Testing, Screening, and Outbreak Response for Institutions of Higher Education (IHEs)

Testing individuals with signs or symptoms consistent with COVID-19

Consistent with CDC’s recommendations, individuals with COVID-19 signs or symptoms should talk to their healthcare provider about testing. In some locations, individuals can also visit their health department’s website to look for the latest information on testing.

One approach to help identify symptomatic individuals promptly for diagnostic testing is universal symptom screening, which involves reporting of self-assessments for symptoms on a daily or regular basis. In the absence of universal symptom screening, students, faculty, and staff members can be encouraged to monitor themselves. Symptoms may range from mild symptoms to severe illness. Symptoms may appear 2–14 days after exposure to SARS-CoV-2.

Symptoms may include:

  • fever or chills
  • cough
  • shortness of breath or difficulty breathing
  • muscle or body aches
  • headache
  • new loss of taste or smell
  • sore throat
  • congestion or runny nose
  • nausea or vomiting or diarrhea

IHE administrators and healthcare providers should immediately provide options to separate students with COVID-19 symptoms or suspected or confirmed COVID-19 diagnoses by providing distance learning options, self-isolation rooms in residence halls or other housing facilities with appropriate level of support to help students manage any physical symptoms associated with the infection and the emotional issues related to isolation for adolescents and young adults (if isolation is not possible in current residence), and alternative food service arrangements for those who live on campus. IHE administrators should also provide alternative teaching and work-from-home options for faculty, instructors, and staff with COVID-19 symptoms, provided that they are well enough to continue working remotely. IHEs should be prepared to refer symptomatic individuals to an appropriate healthcare provider who will determine if viral testing for SARS-CoV-2 is appropriate. If well enough for self-care, the individuals should follow CDC guidance for caring for themselves. IHEs can also encourage individuals to watch for emergency warning signs and seek emergency medical care if these symptoms occur.

IHEs should make a communication plan for individuals with a confirmed COVID-19 diagnosis and those suspected of having COVID-19, as well as a plan to communicate known cases to students, faculty, and staff. If privacy can be ensured, the IHE may also want to be aware of SARS-CoV-2 test results and symptoms through voluntary reporting by their students, faculty, and staff. In the event of an outbreak, the IHE should develop a plan for students to stay at their current place of residence or arrange for accommodations outside the campus for isolating and to attend virtual classes. This plan should also address needed wraparound services, including for COVID-19-positive students during an outbreak, as well as quarantine plans for close contacts.  The plan should ensure communications are accessible for all students, faculty and staff, including those with disabilities and limited English proficiency (e.g., through interpreters and translated materials).

Testing asymptomatic individuals with recent known or suspected exposure to a person with COVID-19

Because of the potential for asymptomatic or pre-symptomatic transmission, IHEs should consider if/how they will contact-trace known and potential contacts of individuals diagnosed with COVID-19 who have been present on campus. To protect student, faculty, and staff confidentiality, a best practice for IHEs would be to consider keeping a record of students diagnosed with COVID-19 in a confidential database, so they can work with local public health departments to contact-trace and test as quickly as possible. The feasibility of identifying and testing close contacts may vary by IHE and local health department.

Additionally, in accordance with state, territorial, tribal, and local laws and regulations, a best practice is for IHEs to work with their local health departments to inform known close contacts (i.e., those who have been in close contact with a person diagnosed with COVID-19) to quarantine in their living quarters or a designated housing location, get tested as advised by their healthcare provider, practice mitigation strategies, and self-monitor for symptoms for 14 days even if they initially test negative.

Areas of campus where students might be crowded together (e.g., residence halls or other congregate living spaces, dining halls, locker rooms, laboratory facilities, libraries, student centers, and lecture rooms) may be settings with the potential for rapid and broad spread of SARS-CoV-2. Diagnostic tests may be appropriate in areas of high community spread, at the discretion of the ordering provider. If necessary, broader testing beyond close contacts may be done simultaneously with other strategies to control transmission of SARS-CoV-2 on campus. This can include expanded or widespread testing described below:

  • Expanded testing: This includes testing of all people who were in proximity of an individual confirmed to have COVID-19 (e.g., those who shared communal spaces or bathrooms) or testing all individuals within a shared setting (e.g., testing all residents on a floor or an entire residence hall). Testing in these situations can be helpful because in high density settings it can be particularly challenging to accurately identify everyone who had close contact with an individual confirmed to have COVID-19. For example, students who do not know each other could potentially be close contacts if they are in a shared communal space. Expanded testing could be prompted by other surveillance efforts, such as wastewater (sewage) surveillance.
  • Widespread testing: This includes testing of individuals who have been potentially exposed at some point. This might also include testing across campus building(s). Widespread testing may also be considered based on the preliminary results from initial, targeted, or expanded testing or repeat periodic campus testing such as testing across residence halls. The implementation of widespread testing may also take into consideration local institutional factors like capacity and availability of testing locally, mitigation strategies, current academic instruction plan (percentage of classes meeting in person), status of residence halls (open or closed, students per room), access to dining halls and recreation areas, access to laboratory facilities, status of sports facilities like weight rooms (are they open or closed), status of other extracurricular activities related to campus including those with large gatherings or congregate living spaces (e.g., communities of faith, sororities, fraternities) and occurrence of athletic events with spectators and other mass gatherings.

For all these strategies, it is recommended that persons quarantined remain in quarantine until they complete 14 days, irrespective of a negative test result. If the SARS-CoV-2 test is positive, the individual should be under isolation. For most persons with COVID-19 illness, isolation and precautions can generally be discontinued 10 days after symptom onset and resolution of fever for at least 24 hours, without the use of fever-reducing medications, and with improvement of other symptoms. For persons who never develop symptoms, isolation and other precautions can be discontinued 10 days after the date of their first positive viral test for SARS-CoV-2 RNA.

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