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Health expert: Liberty University needs more testing to find asymptomatic COVID-19 cases

Health expert: Liberty University needs more testing to find asymptomatic COVID-19 cases

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{child_flags:top_story}Health expert: Liberty University needs more testing to find asymptomatic COVID-19 cases

{child_byline}By RICHARD CHUMNEY

rchumney@newsadvance.com{&by2}

{&by3}(434) 385-5547

{/child_byline}

Due to a lack of widespread testing, the official tally of students sick with the novel coronavirus at Liberty University likely is undercounting those who may not know they’ve contracted the virus, according to a leading health expert.

The university on Tuesday reported 84 students had tested positive for COVID-19 in the preceding two weeks. Another 89 students had tested negative, putting the positivity rate at a striking 48.5%. By comparison, Virginia as a whole reported a seven-day rolling average positivity rate of 7.5% Friday, meaning 7.5 out of every 100 tests returned a positive result last week.

A high percentage of positive results suggests the virus may be spreading undetected and more testing is needed to identify infected individuals, including those without symptoms, said Lucia Mullen, an epidemiologist and senior analyst at the Johns Hopkins Center for Health Security.

“We need to have very regular testing to make sure that people aren’t being exposed,” Mullen said. “This isn’t a one and done thing. As long as the virus is continuously circulating within the community, every day you have a chance of being exposed.”

Liberty tested 328 out of about 15,000 students during the first two weeks of classes, a spokesperson said Tuesday. At the time, 155 of those students still were awaiting results. The university plans to publish weekly updates online starting Monday.

University officials have said the school will move instruction online if 5% of the total on-campus population — including students, staff and faculty — test positive for COVID-19. But Mullen said because Liberty is not testing large numbers of students on a regular basis, the true scope of the virus’ reach on campus is impossible to know.

Mullen suggested colleges and universities should test between 25% to 40% of their populations once or twice per week to find and isolate infected students and employees — especially asymptomatic carriers — before they spread the disease to another person.

The Centers for Disease Control & Prevention estimates about 40% of those with COVID-19 show no signs of the disease. Health experts said asymptomatic carriers may be less likely to spread the disease than symptomatic individuals but asymptomatic transmission can — and often does — occur.

Kerry Gateley, director of the Central Virginia Health District, said Liberty’s high positivity rate reflects the school’s decision to only test students who are presumed to be sick, a practice known as diagnostic testing.

Gateley agreed the only way to uncover the so-called silent asymptomatic spread, which he noted has been linked to large outbreaks across the country, is to conduct widescale surveillance testing quickly and accurately.

But Gateley has not recommended Liberty ramp up testing in part because of the challenges serial testing poses. With such a large student population, and with routine contact between students and city residents, the university would need to perform hundreds or thousands of tests several times per month to find asymptomatic cases.

“You just don’t know,” Gateley said. “And unless you did a whole lot of testing, and did it right, you’re not going to know.”

Liberty has contracted with Central Virginia Family Physicians to run its health center, which is sending test samples to LabCorp, a commercial lab, to be processed. CVFP President Thomas Eppes said last month LabCorp likely would be overwhelmed if Liberty attempted to test each student at the same time.

CVFP has purchased multiple rapid COVID-19 testing machines to be used at Liberty’s health center. But the machines, which are about the size of a coffee maker and can return results for four tests in under an hour, have not yet been delivered because of a manufacturing delay.

In response to written questions, Keith Anderson, executive director of the Health & Wellness Office of Liberty University, rejected the suggestion an increase in testing would help the school manage the virus’ spread on campus.

“For surveillance testing to be accurate and a true monitor of infection rate or asymptomatic transmission in a particular model, there must be a closed system or environment,” Anderson wrote in a statement. “None of our five local universities exist in a closed environment, however. As a result, the feasibility of surveillance testing [with the associated cost and logistics — who to test, what percent, and how] would not provide sufficient additional benefit from the gained information.”

Anderson noted the university’s official count of COVID-19 cases does not offer a complete picture of the number of tests since it may not include results from students who test negative at an outside health provider.

“It is unclear how many tests students or employees are having testing done outside our on-campus office,” he wrote. “Only positive results from those outside locations are likely to get reported to Liberty due to public health requirements. So the raw total of people who are positive increases but this does not account for those that tested negative.”

Liberty is far from the only college or university to not perform widespread testing. Despite the risks posed by asymptomatic spread, the Virginia Department of Health and the CDC did not recommend colleges and universities test students before the semester because the practice had not been systematically studied.

However, some institutions in the state did require students to take what is known as an “entry test” before returning to campus. Others went further and developed widescale testing plans.

George Mason University and Virginia Commonwealth University plan to test a random sample of students to track the spread of the disease. Meanwhile, researchers at Virginia Tech and the University of Virginia are testing campus wastewater to find the early signs of an outbreak.

Gateley, who is leading the response to the pandemic in the Hill City and the surrounding counties, said there are some signs the health threat may be waning locally but stressed the virus still is spreading actively.

The seven-day average of new daily cases in the local health district dropped to 29 Friday, down from a peak of 50 last month, according to VDH data.

“I wouldn’t want to say that we’ve got a defined decline yet but the early signs are promising,” he said. “It’s starting to look like it’s going in the right direction for us now.”

Gateley said his office has not identified infections associated with classroom activity at any of the area colleges and universities. He said the risk of exposure is greatest in residence settings where students are around others for long periods of time.

Still, Mullen warned without a robust testing and contact tracing system, the rapidly spreading coronavirus could race across campus undetected.

That exact scenario unfolded earlier this month at James Madison University. The school was forced to send thousands of students home after the number of positive cases ballooned from a few dozen to hundreds in the span of a week. Like at Liberty, testing was not required for JMU’s about 22,000 students.

Hannah Gaydos, a student living on campus, said she’s been frustrated by Liberty’s approach to the pandemic. She said the school’s mask mandate has not been strictly enforced outside of classrooms and dining halls and the school is not actively encouraging students to get tested.

Gaydos has family members who are vulnerable to COVID-19 and she’s worried she may spread the disease to her loved ones if the university faces a severe outbreak and she’s forced to move back home. Given the risks involved, Gaydos said she is puzzled by Liberty’s decision to not publish daily case counts online and to not test every student, as other colleges and universities in Virginia have done.

“I don’t see any good in what Liberty is doing right now,” she said. “I can’t find a good reason as to why they’re not giving us the numbers and why they’re not enforcing testing.”

James Carrig, a history student, sees things differently. He said Liberty should be praised for offering tests on request, including to students without symptoms. He argued the school likely would face insurmountable logistical challenges if it attempted to test each student. Carrig said he also believes Liberty is closely following all federal and state guidelines and that students have been given the necessary tools to stay safe.

“There are options for complete online learning. You can totally isolate yourself from the student body,” he said. “I think the university is handling it as best as they can.”

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Related to this story

Liberty University on Wednesday reported 135 active COVID-19 cases among its students and employees, a small decrease from the 141 active cases reported a week earlier.

Nearly 1,200 students and employees have been instructed to quarantine, according to the university’s COVID-19 dashboard.

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