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MOUNT VERNON - The numbers are staggering across American colleges and universities.
The University of Georgia has had more than 3,000 COVID-19 cases on campus. The University of Alabama has had over 2,400. The University of South Carolina reports nearly 2,300.
And this state's University of Iowa has had 1,912 cases since Aug. 18, with Iowa State University close behind at 1,553 since Aug. 1.
But Cornell College - Mount Vernon's private liberal arts college with 1,002 mostly-residential students - is different.
As of Monday morning, it was reporting no student cases and two positive employees since Aug. 28.
Of course, Cornell's differences extend beyond its COVID-19 tally - including to its smaller size, its block-system learning structure and its testing tactics.
Unique in this region, Cornell has created its own proactive sampling strategy - pulling from faculty and student summer research - that involves periodic asymptomatic testing of 'high-contact groups,” cluster sampling by residence hall floor and random sampling of faculty and staff. The campus is using an antigen test designed to detect COVID-19 viral proteins through a nasal swab.
Although the U.S. Food and Drug Administration has said positive results from the test are reliable, it also has said antigen tests have a slightly higher rate of false negatives.
The test has been made available under an emergency use authorization supported by a Secretary of Health and Human Services declaration that 'circumstances exist to justify the emergency use.” And Cornell officials said they believe the results they're getting so far are accurate.
'The more you do, the more the test becomes reliable,” Cornell pandemic response coordinator Nancy Reasland said, adding that 'if you get a positive, it's a positive. Where it might fall down a little bit, there might be a slightly higher risk of a false negative. … But we haven't felt like we've been getting false negatives.”
When students, faculty and staff are randomly chosen to visit the Cornell Testing Center, they're instructed to swab their own nose and return to their home or dorm room until results are emailed to them within about an hour.
The stratified nature of Cornell's testing - bolstered by any necessary testing of symptomatic students or those in contact with a positive - is designed to target different avenues of potential spread on campus and provide early warnings of possible outbreaks, according to Cornell statistics lecturer Brandi Shanata, who helped design and develop the testing plan.
'We don't have any positive students at this point, but I think it's realistic to realize that we probably will at some point,” Shanata told The Gazette. 'This sampling strategy is designed so that we get an early warning of where a hot spot might be, and we can dive in to cut it off.”
Testing strategies have taken widely different forms across the county - and even across Iowa - with some schools, like the UI and the University of Northern Iowa, testing only those with symptoms or positive contacts, Others, like ISU, are also testing asymptomatic students upon move-in.
The University of Illinois is using a rapid saliva-based COVID-19 test, which is available on a walk-up basis to faculty, staff and students - with more than 333,700 tests administered so far.
Some institutions required all members of the campus community to quarantine for two weeks upon return to campus. Others, like Coe College in Cedar Rapids, made all campus community members prove a negative test before making a fall return.
When asked why the UI didn't require move-in testing, mandate quarantine upon arrival or implement randomized testing of asymptomatic individuals, officials cited Centers for Disease Control and Prevention guidance and the limited testing supplies.
UI President Bruce Harreld in comments to the Board of Regents last week indicated more testing would be ideal - especially in pushing toward more in-person learning, with 78 percent of that campus' undergraduate credit hours currently online.
'I'm not comfortable that we have the testing capacity and the reagents specifically to allow us to test a large enough percentage of our population,” Harreld told the board, noting rapid testing is ideal.
'If you can do the entire population every day - so we do 40,000 tests every day - that's where we need to get to,” he said. 'It's not like once a week. We need to do this rapidly. This country is way under-testing.”
When asked what is standing in the university's way of rapid testing - like at Cornell, the University of Illinois, or even its own Hawkeye football program, now planning a late start thanks to use of rapid tests - Harreld told The Gazette, 'UI is constantly evaluating new tests and testing techniques.”
'That being said, we are lucky that UI Health Care has developed robust testing capacity at the Pomerantz Family Pavilion and the Quick Care Clinic at the Old Capitol Town Center/University Capitol Centre,” he said, adding, 'UIHC uses the (polymerase chain reaction) test obtained by a nasopharyngeal swab, which is the gold standard for diagnostic testing, FDA approved and 100% sensitive.”
He also said students who don't meet UI testing criteria - by having symptoms or close contact with a positive case - 'are welcome to seek a test through Test Iowa.”
Go home, get ready
Cornell's Reasland said although she didn't foresee her stint as 'pandemic response coordinator” coming, she perhaps unknowingly was preparing for it as far back as 2005 - when she attended a conference.
At that event, keynote speaker Michael Osterholm - a highly-regarded epidemiologist and director of the Center for Infectious Disease Research and Policy at the University of Minnesota - warned to beware of a looming pandemic.
'I don't remember anything else about that conference, except what he said in his opening speech, which was we are long overdue for a pandemic, lots of people are going to die - go home and get ready,” Reasland said. 'He talked at that time about point-of-care testing.”
The advice stuck.
'I decided 15 years ago that point-of-care testing was the preferable way to go,” Reasland said.
When the pandemic Osterholm predicted more than a decade ago arrived, Reasland said she began researching options for tests that turn rapid results.
'College students are busy. You can't have them go in for a test on a Monday and still sitting in their room on Friday waiting for results,” she said. 'That doesn't work for college students. That doesn't work for anybody.”
Partnering with campus researchers - including students who had lost their internships and started digging into state COVID-19 data - Reasland landed on Quidel Corporation's Sofia antigen test.
'They looked into this method as well, and independently thought the same thing that I did - that this is absolutely the way to go,” she said.
Cornell statistics lecturer Shanata, along with her husband and Cornell chemistry professor Jai Shanata, led three teams of students through COVID-19-related summer research - crafting documents and creating charts tracking state- and local-level data the school would use to craft its fall return plan.
The goal, Brandi Shanata said, was to make Cornell College a 'small school with the most customized and largest amount of data at our fingertips.”
The students then helped Cornell come up with its stratified sampling technique - supported by data that showed mass testing wouldn't reduce transmission unless an entire population is tested every five to seven days.
'But there has been some work that's shown that we can actually use a different strategy - this idea of stratified testing, where we test people who are high-contact, people who are having the most contact with other people or are engaging in activities such as singing,” she said.
By randomly testing members of those high-contact groups, clusters of residence hall floors and faculty and staff, Cornell - which runs on a 10-block system that lets students focus on one class only for 18 consecutive days - aims to test up to 300 people per block this semester.
‘I feel safe'
When Maddie Huntzinger, vice president of Cornell's student body, stepped into Cornell's testing center last week, she wasn't experiencing symptoms of COVID-19.
She hadn't been in contact with a known positive case. And she'd never been tested before.
But she pulled back one of the plastic sheets hanging from the ceiling - creating transparent walls around folding chair stations equipped with small tables - and administered her test.
She swabbed just an inch up her nose - far from the invasive lengths other diagnostic tests require - and packaged her specimen as directed.
She learned about 30 minutes later her test was negative. Huntzinger said she feels comfortable with the results and the Cornell strategy of keeping students safe.
Plus, she said, most students are wearing masks and practicing social distancing.
No one wants to have to switch to all-virtual instruction, and Cornell Student Body President Maddix Stovie said she believes Cornell's testing strategy is part of the reason tha's unlikely.
'I feel safe because I know it's a constant thing - it's not just a one-time situation,” Stovie said of the frequent testing.
Beyond testing, Cornell President Jonathan Brand cited several reasons he believes his college is ideally suited to stave off an outbreak - including its block system, which by design keeps students in small cohorts for 18-day chunks at a time.
'I think the fact that our classes only have on average 16 students makes huge difference,” Brand said. 'And our students only take one class at a time.”
One Cornell study recently found a typical university student in a traditional semester might mix with as many as 500 students during a week of being in classes.
'For us, our students won't mix with more than, on average, 15 other students,” he said.
Cornell - which is offering hybrid instruction with a mix of online and in-person learning - is doing its own contact tracing, experiencing high levels of cooperation to date. Brand said students and faculty are required to report positives identified through off-campus testing.
'We have not had any off-campus positives,” he said.
Cornell's fall enrollment is 1,002, and the vast majority of those students - 875 - are living on campus. That helps too, Brand said, with creating a culture of care on campus.
'Last week, I received an email - as did another administrator - from a student who said, ‘My birthday is coming up over block break and I really want to go home, is it OK with you?'” Brand said, praising the student's inquiry.
He told her, 'If your parents want you home, go home.”
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