Testing for SARS-CoV-2 Infection on campus: critical adjunct to universal vaccination
By Tim Evans
In the midst of the fourth COVID-19 wave, there are signs that those provinces with the highest rates of vaccination are managing to avoid a spike in cases leading to hospitalizations and deaths. In contrast, those provinces with the poorest and most unequal vaccine coverage are over-run with ICU admissions and preventable deaths. The news announced by McGill University last week that close to 95% of students are vaccinated is indeed encouraging and bodes well for limiting risks of serious illness amongst students. Credit for the high vaccination rates must be given to the provincial authorities that instituted vaccine mandates. Quebec’s vaccine passport for non-essential activities like going to restaurants, bars, and public performances in late August 2021, led to a surge in vaccination rates particularly amongst younger persons including university students.
While the McGill community has benefitted from the Provinces’ vaccine passport in terms of safety, and is likely to benefit further with the extension of the passport as necessary for entry to the McGill library and potentially classes….. the passports and vaccine mandates are necessary but not sufficient.
With the delta variant – being more transmissible – and the recognition of high levels of infectiousness amongst the vaccinated, there is a need to understand the degree of transmission occurring on campus. The testing for acute infection available at the moment – those with symptoms, or thought to have been in contact with an infected individual - going to testing centers provided by the Province/City – is wholly inadequate. This relates to the lack of incentives for persons with symptoms to declare these and get tested….but more importantly, it fails to recognize the significant incidence of infection that is asymptomatic. Indeed, evidence from college campuses in the USA, where all persons are required to be tested weekly with PCR points to the value of testing as an adjunct to vaccination status. Boston University (BU), for example, with its vaccine mandate has vaccine compliance of over 99% for students and faculty and over 96% for staff. It’s weekly mandatory testing has picked up 510 positive tests over the last 2 months with a test positivity rate of 0.11%. All persons testing positive are isolated and supported in their student, faculty, or staff functions in such a way that their efforts to preserve public health do not come at the cost of their other functions. The result is that the BU campus has test positivity rates that are about one tenth those in the wider Boston and Massachusetts community and has avoided any cases on campus becoming the nidus for uncontrolled outbreaks.
So testing is a critical adjunct that McGill should add to its campus program in order to secure safer conditions on campus. Why this is so important relates to the very reasonable expectation that as the weather cools and transmission conditions for the virus improve especially with much greater indoor activity, it is very reasonable to expect a further increase in cases. The New England states that border with Quebec (Vermont and New Hampshire) are already seeing a rise in cases in recent weeks. Quebec too --- Montreal and McGill – are likely to be part of this seasonal effect. Moreover, in the months to come, there will likely be an increasing risk of transmission arising from waning immunity from vaccination. Rather than wait and see – and hope that we’ll be lucky --- it would be far more prudent to offer a testing program on campus now through the rest of the year such that a much more precise epidemiologic monitoring of the COVID-19 situation can take place and the campus can use timely evidence to ensure the safety of all.
About the Author
Dr. Tim Evans is the Director and Associate Dean of the School of Population and Global Health (SPGH) in the Faculty of Medicine and Associate Vice-Principal (Global Policy and Innovation) at McGill University. He joins McGill after a 6-year tenure as the Senior Director of the Health, Nutrition and Population Global Practice at the World Bank Group. From 2010 to 2013, Tim was Dean of the James P. Grant School of Public Health at BRAC University in Dhaka, Bangladesh, and Senior Advisor to the BRAC Health Program. From 2003 to 2010, he was Assistant Director General at the World Health Organization (WHO). Prior to this, he served as Director of the Health Equity Theme at the Rockefeller Foundation.