June 17, 2020
As you know, we have publicly announced our intention to resume in-person teaching and learning and to repopulate our residential campus in the fall. Since mid-April, our recovery teams have been working nonstop toward these goals with the primary objective of providing a safe and healthy environment for our students, staff, and faculty, acknowledging the presence of COVID-19.
While the announcement was a milestone in that process, it was by no means the end of the work. There are many questions that we have not answered and plans that still need to be finalized. I recognize that many of you have pressing questions and concerns about how our return to campus will be executed especially as this relates to the health and safety of everyone on campus and the details of the classroom environment.
I wish I could answer all your questions now. Every member of our community has been dealing with extraordinarily difficult circumstances. Many are caring for children and elderly family members while teaching and working from home. I know you are all worried about how you will continue to balance these responsibilities when we return to campus if other services such as daycare and K-12 education are not open or are operating in ways that don’t easily align with our schedules. And these issues are all overlaid with the understandable concern about the health risk that COVID-19 continues to pose.
We are working on the unanswered questions. Today, I write to you about the public health and safety processes we are developing and implementing for our students, staff, and faculty, and particularly about the importance of community COVID-19 testing to keep our community safe. Achieving the goal of protecting our community will require the commitment of the entire Boston University community to adhere to necessary practices and protocols. The approach described in this message is to develop layers of protection to limit the spread of the disease and combine these protections with actions to identify infected individuals, get them treatment, and contain any spread of the virus.
The protocols that are described below are comprehensive and will be effective if we adhere to them. They are, of necessity, mandatory for everyone in our academic community.
In the remainder of this letter, I will address four specific issues:
- Public health protocols to help prevent or limit COVID-19 infections
- Symptom reporting by individuals
- Community testing
- Medical intervention for cases of the virus
Public Health Protocols to Help Prevent or Limit COVID-19 Infections
COVID-19 is transmitted when it is “shed” by infected people, primarily in aerosolized droplets emitted by breathing, coughing, and sneezing. The infectivity of the disease is measured by the rate of transmission (RT), which denotes the number of people infected by a single infectious person; RT greater than 1 defines spread of the disease. It is very important to understand that the RT is not an intrinsic property of COVID-19 itself, but a function of the biology of the disease, the environment, and societal and individual actions that limit transmission. There are many things we can do to drive down the transmission of the virus. These include: physical distancing, wearing face coverings, hand washing, air purification, and other sanitation measures. Each of these contributes to lowering RT, and our approach must be to incorporate all these layers of protection.
As you have seen in Back2BU for the reopening of research and clinical services, our campus protocols stipulate all of these actions, which we will continue throughout the fall or until a vaccine is available.
We are also learning that one of the important characteristics of COVID-19 is that it can infect individuals who remain asymptomatic throughout much of the time, if not the entire time, they have the disease, but who nonetheless may be transmitting the virus throughout this period. The exact fraction of infected people who remain asymptomatic is not known precisely, but there are reports that this fraction could be as large as 40 percent of cases. This is a critical observation for minimizing the spread of COVID-19 in our community as it indicates that symptom checking, either by self-attestation or temperature checking, is not enough to stop the spread of the virus.
Our testing program will focus on identifying both asymptomatic and symptomatic members of our community who are carrying COVID-19 so they can be promptly treated and isolated.
Symptom Reporting by Individuals
A first layer of protection for our community is an individual’s obligation to report symptoms of COVID-19. We will do this during the fall with an automated process based on a proprietary health app (using BU authentication) where each member of the community can attest whether they have symptoms of the virus. The information for faculty and staff will go to medical professionals in the Occupational Health Center. Individuals with positive symptoms may be asked to come to a testing center for a test.
A foundation for our strategy for oversight of the community and medical intervention will be the availability of direct testing for the virus. Currently, the most effective method for detecting the presence of the virus is the RT-PCR method. This stands for reverse transcription polymerase chain reaction. The test detects the RNA from the virus using genomic technology. There are a number of ways of acquiring a sample, ranging from the nasopharyngeal method originally used, to new methods of self-acquisition from the nostril (anterior nares or AN) and saliva.
The Boston University testing approach will be based on RT-PCR, at least initially, and will use AN sample collection. It will detect both asymptomatic and symptomatic infected individuals with high accuracy. We are establishing a high-throughput facility for RT-PCR testing in the Rajen Kilachand Center for Integrated Life Sciences & Engineering; the facility has the capacity to process over 5,000 tests per day and to deliver the results in under 24 hours.
We are developing a plan for administering the testing to students, faculty, and staff on the Charles River and Medical Campuses. We will test everyone coming to campus in August as the academic year begins and then continue testing throughout the semester. (Special planning is also underway for student cohorts on the Medical Campus who will begin classroom activities in July.) Using the health app, individuals will be notified at least a day in advance of the need to be tested and the date for the test. The test can be performed at any one of several testing stations that will be deployed on campus. At the station they will receive a test kit with a bar-coded vial for the sample. They will perform the test under observation and leave the vial for transport to the testing facility.
The result of the test will be communicated to them via the app within 24 hours. The test result will also be conveyed to Student Health Services (for students) and the Occupational Health Center (for staff and faculty).
How will we determine how often to test each individual student, staff, and faculty member? Disease modeling and the biology of disease progression give us some guidance. Our strategy is to use testing in concert with the other layers of protection discussed here to drive down the prevalence of the virus in our community. Our testing frequency will be adjusted according to the prevalence of the virus in our community and in Boston.
Although we have not finalized our testing protocols, we are developing them as a function of categories for faculty, staff, and students. The testing for employees includes the University’s dining services vendor.
The four categories we are considering are:
- Residential undergraduate students and RA staff
- Commuting students, staff, and faculty who interact with residential students for significant periods of time either in classes or other activities or who otherwise spend many hours on campus in close contact activities like athletics, performing arts, or in some research and off-campus educational environments.
- Students who live off campus and employees who, due to age or medical condition, have disclosed (through a confidential process) that they fall within a CDC high-risk category (or who have disclosed that they have household members in these categories)
- Students and employees who use public transportation to go to or from campus
- Clinical service employees (including, for example, faculty and students providing services to members of the community, but excluding Boston University Medical Group faculty who do not have classroom or laboratory contact with students and other BU faculty and staff members) and first responders like the BUPD who have high contact hours with each other or must interact frequently with individuals outside the University who may not have taken basic CDC protective measures (masking, distancing, self-diagnosis)
- Commuting students residing off-campus attending in-person classes, but with little contact with residential students
- Commuting employees, including certain faculty, who are student-facing, but have little contact with residential students and have limited contact hours in venues such as classrooms. Although at risk for infections from outside the Boston University community, individuals in this category will work within protocols established for entry into the BU work environment.
- Commuting employees whose job duties require very limited contact with students and who can control their contact with other employees so as to limit interactions to small groups of individuals with appropriate work environment protocols in place and minimal contact hours
- Students, faculty, and staff who engage only in virtual learning, working, and other activities and events and who do not commute to campus
Although the details of testing strategies for each category are under development, some decisions have been made. We will test all members of categories 1–3 before the start of classes. Presently, we also are planning to test all members of categories 1 and 2 at least weekly. The processes for determining how individual faculty and staff are accommodated within the groups will be forthcoming soon as well.
Medical Intervention for Cases of the Virus
If a faculty or staff member tests positive, the Occupational Health Center will be in touch with the individual about both medical and public health measures. The individual will also be retested to verify the positive result.
Students who test positive will be contacted by Student Health Services. The individual will also be retested to verify the positive result. Residential students who test positive will be moved to special isolation rooms with supervised medical care. We are setting aside rooms for this purpose.
Contact tracing for rapid identification of those who might have been exposed to the virus by an infected person is key to controlling its spread—this is an essential motivation for fast turnaround of the test. The University will implement contact tracing for anyone in the BU community who has tested positive and has had interactions on campus. For residential students, the individuals in their immediate housing group or household will be a primary focus, as well as others with whom they have had close contact in preceding days. In the spring we began a contact tracing program for this purpose and will expand it for the fall.
Life on campus will not look or be the same as it was last fall. However, our plans to return to campus operations with new protocols and policies will enable us to reconstitute the vibrant residential community that is the foundation of the learning environment that our students and their parents expect from Boston University. Most importantly, the layers of protection I have described above are designed to keep our students, faculty, and staff healthy by helping to prevent the spread of COVID-19 in our community.
Please stay safe and well.
Robert A. Brown
*This letter was updated on June 23 to clarify the contact tracing population.