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Can a multifaceted approach lead to control of COVID-19 transmission and spread on an urban campus?
In this case series including more than 500 000 COVID-19 tests and 719 individuals with COVID-19 at Boston University, active surveillance of campus populations, isolation of individuals with SARS-CoV-2 infection, early and vigorous contact tracing and quarantine, regular communication, robust data systems, and strong leadership were associated with minimal transmission of SARS-CoV-2. Most transmission occurred off campus, and there was no evidence of classroom transmission.
These findings suggest that using frequent testing, vigorous contact tracing, rapid isolation and quarantine, and a strong leadership structure to ensure rapid decision-making and adaption to emerging data, controlling the spread of SARS-CoV-2 on an urban campus was feasible despite worsening local transmission during the semester.
The COVID-19 pandemic has severely disrupted US educational institutions. Given potential adverse financial and psychosocial effects of campus closures, many institutions developed strategies to reopen campuses in the fall 2020 semester despite the ongoing threat of COVID-19. However, many institutions opted to have limited campus reopening to minimize potential risk of spread of SARS-CoV-2.
To analyze how Boston University (BU) fully reopened its campus in the fall of 2020 and controlled COVID-19 transmission despite worsening transmission in Boston, Massachusetts.
Design, Setting, and Participants
This multifaceted intervention case series was conducted at a large urban university campus in Boston, Massachusetts, during the fall 2020 semester. The BU response included a high-throughput SARS-CoV-2 polymerase chain reaction testing facility with capacity to deliver results in less than 24 hours; routine asymptomatic screening for COVID-19; daily health attestations; adherence monitoring and feedback; robust contact tracing, quarantine, and isolation in on-campus facilities; face mask use; enhanced hand hygiene; social distancing recommendations; dedensification of classrooms and public places; and enhancement of all building air systems. Data were analyzed from December 20, 2020, to January 31, 2021.
Main Outcomes and Measures
SARS-CoV-2 diagnosis confirmed by reverse transcription–polymerase chain reaction of anterior nares specimens and sources of transmission, as determined through contact tracing.
Between August and December 2020, BU conducted more than 500 000 COVID-19 tests and identified 719 individuals with COVID-19, including 496 students (69.0%), 11 faculty (1.5%), and 212 staff (29.5%). Overall, 718 individuals, or 1.8% of the BU community, had test results positive for SARS-CoV-2. Of 837 close contacts traced, 86 individuals (10.3%) had test results positive for COVID-19. BU contact tracers identified a source of transmission for 370 individuals (51.5%), with 206 individuals (55.7%) identifying a non-BU source. Among 5 faculty and 84 staff with SARS-CoV-2 with a known source of infection, most reported a transmission source outside of BU (all 5 faculty members [100%] and 67 staff members [79.8%]). A BU source was identified by 108 of 183 undergraduate students with SARS-CoV-2 (59.0%) and 39 of 98 graduate students with SARS-CoV-2 (39.8%); notably, no transmission was traced to a classroom setting.
Conclusions and Relevance
In this case series of COVID-19 transmission, BU used a coordinated strategy of testing, contact tracing, isolation, and quarantine, with robust management and oversight, to control COVID-19 transmission in an urban university setting.
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Accepted for Publication: May 3, 2021.
Published: June 25, 2021. doi:10.1001/jamanetworkopen.2021.16425
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Hamer DH et al. JAMA Network Open.
Corresponding Author: Davidson H. Hamer, MD, Department of Global Health, Boston University School of Public Health, 801 Massachusetts Ave, Crosstown Third Floor, Boston, MA 02118 (email@example.com).
Author Contributions: Drs Hamer and Kolaczyk had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Kolaczyk, Waters, and Brown contributed equally as co–senior authors.
Concept and design: Hamer, White, Jenkins, Gill, Landsberg, Klapperich, Platt, Densmore, Landaverde, Rose, Miller, Kolaczyk, Waters, Brown.
Acquisition, analysis, or interpretation of data: Hamer, White, Jenkins, Landsberg, Klapperich, Bulekova, Platt, Decarie, Gilmore, Pilkington, MacDowell, Faria, Li, Rose, Burgay, Doucette-Stamm, Lockard, Elmore, Schroeder, Zaia, Kolaczyk, Brown.
Drafting of the manuscript: Hamer, White, Jenkins, Gill, Landsberg, Klapperich, Decarie, Gilmore, Faria, Li, Rose, Miller, Doucette-Stamm, Lockard, Kolaczyk, Waters.
Critical revision of the manuscript for important intellectual content: Hamer, White, Jenkins, Gill, Landsberg, Klapperich, Bulekova, Platt, Decarie, Pilkington, MacDowell, Densmore, Landaverde, Burgay, Doucette-Stamm, Elmore, Schroeder, Zaia, Brown.
Statistical analysis: White, Landsberg, Bulekova, Li, Kolaczyk, Brown.
Obtained funding: Klapperich, Waters, Brown.
Administrative, technical, or material support: Hamer, Landsberg, Klapperich, Decarie, Gilmore, Pilkington, MacDowell, Faria, Densmore, Landaverde, Burgay, Miller, Doucette-Stamm, Lockard, Elmore, Waters, Brown.
Supervision: Hamer, Klapperich, Platt, Densmore, Doucette-Stamm, Schroeder, Kolaczyk, Waters.
Conflict of Interest Disclosures: Dr Hamer reported receiving grants from the Centers for Disease Control and Prevention and personal fees from Xenophon Strategies, Major League Soccer, the Professional Golf Association, and Equinox outside the submitted work. Dr Gill reported receiving personal fees from CureVac and Takeda outside the submitted work. Dr Klapperich reported receiving grants from the National Institutes of Health and Department of Defense and serving as a cofounder of Biosens8 outside the submitted work. Dr Densmore reported serving as a founder for BioSens8, Lattice Automation, and Asimov outside the submitted work. No other disclosures were reported.
Funding/Support: This work was funded internally by Boston University (BU). All authors are BU employees or consultants.
Role of the Funder/Sponsor: The funder was involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, and approval of the manuscript; and decision to submit the manuscript for publication.
Additional Contributions: Carrie Landa, PhD, (Student Health Services) provided critical input to the development of the Healthway system for students and the public facing dashboard as well as the broader university campaigns; Brian Gregor, PhD (BU Information Services & Technology) assisted in covasim code customization; Rita R. Chen, BS (BU Biological Design Center and Department of Electrical and Computer Engineering), assisted in development of the COVID-19 testing laboratory automation protocol using liquid-handling robots; Dany Fu, BS (Hariri Institute of Computing) assisted with assay automation and laboratory information management system (LIMS) integration; David McIntyre, BS, PhD (Biomedical Engineering Department, CIDAR Lab) was the lead internal automation specialist programming and debugging the COVID testing protocols; Ryuichi Ohhata (CIDAR Lab and Department of Electrical and Computer Engineering) assisted with the back-up plugin development for the LIMS; Luis Ortiz, PhD (Biological Design Center and Department of Molecular Biology, Cell Biology & Biochemistry) assisted with the automation pipeline and LIMS integration; Radhakrishna Sanka, MS (Biological Design Center and Department of Electrical and Computer Engineering), assisted with the automation pipe; and Samuel M. D. Oliveira, MSc, PhD (Biological Design Center, and Department of Electrical and Computer Engineering) led the initial project for protocol automation using liquid-handling robots. All acknowledged individuals were paid by BU for their efforts and have provided written consent to being named in this publication.
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