Q&A: How BU Plans to Test Students, Faculty, and Staff for COVID-19
ENG’s Catherine Klapperich on how self-sampling, robots, and a new lab will help make campus as safe as possible
The key step in the return to any sort of residential life at Boston University is testing people for COVID-19—making students, faculty, and staff comfortable about coming back by ensuring the campus is being tested regularly for the novel coronavirus.
With more than 30,000 students and more than 10,000 employees, it’s a challenge BU has decided to handle itself. Under the guidance of the BU Precision Diagnostics Center at the College of Engineering, and its director, Catherine Klapperich, an ENG professor of biomedical engineering, and an appointed professor of biomedical engineering and materials science and engineering, the University is taking steps to stand up its own testing program to help contain the virus that has infected more than 1.5 million people nationwide and killed more than 95,000, including more than 6,000 deaths in Massachusetts.
Standing up a testing center is an enormous undertaking, as Klapperich explains in this interview with BU Today. The conversation has been edited and condensed for clarity.
With Catherine Klapperich
BU Today: How did you first learn that BU was thinking about implementing its own testing plan, and what was your reaction?
Klapperich: I got a note from [BU President] Bob Brown to talk about possibilities for testing across all of BU’s campuses. I had been running the thought experiment in my head for a few weeks, trying to figure out how we could open up safely. The CReM [Center for Regenerative Medicine] had done an amazing job expanding the testing capabilities at Boston Medical Center, and I had been following that closely. I got some guidance from George Murphy and Nancy Miller, both School of Medicine associate professors, who put that effort together. They remain consultants to me on this project. Their initiative in putting that together was inspiring, and I thought we could greatly expand the number of tests BU performs across all campuses beyond what CReM can do.
My first stop was my colleague Doug Densmore, an ENG associate professor of electrical and computer engineering, who works with liquid handling robots and software to do synthetic biology. His lab likes to say they specialize in “building biology,” and that was exactly what was needed here. I can develop assays to test for diseases—that is what I do in my research lab. But automating it at scale is a totally different engineering problem. Doug and his team made an estimate for what kind of equipment would be needed to get to this many tests per day. We made a proposal to President Brown and his budget committee, got the funds allocated, and started the job of setting up the lab.
BU Today: Could you explain why the University has decided to take this step?
Klapperich: Without a vaccine or a very effective treatment, the major tools in our toolbox are testing and tracing. In the United States, the scale-up of this testing at the federal level did not get off to a good start, and a lot of the work fell on the large lab companies. The scale of testing needed is so large that the large lab companies were unable to guarantee fast enough turnaround time to monitor a large community like ours. Also, the priority for fast testing from those services needs to, and should, go to healthcare providers who are on the front line. So, by bringing capacity in-house, we should be able to get testing to our community faster. We also hope to build excess capacity to help others.
BU Today: Should this make members of the BU community feel safer about returning to campus? Will you personally feel safer knowing this testing is happening?
Klapperich: Yes. I used to have a mentor who said something like, “If you can’t measure it, you can’t improve it.” We can’t do adequate risk assessment and risk reduction if we don’t know the prevalence of the virus in our community. If we learn that particular situations are high risk, we can alert people to increase distance and take other steps. Testing like this will take asymptomatic infections out of the chain of infection earlier, and fewer people will get sick as a result. It is not a guarantee of safety, of course. But it’s worlds better than where we are now. Right now, very few asymptomatic people are being tested in this country. Without that information, everyone has to assume that they and everyone else could possibly be infected.
The most safe that I will feel is when people can get the test we are offering and an antibody test that can tell you if you have ever been infected by the novel virus. And if someone does test positive, then BU can make sure they immediately get the care they need from Student Health or Occupational Health. Then people can have data about their own risk of infection and their risk of spreading it to others unknowingly. Both of these are important. A full suite of tests like that will not be available until the end of the year at the earliest. (The University also has set up a COVID hotline, 617-358-4990, for anyone to call Monday through Friday from 9 am to 5 pm. And students can message a nurse 24/7 through their Patient Connect portal.)
So under this plan BU is laying out, who exactly would be tested?
Students, faculty, and staff. What we don’t know is exactly who will get tested, and how often. The goal here is surveillance. You’re trying to play a numbers game. How long someone is infected before they transmit the virus to someone else—that’s a big question. At the end of the first week after the undergraduates return to campus, we will have been able to perform a lot of tests. Once we do that, we will have a good sense of the prevalence of the virus in our campus community and we can decide where to go from there.
Would everyone get tested with the same frequency?
Not necessarily. For example, I expect students with roommates and living in high-density dorms would get screened more.
Because this virus spreads so quickly, it’s possible a person could test negative Monday and positive Tuesday. Will people be retested?
If you are a freshman in Warren Towers, as an example, you could be tested at least once a week, or maybe twice a week. There has to be some procedure to follow if someone tests positive, and that’s still being ironed out. This is what mom and dad are going to want to know. If my son or daughter gets sick or is exposed to a known case, would they come home? So far, from what we’ve seen, most people in the typical undergraduate age group would not get very sick. If someone is sick and has manageable symptoms, they will self-quarantine either in place or in a separate dorm. They may be able to continue to participate in classes remotely. The same would be true for students with known exposure. They would be isolated, monitored, and allowed to continue classes remotely until a safe period of time has passed.
Do you envision faculty and staff being tested with the same frequency as students?
It’s not clear yet. Once a week for faculty and staff? We’re not sure. It depends on how often faculty and staff are coming to campus. Many people will be able to continue to work remotely, and may not need testing quite as often. What we’re still determining is the distribution of the test kits.
OK. Test kits—there are a lot of tests out there right now. Can you explain what test BU is choosing to use and why?
We are not planning any antibody and antigen testing at this time. We are going to do the RT-PCR test [it stands for reverse transcription-polymerase chain reaction]. It’s a test that detects the genetic material of the virus. If it’s in your mouth, nose, throat, nasal cavity, this is able to detect that virus. The test can take small amounts of that viral genome and amplify it until a lot of it is present in the test well. The test well will light up if it’s there.
Why use this test?
This test is considered the gold standard—it has the highest sensitivity for this kind of infection. It can catch people who are asymptomatic and/or people early in the course of disease, which is why we like it as a screening tool.
Can you explain how the test is done?
The science is rapidly evolving, but we hope to know very soon. What seems most likely is we will use self-sampling, and an anterior nasal specimen collected into sterile saline by the person being tested. The sample will be put into a buffer by the person, sealed, and sent to the test center. The [deeper, more invasive] nasopharyngeal swab sample—you cannot do that to yourself. There is a task force right now that’s looking at these options.
If it’s self-sampling, would some people still come to get tested at an office?
People who have symptoms and need to be evaluated in person would probably come in to get tested, whether it’s at Student Health Services, or after first seeing their primary care provider, they could visit the Occupational Health Center. But in terms of mass surveillance testing, testing kits could be delivered to a building and then students would sample themselves, people would come around and pick up the test kits, and students would get the results back via Student Health electronically.
Studies have shown that with PCR testing there can be a prevalence of false negatives. Does that concern you?
It’s true. But I am much less concerned about false negatives with PCR than other tests. False negative is when someone has COVID, but they come up negative on the test instead of positive. Most likely that happens when the sample was not taken well and there was not enough material to amplify in the test. Yes, it’s a risk, but I am much less concerned with false negatives using this test than I am by the others we talked about.
To test large numbers of people in a short time sounds time-consuming.
Right now if you go to a hospital and get a PCR test done, the turnaround time can vary. In my lab, with one person, maybe we could do 90 people a day. That’s with one person running tests. With two people, maybe 180 day. So maybe we could get up to 500 tests a day in multiple shifts. But robots do sample preparation and test setup really, really well. And they do it with higher accuracy—and don’t get tired! This allows you to rapidly scale up the amount of testing you can do.
Is BU going to purchase these kinds of robots to help conduct more tests faster?
We are purchasing robots, some will be for sample preparation, some for setting the reactions. Everyone’s sort of realizing they have to do this testing themselves.
But is it realistic that every institution can buy a robot?
No, which is why if we could scale this up, and we could potentially work with other institutions, like the City of Boston, as an example, that cannot do it themselves. And that would be incredibly rewarding, to be able to help others.
What is the timing?
The aim is to be ready to roll by the end of August. I’d like to say by August 15. But that’s really tight. We want to be able to do some run-throughs before the entire student population arrives.
What would you say to a faculty member who might be nervous about returning to campus to teach classes in person?
I get it. I think of my own class. There are 80 students. Maybe there’s a scenario where half come one day and we socially distance, and we do alternate days. But I still have to be there every day. And I am the oldest one.
It sounds like you’re excited about the potential to be able to conduct this level of coronavirus testing.
We know what this virus is. We are learning how it works. People are doing controlled experiments to learn how to stop it. We know a lot about it. We just need to know where it is, when it is in certain places, and for how long. And that’s what testing is for. Where it is and where it’s likely to go next. That’s how we are going to protect people.