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Assessment of a Multifaceted Approach, Including Frequent PCR Testing, to Mitigation of COVID-19 Transmission at a Residential Historically Black University

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Would a multimodal strategy of mitigation and testing be adequate to safely reopen a residential historically Black college and university (HBCU) campus in the setting of increasing COVID-19 positivity rates?

Findings  In this cohort study among 2320 individuals at a publicly funded HBCU, combining an active messaging campaign on shared responsibility and mitigation measures with frequent polymerase chain reaction testing was associated with decreased COVID-19 positivity rates compared with the surrounding community. The need for isolation and quarantine dormitory occupancy was limited.

Meaning  This study found that, in the setting of increased community COVID-19 positivity rates and the absence of a vaccine, well-described mitigation efforts and frequent testing were associated with decreased spread of disease.


Importance  COVID-19 posed an unprecedented threat to residential colleges in the fall of 2020. While there were mathematical models of COVID-19 transmission, there were no established or tested protocols of COVID-19 testing or mitigation for school administrators to follow.

Objective  To investigate the association of a multifaceted COVID-19 mitigation strategy using social, behavioral, and educational interventions and a program of frequent testing with prevalence of disease spread.

Design, Setting, and Participants  This cohort study was conducted as a retrospective review of COVID-19 positivity from August 16, 2020, to April 30, 2021, at Delaware State University, a publicly funded historically Black university. Participants included all students, faculty, and staff members with a campus presence. Positivity rates after use of mitigation strategies and testing on campus were compared with those of the surrounding community. Data were analyzed from July through September 2021.

Exposures  Mitigation strategies included education and outreach about social distancing, masking, and handwashing, and a COVID-19 testing plan consisted of twice-weekly polymerase chain reaction (PCR) screening using anterior nasal samples (fall and early spring semester) and then saliva-based samples (middle to late spring semester).

Main Outcomes and Measures  Cumulative tests, infections, daily quarantine, and isolation residence hall occupancy were measured, and comparisons were made with statewide COVID-19 positivity rates.

Results  The campus cohort included 2320 individuals (1575 resident students, 415 nonresident students, and 330 faculty or staff members). There were 1488 (64.1%) women and 832 (35.9%) men; mean (SD) age was 27.5 (12.9) years. During the fall semester, 36 500 COVID-19 PCR tests were performed. Weekly positivity rates ranged from 0 of 372 tests to 16 of 869 tests (1.8%) (mean [SD] positivity rate, 0.5% [0.5%]; 168 positive results and 36 312 negative results). During the same period, statewide positivity ranged from 589 of 25 120 tests (2.3%) to 5405 of 54 596 tests (9.9%) (mean [SD] positivity rate, 4.8% [2.6%]). In the spring semester, 39 045 PCR tests were performed. Weekly positivity rates ranged from 4 of 2028 tests (0.2%) to 36 of 900 tests (4.0%) (mean [SD] positivity rate, 0.8% [0.9%]; 267 positive results and 38 767 negative results). During the same period, statewide positivity ranged from 1336 of 37 254 tests (3.6%) to 3630 of 42 458 tests (8.5%) (mean [SD] positivity rate, 5.1% [1.3%]). Compared with statewide rates, campus positivity rates were mean (SD) 4.4 (2.6) percentage points lower during the fall semester (P < .001) and mean (SD) 5.6 (1.6) percentage points lower during the spring semester (P < .001). Total daily quarantine and isolation residence hall occupancy ranged from 0 to 43 students in the fall and 1 to 47 students during the spring.

Conclusions and Relevance  This study found that the combination of campuswide mitigation policies and twice-weekly COVID-19 PCR screening was associated with a significant decrease in COVID-19 positivity at a residential historically Black university campus compared with the surrounding community. Given the socioeconomic demographics of many students at historically Black colleges and universities, keeping these resident campuses open is critical not only to ensure access to educational resources, but also to provide housing and food security.

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Article Information

Accepted for Publication: October 5, 2021.

Published: December 13, 2021. doi:10.1001/jamanetworkopen.2021.37189

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Hockstein NG et al. JAMA Network Open.

Corresponding Author: Neil G. Hockstein, MD, ENT and Allergy of Delaware, 700 Prides Crossing, Ste 200, Newark, DE 19713 (nhockstein@entad.org).

Author Contributions: Dr. Hockstein had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Hockstein, Moultrie, Mason, Scott, Coker, Tuxward, DeLauder, Allen.

Acquisition, analysis, or interpretation of data: Hockstein, Fisher, Scott, Terheyden, Canter, Coons.

Drafting of the manuscript: Hockstein, Moultrie, Canter, Coons, Allen.

Critical revision of the manuscript for important intellectual content: Fisher, Mason, Scott, Coker, Tuxward, Terheyden, DeLauder.

Statistical analysis: Hockstein, Scott, Canter, Coons.

Obtained funding: Hockstein, Allen.

Administrative, technical, or material support: Hockstein, Moultrie, Fisher, Mason, Scott, Tuxward, Terheyden, DeLauder, Allen.

Supervision: Scott.

Conflict of Interest Disclosures: Ms Moultrie and Drs Fisher and Mason reported receiving grants from Testing for America (TFA) during the conduct of the study. Dr Mason reported receiving grants from Testing for America outside the submitted work. Lt Tuxward reported receiving consulting fees from TFA during the conduct of the study. Ms Terheyden reported receiving personal fees from TFA during the conduct of the study. No other disclosures were reported.

Funding/Support: This project was supported by the Testing for America Board of Directors.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Smalley  A., Higher education responses to Coronavirus (COVID-19). Accessed July 2021. https://www.ncsl.org/research/education/higher-education-responses-to-coronavirus-covid-19.aspx
Allen  T., Keeping faith, giving back: DSU offers facilities for testing, hospital overflow (opinion). Accessed July 2021. https://www.delawareonline.com/story/opinion/2020/04/03/keeping-faith-giving-back-dsu-offers-facilities-testing-hospital-overflow/5109468002/
Murty  KS , Payne  TB .  Pandemics of COVID-19 and racism: how HBCUs are coping.   AIMS Public Health. 2021;8(2):333-351. doi:10.3934/publichealth.2021026PubMedGoogle ScholarCrossref
Esbin  MN , Whitney  ON , Chong  S , Maurer  A , Darzacq  X , Tjian  R .  Overcoming the bottleneck to widespread testing: a rapid review of nucleic acid testing approaches for COVID-19 detection.   RNA. 2020;26(7):771-783. doi:10.1261/rna.076232.120PubMedGoogle ScholarCrossref
Nagura-Ikeda  M , Imai  K , Tabata  S ,  et al.  Clinical evaluation of self-collected saliva by quantitative reverse transcription-PCR (RT-qPCR), direct RT-qPCR, reverse transcription-loop-mediated isothermal amplification, and a rapid antigen test to diagnose COVID-19.   J Clin Microbiol. 2020;58(9):e01438-20. doi:10.1128/JCM.01438-20PubMedGoogle Scholar
Wyllie  AL , Fournier  J , Casanovas-Massana  A ,  et al.  Saliva or nasopharyngeal swab specimens for detection of SARS-CoV-2.   N Engl J Med. 2020;383(13):1283-1286. doi:10.1056/NEJMc2016359PubMedGoogle ScholarCrossref
Becker  D , Sandoval  A , Amin  A ,  et al  Saliva is less sensitive than nasopharyngeal swabs for COVID-19 detection in the community setting.   medRxiv. Preprint posted online May 17, 2020. doi:10.1101/2020.05.11.20092338Google Scholar
College launches innovative new COVID-19 testing protocols. Good Morning America. Accessed November 5, 2021. https://www.goodmorningamerica.com/news/video/college-launches-innovative-covid-19-testing-protocols-72377355
Campus shield/COVID-19 health screening. Delaware State University. Accessed July 2021. https://www.desu.edu/student-life/student-health-services/coronavirus/campus-shield-covid-19-health-screening
US Food and Drug Administration. Emergency use authorization (EAU) summary: Guardant-19. Updated December 28, 2020. Accessed November 11, 2021. https://www.fda.gov/media/141487/download
H  Quinn . Delaware State University launched a lab for COVID-19 testing in Wilmington. Technical.ly. Accessed July 2021. https://technical.ly/delaware/2021/01/29/del-state-lab-covid19-testing/
US Food and Drug Administration. Coronavirus (COVID-19) update: FDA issues emergency use authorization to Yale School of Public Health for SalivaDirect, which uses a new method of saliva sample processing. Accessed July 2021. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-issues-emergency-use-authorization-yale-school-public-health
My Healthy Community. COVID-19 dashboard. Accessed July 2021. https://myhealthycommunity.dhss.delaware.gov/locations/county-new-castle/cases
Thurgood Marshall College Fund. About HBCUs. Accessed July 2021. https://www.tmcf.org/about-us/member-schools/about-hbcus/
Webb Hooper  M , Nápoles  AM , Pérez-Stable  EJ .  COVID-19 and racial/ethnic disparities.   JAMA. 2020;323(24):2466-2467. doi:10.1001/jama.2020.8598PubMedGoogle ScholarCrossref
Mackey  K , Ayers  CK , Kondo  KK ,  et al.  Racial and ethnic disparities in COVID-19–related infections, hospitalizations, and deaths: a systematic review.   Ann Intern Med. 2021;174(3):362-373. doi:10.7326/M20-6306PubMedGoogle ScholarCrossref
Paltiel  AD , Zheng  A , Walensky  RP .  Assessment of SARS-CoV-2 screening strategies to permit the safe reopening of college campuses in the United States.   JAMA Netw Open. 2020;3(7):e2016818. doi:10.1001/jamanetworkopen.2020.16818PubMedGoogle Scholar
Benneyan  JC , Gehrke  C , Ilies  I , Nehls  N .  Potential community and campus COVID-19 outcomes under university and college reopening scenarios.   medRxiv. Published online September 2, 2020:2020.08.29.20184366. doi:10.1101/2020.08.29.20184366PubMedGoogle Scholar
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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