Absent clear guidance on COVID-19 testing, Colorado colleges go their own way

Colorado colleges and universities that brought students back for in-person classes — and, in many cases, to live on campus — adopted extensive COVID-19 testing strategies in hopes of controlling outbreaks and maintaining some normalcy for students during the pandemic.

The specifics of each campus’ strategy vary greatly, though, just as school budgets and populations do.

Federal coronavirus relief legislation provided some funding that many colleges have used to help pay for testing. But in Colorado, budget cuts to higher education meant they had less cash to work with than during a normal year.

The CARES Act, which President Donald Trump signed in March, directly provided $173.3 million for around 75 colleges and universities in Colorado. None of that money was specifically earmarked for testing, though half of it was designated for students, and the remaining funds came with other requirements for higher education institutions.

In May, Gov. Jared Polis designated $450 million from the CARES Act for the state’s public colleges and universities. But Colorado lawmakers, facing steep revenue losses due to the pandemic-fueled economic downturn, days later cut $493 million, or 58%, from the state’s higher education budget.

Relief money helps, but resources limited

The University of Colorado Boulder estimates the cost of testing this semester at around $2.8 million, a figure that includes saliva tests (used to monitor students for COVID-19, but not for diagnosis), wastewater testing to detect the virus in sewage, contact tracing and diagnostic testing (nasal swab tests), according to spokesperson Joshua Lindenstein.

That testing is paid for through the CARES Act funds that CU Boulder received from the state of Colorado. Unless there’s another coronavirus relief deal in Congress before the new year — with funding for higher education — the college might have to put other funds toward testing in the spring.

“Determination of funding sources for the spring 2021 semester is under way in light of (CARES Act) funding expiration at end of this year,” CU Boulder spokesperson Melanie Parra said in an email.

CU Boulder requires weekly saliva monitoring tests for residential on-campus students and employees, while those living off-campus can choose to participate in the monitoring program, also known as surveillance testing. Those who receive a positive result are referred for a diagnostic test, because saliva tests have not been approved for diagnosis and can sometimes yield false-positive or false-negative results.

CU Boulder had 6,271 students move into the residence halls at the start of the semester, according to a spokesperson.

In an Oct. 23 announcement about the spring semester, CU Boulder said student test results will continue to be one of the university’s “key data points” for determining “levels of operations,” including when to pause in-person classes.

Many Colorado colleges and universities, including the University of Colorado system, have declined to raise tuition during the pandemic — at least so far — and don’t impose extra testing fees on students. But they’ve managed to foot the bill for multiple forms of COVID-19 screening, testing, contact tracing and isolation for students, faculty and staff.

At Colorado School of Mines, a smaller university in Golden that has about 2,000 students living on campus, testing will cost around $250,000 — as a “rough estimate,” said Peter Han, chief of staff at the president’s office.

School of Mines is providing surveillance testing every other week for asymptomatic students living in residence halls or Greek houses. Diagnostic testing is also available at the student health center.

Testing for the fall semester is covered by CARES Act funds, Han said. If another round of federal relief doesn’t come next semester, he added, the cost of testing will have to come out of the school’s operating budget — but a tuition increase is unlikely.

“We feel like it’s an important investment,” Han said. “It’s not our only way we’re helping to mitigate the viral spread, but it’s an important part of our strategy.”

School of Mines is working with a third-party provider for surveillance testing.

That provider, COVIDCheck Colorado, is a social benefit enterprise of the Gary Community Investment Company that “represents a philanthropic health consortium whose mission is to help Coloradans navigate the COVID-19 pandemic and get back to our community safely,” according to its website.

In addition to School of Mines, COVIDCheck Colorado is partnering with Colorado Christian University, Colorado Mesa University, University of Colorado Denver, Metro State University, Fort Lewis College, Naropa University, and, for athletes only, the University of Northern Colorado, according to a spokesperson for the company.

“COVIDCheck Colorado has been a great community partner in terms of how they price their tests,” Han said.

At the University of Northern Colorado, the cost of testing is “relatively minimal on UNC’s behalf, because of the fact that at this point, (student) insurance is covering the bulk of the testing,” said Blaine Nickeson, associate vice president for administration and chair of UNC’s Coronavirus Task Force.

Under federal legislation passed in March, insurance companies are required to cover tests for people with COVID-19 symptoms or known exposure to the virus — but federal guidance does not require them to cover routine tests for screening or monitoring.

Nickeson estimates that the campus will end up spending around $50,000 on testing for the semester. The university provides diagnostic testing through its student health center and until recently has not provided campus-wide monitoring tests for asymptomatic students.

On Oct. 13, UNC began conducting random surveillance testing of students living in university housing. About one-quarter of students will be tested each week. Around 2,200 students are living on campus, Nickeson estimated.

“With testing we’re trying to add on different layers as the technology changes and as the availability changes,” Nickeson said, adding that UNC has averaged about 75 diagnostic tests per week, plus 800 surveillance tests a month for student athletes. “We’re really hopeful that in the next couple of months, the cost of testing will continue to go down and the availability of testing will continue to go up.”

Nickeson said the first round of CARES Act money directly allocated for UNC didn’t even cover housing and dining credits it gave students when it closed down for the spring.

Given the deep budget cuts to higher education, “it wasn’t like a whole bunch of additional CARES Act money that we were able to utilize” after Polis designated more of the state’s relief money for higher education, he said.

Unlike CU Boulder, UNC is not conducting wastewater testing of student dormitories to look for traces of the virus. This strategy serves as an early warning sign of virus prevalence, since asymptomatic people or pre-symptomatic people often shed the coronavirus in feces.

Colorado State University, which also uses wastewater testing, has used its own program to decide where to deploy tests on campus. When large amounts of the virus are detected in sewage from a residence hall through wastewater testing, school officials quarantine just those residents until all of the students in that dormitory are tested.

“It’s something we would like to do,” Nickeson said of wastewater testing. “CU and CSU are doing it, but they’re doing it in their own labs. For us, we don’t have the lab capabilities, and it’s cost-prohibitive to do it with the outside vendors. So that’s why we’ve sort of started up our surveillance testing on campus.”

Likewise, Han said School of Mines has not fully implemented wastewater testing, but is working on developing protocols around such a system.

Colleges don’t have clear testing standards

Nationally, COVID-19 testing strategies vary with a number of factors — the size of a school and the resources it has available, the amount of virus transmission in a community where the college is located, and the priorities of leadership.

Though the coronavirus relief legislation provided some funding to help cover coronavirus-related costs such as testing and safety measures, specific instructions for best testing practices weren’t provided by Congress or the administration.

“The federal government was not terribly helpful,” said Terry Hartle, senior vice president of government relations for the American Council on Education. “There was a great deal of pressure on colleges and universities to reopen, but there were no guidelines.”

Rather, state and federal health agencies provide higher education testing guidance that include broader recommendations.

The Centers for Disease Control and Prevention first published COVID-19 guidelines for higher education in June and last updated them Oct. 21. Currently, the federal guidelines recommend that colleges and universities use testing as “one component of a comprehensive strategy,” which should also include “promoting behaviors that reduce spread, maintaining healthy environments, maintaining healthy operations, and preparing for when someone gets sick.”

Given the variety of location and size among higher education institutions, they should work with their local health agency to determine the most effective testing plan, the CDC says.

According to the CDC, faculty, staff and students should be considered for testing and offered it if they:

• have symptoms of COVID-19
• have a recent known or suspected exposure to someone who has tested positive
• have been referred for testing by a health care provider or health agency
• are part of a cohort (group of students and staff) for whom testing is recommended due to an outbreak
• are attending a college that requires COVID-19 testing upon entry
• “are in a community where public health officials are recommending expanded testing on a voluntary basis,” including for asymptomatic people
• volunteer to be tested as part of surveillance testing

The latest version of the CDC guidance also notes: “Testing a random sample of asymptomatic students, faculty, and staff could increase the timeliness of outbreak detection and response by rapidly identifying and isolating COVID-19 cases that would have otherwise gone undetected without testing; the number of students tested should take into consideration the population size of students, faculty, and staff.”

The agency’s original guidance in June did not recommend testing of all students before they arrived on campus, which many institutions did anyway. That earlier guidance also only recommended testing for people with symptoms or suspected exposures to COVID-19.

In its own guidance, the Colorado Department of Public Health and Environment likewise doesn’t provide specific requirements for testing at colleges and universities, but calls close coordination with a local public health agency “critical.”

CDPHE’s guidance for higher education does not recommend “routine testing of healthy students, faculty, or staff” in most circumstances. A person who is exposed to someone with confirmed or suspected COVID-19 should be tested a week later, or as soon as they develop symptoms, according to CDPHE.

Regis University, a private college in Denver, is now being required by the Denver Department of Public Health and Environment to test all residential students for COVID-19 after an outbreak on campus, said Barbara Wilcots, vice president of student affairs. The school may only need that one round of surveillance testing — still ongoing — to adequately address the outbreak, since new cases have slowed down.

Before the school year started, Wilcots said, it was the university’s understanding that monitoring testing wasn’t recommended by the state. Regis didn’t implement routine testing of asymptomatic students at the beginning of the semester.

However, the university still spent some of its federally allocated CARES Act money on $40,000 worth of equipment, and uses that to process tests for students with COVID-19 symptoms, or known or suspected exposures.

In total, the campus — home to about 750 students — has experienced 77 cases, with 10 active cases as of Oct. 21.

The university is still figuring out the specifics of its testing strategy for next semester, Wilcots said.

“Our hope is that we’ll have the opportunity to test all residential students when they return,” she said, adding that the ultimate goal was to “understand how we can keep our students as safe as we possibly can.”

Students “can’t afford to lose semesters or a year trying to figure this thing out,” she said.

Regis University is still assessing whether to raise tuition or room and board for next year. However, Wilcots said, any potential increases won’t be a result of COVID-19 related costs.

Big universities see widespread transmission, smaller ones avoid similar outbreaks

COVID-19 testing at colleges and universities nationally is “really all over the map in terms of how they do it,” Hartle said. “It’s the course of the pandemic in the area where the school is located that has a lot to do with it.”

Universities across the state have also seen a range of outcomes. Outbreaks at CU Boulder caused cases to spike in Boulder County, health officials said, leading to strict public health orders that temporarily kept students from gathering in groups of more than two, plus stay-at-home orders for certain fraternity and sorority houses.

Since Aug. 24, CU Boulder has conducted more than 40,200 saliva-based molecular PCR tests for surveillance of asymptomatic people and 6,070 diagnostic nasal swab PCR tests.

Cases spiked in mid-September. On the worst day, Sept. 17, 130 positive results were detected through diagnostic tests conducted by CU Boulder Medical Services.

Since then, CU Boulder’s situation seems to have improved. The latest Boulder County Public Health order on gatherings — which required students to congregate in groups of no more than six — was lifted Oct. 20. Just nine positive test results were reported by CU Boulder for the week ending that day.

Colorado State University in Fort Collins is using wastewater testing as a key component of its strategy. Rather than conduct regular monitoring tests, the university contacts students living in residence halls where wastewater testing finds large amounts of the virus and requires them to get tested.

The school’s Pandemic Preparedness Team conducted more than 22,280 tests of on- and off-campus students, faculty and staff between Aug. 17 and Oct. 7, according to its website.

Those tests are administered and paid for by the university, and are only for the students it contacts and requires to get tested because of virus detected in sewage or potential exposure. Of those tests, 261 have been positive.

Students who aren’t contacted and asked to get tested by CSU, but want to get tested, are instructed to visit a Larimer County Public Health site. CSU’s website also says it planned to switch to primarily using saliva screening tests starting Oct. 10, and that “nasal swab tests will be reserved for individuals whose saliva screening indicates that the virus that causes COVID-19 could be present.”

“The saliva test offers the possibility that the university could scale up testing numbers, potentially providing the opportunity for any student, faculty or staff member who wants to get a test to do so,” the website says.

The university’s total number of cases since May is 614. That number, from the school’s COVID-19 dashboard, includes test results “compiled by CSU Public Health, Larimer County public health, and private physicians.”

Cases at CSU peaked Sept. 22, with 25 reported that day among students and one among staff. The school reported a total of 51 cases for the week ending Oct. 20.

Other colleges have seen far fewer cases.

School of Mines has reported 79 cases of COVID-19 since Aug. 17, with 14 active cases as of Oct. 20. For the week ending Oct. 20, eight cases were reported, all but one among students living off campus.

COVIDCheck Colorado has conducted a total of about 11,500 tests for School of Mines, of which 60 came back positive.

UNC has reported a total of 58 COVID-19 cases since Aug. 24, including 12 new cases between Oct. 14 and 21. Its website notes that the school only reports “confirmed cases through which other members of the university community may have been directly exposed.”

In the first week of conducting random surveillance tests for asymptomatic students in university housing, UNC conducted 351 tests. Of those, 269 yielded negative results, and the results of the remaining tests were still pending as of Oct. 21, according to the school’s website.

One advantage for UNC in avoiding large outbreaks: “We don’t have giant fraternity houses and sorority houses, so we don’t have some of those sort of places where we’ve seen big parties and things like that in Boulder,” Nickeson said.

“Our students continue to take this seriously, and I think with every week that goes by, everybody feels a little better,” he added.

Editor’s note: This story has been updated to include the number of students in CU Boulder, University of Denver and Adams State University residence halls.