. “Congregate housing” actually refers to all student housing and approved off-campus housing, he said, suggesting that any student would be eligible for a test each week. Staff such as healthcare workers, custodians, public safety, facilities, dining and residential life personnel will also be “targeted” for TDT, he said, and faculty members who interact with students “may also be tested.” 

Peluso did not clarify how the college plans to break down the 750 weekly tests among students, staff and faculty each week, but wrote that “the breakdown will vary depending on local community and campus prevalence of illness.” The Return to Campus Guide urges faculty and staff to “consult their healthcare providers for medical advice, including testing options.” 

Mirroring approaches at other colleges, administrators see testing as one piece of a broad plan for Covid-19 containment. Experts agree that strict behavioral interventions are also an essential part of safe college reopening, and that testing must be coupled with these measures to make campuses safe. “Physical distancing, gathering size restrictions, hand hygiene and face coverings have been very successful in mitigating the spread of illness in places using those strategies,” Peluso said. 

Those steps are outlined extensively in the Return to Campus Guide, along with the college’s plan to have students quarantine prior to their arrival and to “open” campus in phases. 

However, the 750 tests-per-week plan places the college’s testing frequency well behind some peer schools: Every University of Vermont student will be tested each week for the first three weeks of the university’s semester, after which UVM will re-evaluate its plan. Champlain College, Wesleyan and Tufts universities also plan to test all students weekly during the fall semester. Harvard will test students every three days and, in a plan that could cost up to $10 million, Colby will test twice-weekly. In the cases of Harvard and UVM, both schools could consider a TDT-type approach later in the semester, but only if their initial bouts of heavy testing yield low infection rates. 

Johns Hopkins University — which is in a much denser urban area than Middlebury — had planned on testing all students twice-weekly this fall, but cancelled in-person classes last week. One of the university’s top infectious disease specialists later called the rigorous testing strategy it had planned to use “an incomplete defense.” 

The college is prepared to raise or lower its number of weekly TDT tests depending on level of infection in the community, Peluso said, and if viral prevalence remains low, it may use some of the 750 tests allocated for TDT to test symptomatic community members. Testing will be free for students on the college’s health insurance. 

“We have purchased enough test capacity to perform arrival testing for all students, and 750 tests per week for 12 weeks, plus some reserve testing for surge or symptomatic students,” he said. 

Students interviewed by the Campus shared mixed feelings about the testing plan, with some grateful for arrival day and day seven testing, while others said they wished the college would test more throughout the semester. 

“One of the reasons that I have any confidence in Middlebury's return plan at all is that everyone, including asymptomatic folks, is getting tested upon arrival to campus. Without that, I would be extremely hesitant to return,” said Keith Chatinover ’22.5. 

Others are less optimistic. “One hundred percent of people tested once over a five-week period is not going to prevent an outbreak from exploding,” said Michael Koutelos ’20.5. (With the 750 weekly TDT tests targeting certain members of the community over others, it is possible that some students could go more than five weeks without being tested.) 

Colleges’ Covid-19 testing plans depend heavily on finances, and many institutions around the country will test with less frequency than Middlebury. 

The college’s plan to test students on arrival and seven days later is a step many smaller institutions are not able to take for financial reasons, for example: Small schools like Cornell College in Iowa will not test students upon entry. And free testing under college insurance is also not available at every school. Students at St. Michaels University, which plans to test students randomly and won’t test any student more than four times throughout the term, will have to pay a $150 testing fee, according to the Burlington Free Press. Syracuse University will charge students $49 for “testing kits.” 

Testing 750 community members weekly falls short of some expert-recommended testing levels that may be required to maintain a “controllable” level of Covid-19 infection on campuses. A widely covered study published by the Journal of the American Medical Association called on colleges to test every community member once every two days to “yield a modest number of containable infections” — but acknowledged that doing so “sets a very high bar ...logistically, financially and behaviorally.” 

When asked how Middlebury settled on testing 750 community members per week, Peluso pointed to the Center of Disease Control (CDC), Vermont Department of Health and American College Health Association Guidelines. He wrote that the possibility of false positive tests arising from widespread testing of asymptomatic students was one factor that pushed the college to do fewer tests. “The increased risk of false positive results in low prevalence situations, with ensuing isolation and quarantine of individuals who do not actually have the disease, must be considered,” he wrote. 

While the likelihood of a test yielding an incorrect result does increase in communities with low disease prevalence, prevalence estimates are “a snapshot in time,” according to Director of Global Health Programs Pam Berenbaum. Disease prevalence at Middlebury and in Addison County could thus be different in late August, with students returning to campus from around the country, than it is now (the county as of August 10 had just 2.5 Covid-19 cases per 100,000 residents, according to the New York Times). 

Another question about testing at Middlebury lies in the ability of the Broad Institute, the Harvard and MIT-based lab that will head Middlebury’s testing, to increase its testing capacity to fill the needs of dozens of Northeast universities and colleges. The institute plans to provide tests for at least 25 colleges the Campus was able to find, including Colby, Williams, Harvard and UVM, all of which have testing-intensive plans. 

Broad has ramped up its testing in the past few weeks. Since it began testing in March, it has performed an average of 3,511 tests per day, and has the capacity to ramp up to 100,000 tests per day if needed, according to the Boston Globe. But the highest number of tests the institute has conducted to date was 13,008 tests on Aug. 6. 

Middlebury will pay Broad $30 per test, which brings the cost of its TDT plan to $22,500 per week, assuming the college holds 750 tests weekly (Peluso added that “there are other fixed costs such as courier fees, staff time and PPE needs that add to the total cost,” and the total cost of testing could vary depending on testing of symptomatic people). 

Administrators say they’ve worked closely with Vermont state and local governments in building a reopening strategy and describe Vermont’s stellar record in keeping infection rate low as a buffer in their plan not to test all students weekly. 

“We have lower disease prevalence in the region which makes it less likely that the illness would come to campus from local community spread than if Middlebury were in a higher prevalence area. That does not mean it won’t happen, it’s just far less likely to happen,” Peluso said. “Vermont, and the Middlebury area in particular, has done a great job in keeping the spread of Covid-19 low.” 

But that success could mean little when students come to campus from different parts of the country. While many students have spent summer in the town of Middlebury or other places away from home, a Campus analysis found that of roughly 12,000 students enrolled at Bates, Bowdoin, Tufts, Connecticut College and Middlebury, 20% are originally from states designated as White House “red zones” as of Aug. 3, with another 78% living in the “yellow zone,” areas with moderate levels of infection. 

Just 2% of students reside in the only “green zone” that presently exists in the country — the Green Mountain State itself. 

Digital Director Benjy Renton contributed reporting.