Students Reject Coronavirus Testing
Halfway through the semester, schools are reporting participation rates far below their goals, prompting at least one school to go so far as to offer prizes to students who volunteer to get a coronavirus test.
Texas colleges offer free coronavirus tests. Why aren't more students getting tested?
"Texas colleges offer free coronavirus tests. Why aren't more students getting tested?" was first published by The Texas Tribune, a nonprofit, nonpartisan media organization that informs Texans — and engages with them — about public policy, politics, government and statewide issues.
Texas colleges and universities spent the summer months bulking up their testing capacity to catch COVID-19 outbreaks fueled by students who are infected but don’t show symptoms.
The University of Texas at Austin said it could test up to 5,000 asymptomatic students, faculty and staff weekly. Texas A&M University trumpeted a similar goal of testing more than 5,000 students each week – about 7% of the student body. And the University of Texas at El Paso, with about 25,000 students, said it had the capacity to test up to 2,500 campus members weekly.
But halfway through the semester, schools are reporting participation rates far below their goals, prompting at least one school to go so far as to offer prizes to students who volunteer to get a coronavirus test.
UT-Austin, which has more than 50,000 students, has only required students to be tested before attending football games. During the first five weeks of the semester, the school had the capacity to test 25,000 community members but tested only 8,870 – an average of about 1,770 per week. That included the 1,198 students tested for the first home football game on Sept. 12.
“Why aren’t we testing 5,000 people per week? The answer, in part, is that we have fewer than 5,000 people a week who have been willing to take the tests,” reads a Sept. 28 memo from the UT-Austin Faculty Council.
Texas A&M conducted 6,195 tests in its first two rounds of random testing through Sept. 12. Meanwhile UT-El Paso, which tested 6,691 campus members from Aug. 17 to Sept. 18, has yet to break 2,000 weekly tests, the El Paso Times reports.
Experts say routine testing is crucial to stomping out “silent spread” on college campuses, as the CDC estimates 40% of COVID-19 infections are asymptomatic. And school officials rely on the results to get an accurate snapshot of the community’s health.
Major Texas universities have already mandated rigorous testing regimens for athletes, and some schools in other parts of the country require students and employees to get tested multiple times a week. But if the goal is to identify people who might trigger an outbreak on campus, waiting for students and staff to volunteer to get tested “doesn’t make a whole lot of sense,” said David Paltiel, a professor at the Yale School of Public Health.
“Frankly, I think the whole idea is flawed from the get-go,” Paltiel said. “Unless you're going to have a routine program that you require the entire population to adhere to, I just don't know what you're doing.”
School officials are stopping short of calling testing participation a problem, even as they work to increase it.
Shawn Gibbs, dean of the School of Public Health at Texas A&M, said participation is “pretty much what we expected it to be.”
“Our participation rate isn’t low,” he said. “We always would like higher participation, and we're in the process, like everyone else, of taking a look at the students who aren't participating and trying to figure out ways to incentivize participation.”
At Texas A&M, that means appealing to “selfless service,” one of the Aggie core values, and emphasizing that the saliva-based tests are free, quick and easy, Gibbs said. The flagship College Station campus reported 144 active cases as of Sept. 29.
UT-Austin’s goal is to test 1,000 asymptomatic people per day, and participation is gradually building in that direction, said Michael Godwin, program director of the university’s proactive community testing. Monday was “a really great day,” he said, with close to 700 people coming out. The flagship reported 67 estimated active cases as of Sept. 30.
To boost participation, the school is launching an incentive program, with raffle prizes for students including $50 gift cards to local and national vendors, Godwin said. The university has also enlisted professors to make class-wide announcements and deployed ads on Canvas, its online learning platform.
UT-Austin faculty participation in the testing has been “very low,” according to the Sept. 28 Faculty Council memo.
“I don’t think anyone expected to see 5,000 people in the first week,” Godwin said. “It takes a little bit of time to get the word out, to get the process set up and working well, and … we’ll continue to build on what we have and get more people in the door to get tested regularly.”
Mandatory testing at Baylor
Students might dodge invitations to test for a number of reasons – especially if they don’t feel sick, said Diana Cervantes, an epidemiologist at the University of North Texas Health Science Center. Students may also be avoiding the inconvenience of quarantines in the event they do test positive.
“Let's say I think I had a high-risk exposure and I think that testing positive is going to mean something detrimental to me, maybe I'd decide not to get tested,” Cervantes said.
Julia Elder, a UT-Austin master’s student, said she has not taken the university up on its offers to get tested because she worries about being exposed to the virus during her appointment. Elder hasn’t eaten in a restaurant or socially interacted with anyone since March. She takes online classes and only leaves the West Campus apartment she shares with her twin sister to pick up food.
“I definitely have wanted to get tested … but it seems like more interaction than I do on a daily basis,” Elder said, adding that she recently drove past the health center and saw a line of students wrapped around the building. “It seems like an unnecessary risk to take if I feel fine.”
Some universities are making testing mandatory.
At the University of Illinois Urbana-Champaign, students and employees must get tested twice a week. They’re testing about 10,000 people per day, and reporting positivity rates below a half of a percent. The university feels “very confident” in its plan, in part because it’s mandatory, said Robin Neal Kaler, associate chancellor of public affairs at UIUC.
“Our data scientists showed if you tested the vast majority of people twice a week … that would be enough to slow the spread, to keep potential outbreaks under control, and to let you know about them quickly enough that you can deal with them,” Kaler said.
“But that only works if it's mandatory testing. And it only works if you're testing basically the entire population, which is what we decided to do,” she added.
In Texas, Baylor University is one of the only institutions to require testing. The private Christian university chooses 5% of students and 5% of employees for mandatory testing each week; failure to comply may result in disciplinary action.
Unlike other Texas universities, Baylor also required a negative test from students and employees before they returned to campus in August. The school reported 62 active cases as of Oct. 1.
“We felt ... we needed to make it mandatory partly because there was some concern if people were left on their own, they would not want to be tested,” said Jim Marsh, dean for student health and wellness at Baylor. He added that even though the testing is mandatory, the school gives students raffle prizes such as meal vouchers, football tickets and scholarships for participating.
Legality in question
So far, none of the major public universities in Texas require testing – though some have left the door open.
Godwin said state law restricts UT-Austin’s authority to require testing “as a prerequisite to accessing any kind of educational benefit, or work, in the case of faculty and staff.”
“We are following the advice of the Office of the Attorney General,” UT spokesperson J.B. Bird said in an email. “State universities have not been delegated the authority to mandate testing as a requirement for pursuing an education.”
A spokesperson for the Texas attorney general's office said they can’t comment on whether it’s legal to require students to get tested because the office hasn’t been asked to give an official opinion on the matter.
In September, UT-Austin students had to test negative to attend a football game against UT-El Paso, even though the other 15,000 fans did not. Godwin said testing was allowed to be required in that instance because football games are not considered an educational benefit.
But Texas A&M has said it will move to mandatory testing if school officials deem it necessary.
“Our legal view is that we have the legal authority to require random testing on campus if it is necessary to protect public health and safety, but the issue has not been squarely addressed by the courts,” said System spokesperson Laylan Copelin. “So far, voluntary participation has been sufficient to meet the public health goal and mandatory testing is not necessary.”
For now, school officials hope their messaging and prizes will turn out more students, though Elder, the UT master’s student, questions whether it will be enough.
“Anything short of a reduction in tuition, there's no incentive they could provide anyone for getting tested,” Elder said.
Disclosure: The University of Texas at Austin, Texas A&M University, the University of Texas at El Paso, the University of North Texas and Baylor University have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.
This article originally appeared in The Texas Tribune at https://www.texastribune.org/2020/10/05/texas-coronavirus-college-free-tests/.
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Testing Backlogs Skewed Coronavirus Data
The Texas Department of State Health Services said it will now rely on a calculation that takes into account the date on which a coronavirus test was administered, rather than when it was reported.
Texas officials change how the state reports positivity rate after testing backlogs skewed coronavirus data
"Texas officials change how the state reports positivity rate after testing backlogs skewed coronavirus data" was first published by The Texas Tribune, a nonprofit, nonpartisan media organization that informs Texans — and engages with them — about public policy, politics, government and statewide issues.
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Texas health officials announced Monday that they are changing the way the state reports a key metric used to evaluate the extent of coronavirus infection, a move that conceded that the state’s previous method of calculating the “positivity rate” muddied the extent of viral transmission by mixing old data with new.
The Texas Department of State Health Services said it will now “primarily rely” on a new calculation of the daily positivity rate — defined as the share of tests that yield positive results — that takes into account the date on which a coronavirus test was administered. Officials said the new metric will give a more accurate representation of viral transmission in Texas on a given day.
It also means that each day’s positivity rate will be an oft-changing number, fluctuating as officials collect lab results over time. Labs and hospitals report their test results to the state with varying degrees of timeliness, and state officials will have to recalculate the positivity rates for previous days as more test results from those dates pour in.
That’s a departure from the current system, which calculates the positivity rate based on the date the health agency receives test results, which can be weeks or even months after the tests were administered.
It marks the latest in a series of data methodology changes and corrections health officials have issued over the course of the pandemic.
While touting the new reporting method as an improvement, state officials defended the old system as providing the best information that was available at the time. The new positivity rate for the most part closely resembles the old metric, particularly when viewed as a trend line over time, officials said.
Health department spokesperson Chris Van Deusen said in an email that the different positivity rates generally moved in parallel until about August, when the state reported dumps of test results. “As long as the test results and new cases were reported fairly close in time, the case reported date was working as a metric,” he said.
Asked if the health department had concerns about the accuracy of the positivity rate before August, Van Deusen said, “We have to go off of the data that we have.”
The state said it will begin releasing the positivity rate under both the new and old methods later Monday. Health officials said they will publish a third positivity rate metric, which is calculated based on when lab results were reported to a national disease surveillance system, NEDSS, which officials said would reduce reporting lag time.
In its announcement, the Texas Department of State Health Services said the new calculations for the positivity rate will provide a more accurate representation of coronavirus transmission on any given day. It said the change was made after technology improvements last month improved the department's ability to use data from labs and other testing sites. The agency said that until recently, it wasn’t able to track test results by the date they were administered.
The state can now process about 100,000 lab reports per day, officials said, compared with about 45,000 per day before August.
“As the COVID-19 pandemic evolves, so must the data we share,” Texas Department of State Health Services Commissioner John Hellerstedt said in a prepared statement. “Our information must provide the clearest possible picture of what is happening now and what has occurred in the past.”
Gov. Greg Abbott has pointed to the positivity rate as one metric that guides the state’s response to the pandemic, helping policymakers calibrate the level of restrictions placed on bars and restaurants, for example. Abbott has previously said that a rate above 10% would be considered a red flag. According to the state's old calculations, the rate regularly exceeded that level in late June, after Abbott began allowing businesses to reopen in phases in early May.
The department did not immediately respond to a question about whether it agrees with the governor’s threshold.
Health experts have raised questions about the value of the old metric since it included test results from widely variable time periods, and they have pointed out the limitations of the state’s data.
“The numbers that we see from the county health departments or the state health department … they're not useless, but they are highly qualified and unreliable in terms of studying the trend,” Rajesh Nandy, associate professor of biostatistics and epidemiology at the University of North Texas Health Science Center at Fort Worth, has said.
Coronavirus test results vastly undercount the extent of viral transmission; researchers estimate that the true number of coronavirus cases could be more than 10 times the number of positive tests. As many as half of the people who contract the virus may never experience symptoms and may not seek out testing.
Texas health officials said Monday that the positivity rate is just one of many metrics that inform disease surveillance. After a midsummer surge that overwhelmed some Texas hospitals, particularly in South Texas, the state’s number of coronavirus hospitalizations has fallen in August and September. Still, rates of viral spread and hospitalizations are higher now than they were before Abbott began the phased reopening of businesses in May. More than 14,000 Texans have died from the virus, according to the state’s accounting.
The decision to start calculating and posting the additional positivity rates began this summer, when thousands of backlogged tests were added to the health department’s reporting system, causing the positivity rate to spike, health department officials said.
Part of that logjam — some 350,000 of more than 850,000 tests — had accumulated because the state could not process enough test results each day before an Aug. 1 system upgrade. Labs have also struggled to upload their test results to the state’s system, with formatting errors and glitches as minor as an errant question mark sometimes causing monthslong delays. Local officials and lawmakers have called the data “meaningless” and “inaccurate.”
Just Sunday, San Antonio officials shared a health department email that revealed more backlogs — this time of roughly 205,000 test results from HCA Houston Healthcare, including 21,366 positive cases extending as far back as March. Baylor Scott and White and the health department’s own lab in Austin also encountered a “routing error” during the system upgrade that prevented some 140,000 test results from June to the present from being processed into NEDSS.
Van Deusen said some of the cases were reported to local health departments despite the “routing error.”
“I wish I could guarantee there would never be another IT issue that interrupts lab reports, but that’s probably not realistic,” Van Deusen said.
About 800 facilities have registered or are in the process of working with the health department to submit test results — many of them long-term care facilities, including nursing homes that are now under a federal mandate to regularly test staff for the first time, Van Deusen said. The department could not immediately provide a number for how many labs already testing Texans have been unable to upload their results into the state system so far.
The state has hired health technology company Persivia to help improve the reporting process. Another consultant, Deloitte, joined the Department of Information Resources and Abbott’s office in working with DSHS to improve “data quality and transparency,” the health department said.
State data will also start to more accurately and efficiently separate tests by county, which could eliminate a large pool of tests that have been stubbornly categorized as “pending assignment” without being tied to a specific county, health officials said.
Disclosure: The University of North Texas Health Science Center, Baylor Scott and White, and Deloitte have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.
This article originally appeared in The Texas Tribune at https://www.texastribune.org/2020/09/14/texas-coronavirus-positivity-rate/.
The Texas Tribune is proud to celebrate 10 years of exceptional journalism for an exceptional state. Explore the next 10 years with us.