Here are updates on IU's fall plan to prevent and monitor coronavirus

Pre-arrival COVID-19 tests are recommended for all students, regardless of their residence situation on campus, according to the webinar.

Students living in residence halls, greek housing or on-campus apartments this fall are required to get a COVID-19 test within 10 days of their permanent move-in date. Students must take a symptomatic test — the one where they poke around in one's nose. Results must be submitted to IU online. If a student tests positive or they don't submit test results to the university, they will not be permitted to move in and attend class on campus.

Students coming to campus from outside the United States are not required to get a pre-arrival COVID-19 test, but are required to self quarantine for 14 days once they arrive in the country. Once international students get to campus, they will receive a vault-at-home test from the university, which is a saliva test they will self-administer and then mail to Rutgers University for testing due to a partnership between the two schools.

Students living off-campus are not required to get a pre-arrival test. All students are asked to follow guidelines from the Centers for Disease Control and Prevention, including social distancing, wearing masks in public and avoiding large events for at least 14 days, before they arrive on campus.

IU plans to use different types of tests for different scenarios. Symptomatic tests — the nasal ones — are used if a patient already suspects they have COVID-19. The tests are usually covered by health insurance, but if a student’s insurance doesn’t cover them or if they don’t have insurance, IU will cover the cost of their test, according to the webinar. These tests are “the gold standard with respect to sensitivity and specificity,” according to Aaron Carroll’s comments in the webinar.

“When someone is symptomatic, we absolutely positively need to know if they’re infected both for clinical purposes and management purposes,” Carroll said.

Surveillance testing, which is used to assess large groups of the population to assess the health of IU as a whole, is different. These tests will just require a saliva sample — when students arrive, they will go to a station set up somewhere on campus, drool in a container and their bodily fluid will be shipped to Rutgers University to be tested. Results will come back in one to two days. The cost of these surveillance tests will be completely covered by the university. It’s much easier to get these samples, but they can be less accurate than the more painful nasal tests.

“We have an expectation that the sensitivity may be lower, because we’re using saliva and because we’re using a different test,” Carroll said in the webinar. “Our goal is not diagnosis, our goal is to reduce the spread. If we’re missing some people who are the least infectious, that’s the cost of business.”

Though saliva tests are less reliable case by case, efficiency, speed and the highest amount of tests possible are required to monitor the virus at a university as large as IU. These tests are the most cost-effective and realistic tool, according to the webinar.

All students living on or off campus will be tested for coronavirus once they arrive, regardless of their pre-arrival testing requirements. The purpose of the arrival test is more to monitor the state of COVID-19 on campus overall rather than identifying specific cases.

From Aug. 8-20, approximately 11,500 students will move into on-campus housing and about 3,000 students will move into greek housing. Each of these students will take a BD antigen test — a symptomatic nasal test — when they arrive. These are more accurate than saliva tests and provide results in 10 to 15 minutes. Each student is allowed two guests to help with move in. Guests will not be provided with antigen tests.

If students test positive, they will be asked to return home or isolate on campus if returning home is considered unsafe. IU has set aside over 500 rooms for isolating students who live on campus, and each greek house will have its own isolation area, though details on that are not completely fleshed out, according to the webinar.

From Aug. 14-20, about 22,000 students who are moving into off-campus housing for the semester will be tested, according to the webinar. These students will likely go to Memorial Stadium to receive vault-on-site saliva tests that will be sent to Rutgers for processing. If they test positive, they will also be asked to isolate or go home, but IU will not offer a location to isolate for off-campus students.

A recent study conducted by researchers from Yale and Harvard found that students could return to campus with almost guaranteed safety if they were tested every two days. While IU lacks the infrastructure to test that frequently, Carroll, Beeler and Gardner agreed in the webinar that concentrated surveillance of cases with as much frequency as possible is necessary to keep the COVID-19 situation under control this semester.

Students, faculty and staff will be randomly selected periodically, ideally once a week or once every two weeks, to be randomly tested for the coronavirus. The chosen individuals will be notified virtually that they must report to a testing location within a certain period to be tested. These random checks will use the surveillance saliva tests processed at Rutgers with results coming back within 24-48 hours, according to the webinar.

Carroll said IU’s goal is to test 10,000 individuals per week across all IU campuses, noting that while saliva testing isn’t always accurate, it’s “good enough for surveillance purposes.”

IU does not currently have the resources to process all these tests, and is planning to process most of them in its partnership with Rutgers University. The panelists said IU is planning to develop two labs on its IU-Purdue University Indianapolis campus and one at the Bloomington campus where tests will eventually be processed. These labs will theoretically be ready for use in about eight weeks.

Carroll also noted that when testing capacities increase, the university will be able to test more samples by using a technique called pooling, which is when several saliva samples are mixed together and tested at once. In this method, if the mix of samples is negative, all of those individuals test negative, but if it is a positive result, then each individual sample in the pool must be retested to determine which individual has the virus.

This method will be used to cut costs, increase efficiency and increase the amount of tests in the future, according to the webinar.

If a student tests positive, the university will respond as fast as possible with contact tracing. Contact tracing is an important part of limiting the spread of individual patients who are sick, but Gardner emphasized the importance of preventative methods in addition to this procedure, acknowledging that contact tracing is like the “last line of defense” and is “not a replacement for behavior change.”

Students diagnosed with COVID-19 will get a phone call from IU Health, MCHD, or possibly both. They will be required to isolate, either in an IU-provided room, in their off-campus housing or at their home away from campus. Contact tracers will ask who they have been within six feet of for more than 15 minutes in the past several days and more specific questions about what types of rooms they have been in to determine who else needs to quarantine.

IU's own contact tracers will partner with the Monroe County Health Department and the Indiana State Department of Health to trace COVID-19 cases. Speed and efficiency is a top priority for finding and notifying those who have been in contact with someone who tested positive, according to the webinar.

Many aspects of IU’s COVID-19 plans depend on student, faculty and staff compliance. For example, everyone is asked to take their temperature daily, but there is no way to realistically enforce this policy.

When asked about how random testing will be enforced, Carroll did not provide a concrete enforcement plan, but said that “there are expectations about what's necessary to be on campus.” According to the webinar, Provost Lauren Robel plans to announce more details on how random testing and other policies will be enforced sometime this week.

When asked about the enforcement of limits on social gatherings, which should not exceed 10 people according to university guidelines, IU spokesperson Chuck Carney said members of greek organizations as well as other students on campus will be subject to disciplinary action from the university if they violate these rules. He said there is not specific disciplinary guidance planned out for how parties will be dealt with, but some actions will be taken.

Carney said off-campus parties will be dealt with slightly differently because they are under the jurisdiction of city and county health orders, which limit private gatherings to 50 people or fewer and require masks and social distancing at all gatherings. Carney did not specify how the university plans to deal with potential off-campus parties, but said they will be subject to city and county officials.

There is no specific benchmark of cases or other data that would cause IU to close down and go 100% virtual as it did in the spring semester. Instead, the university will monitor a series of different benchmarks to determine how everything is going, and if too many benchmarks are alarming, it may send students home, according to the webinar.

Beeler said if too many of the data points, including cases on campus and Bloomington overall and success of contact tracing, aren't going well, he and his colleagues will notify administrators and they will make decisions from there.

Here are the data points included in the webinar presentation that would be potential triggers for students to go home:

• If contact tracing procedures see more than a five-day delay
• If there is a delay greater than 72 hours in getting positive test results
• If the contact tracing success rate is less than 90%
• If hospital ward and ICU bed capacity at the closest hospital is greater than 80%
• If there aren't enough hospital ventilators and personal protective equipment (less than 14 days available on hand)
• If the seven-day rolling average change in positive cases among everyone tested (symptomatic and asymptomatic) exceeds 10%
• If the three-day rolling average change in positive cases among all tested (symptomatic and asymptomatic) exceeds 20%
• If utilization of quarantine/isolation dorms exceeds 75%
• If over 10% of the total population is in quarantine/isolation
• If over 10% of the residential population in isolation/quarantine
• If lab test turn around time is longer than two days

The panelists reiterated that there is no magic number of factors that will cause the university to close. The decision will depend on the discretion of university administrators and medical advisers, and these points are just one part of that process.

IU has not released much information about what would happen if campus shut down. It is not clear whether students will be forced to leave campus, how long they would have to move their belongings or whether students would receive financial support from the university. IU has also not released any information that suggests tuition refunds are a possibility.

While data points like the number of cases, effectiveness of contact tracing and other IU-specific metrics will be monitored internally, the panelists as well as Carney did not know how and when this information would be provided to the public. Carney said many of the data points not specific to IU, such as hospital capacity and the number of available ventilators, are accessible on external websites.

IU students, parents, staff and faculty may have to rely on reports from Monroe County overall to get numbers on how many cases IU is seeing. However, the case reporting process from the Indiana State Department of Health, which provides that information, has often been slow and sometimes inaccurate — case data on long-term care facilities for example, which is supposed to be reported in ISDH's daily numbers, is still not reported consistently.

IU’s reporting process is also unclear. Since the MCHD gets all of its data from the state, it is not evident whether IU will keep track of its own case data for staff, faculty and students or whether it will depend on the reports from the state as well, which could make reporting slow and inaccurate.

In addition to the coronavirus, the panelists voiced concerns about the impending flu season. Since many symptoms of COVID-19 are similar to flu symptoms, they emphasized the importance of flu vaccines and prevention to avoid confusion between the two illnesses.

Beeler said prevention measures will be especially important during flu season due to the added level of confusion and sickness in the population. He mentioned that IU may provide large numbers of flu vaccinations to students, staff and faculty in an effort to prevent flu outbreaks, in addition to pushing flu awareness in public health messages.

“We may have local outbreaks,” Beeler said. “To be 100% honest, this virus is extremely difficult to control.”