Stanford leaders and health experts detail university’s COVID-19 surveillance testing program
A panel of Stanford medical experts described steps the university has taken to develop and implement a COVID-19 testing program that will supplement, but not be a substitute for, basic precautions.
In a webinar on Wednesday, university and Stanford health leaders discussed the development and implementation of the new COVID-19 testing program for onsite members of the campus community.
Under the program, announced on Aug. 20, a weekly onsite surveillance testing program for students on campus began on Monday. In addition, surveillance testing is now being phased in on a recommended weekly basis for faculty, staff and postdoctoral scholars conducting regular work on site.
“The testing program we’ve introduced is an important part of our effort to support the health and safety of the Stanford community as we continue to confront the coronavirus pandemic,” President Marc Tessier-Lavigne said in opening the webinar. He thanked “the many people who have spent countless hours developing and executing this program, driven by their concern for the health of our community.”
The panel of medical experts for the webinar, which was chaired by Tim Stearns, professor of genetics and senior associate vice provost for research, described the medical underpinnings of the testing program. Panelists discussed the tests being used, the strategy behind the testing plan and how testing supports the health of the campus community.
The testing program grew out of a task force that Provost Persis Drell asked Lloyd Minor, dean of the School of Medicine, to convene. As a result, Stanford contracted with two testing firms whose methodologies have FDA emergency-use authorization.
Drell and Minor said community safety was the top concern.
“That was the driving motivation as we considered a number of options for surveillance testing,” Minor said. “We went with two vendors because across the board, the supply chain for testing for COVID-19 remains quite fragile. We wanted to have the benefit of two vendors that we were working with simultaneously in case, during the course of these coming weeks and months, one becomes more challenged in terms of being able to meet the demand – and then we could potentially have the other as a backup.”
Thomas Montine, chair of the Department of Pathology, described how Stanford is moving from symptomatic testing, reacting to people who are concerned about their symptoms, to a screening program.
“Instead of testing one individual, we test many people with the goal of finding the rare person who doesn’t have symptoms but is infected by the virus,” Montine said. “So, it’s quite a different approach. Rather than using a single test, the strategy here is to use repeat testing.”
Associate Professor of Surgery Kristan Staudenmayer explained the decision to “develop a testing strategy that would be dynamic,” with an initial weekly testing cadence but the flexibility to alter the frequency of testing over time based on public health conditions.
“Through continuous monitoring and adjusting of the strategy to meet the needs of the campus population, we would be able to right-size our testing strategy and make sure that we are doing enough to prevent spread, but not too much that we are generating false positives,” Staudenmayer said. “In this way, we can assure that people who are arriving on campus and who are staying on campus will have the safest possible outcome.”
She said related work includes the development of reporting strategies aimed at continuous monitoring, in order to make needed changes quickly.
Yvonne “Bonnie” Maldonado, a senior associate dean and professor of pediatric infectious diseases and of health research and policy, said implementing the testing program now will be important as people return to campus from other areas for the autumn quarter.
“The good news is we will have a baseline we think will be low enough to not sustain transmission,” she said. “The behaviors that everybody participates in can help us to keep those transmission rates down at a level where we cannot completely eliminate infections – but at least avoid enough infections that we can control the virus within our own Stanford community.”
Panelists also reported on the initial implementation of the two vendors’ testing programs.
Verily, a company focused on life sciences research and health care, is overseeing sample collection and processing for students. Color, a company that specializes in population health management, is providing nasal-swab testing kits for self-collection and performing clinical lab testing on kits that are submitted by faculty, staff and postdoctoral scholars.
Most student testing had been transferred to the Verily location at the Frances C. Arrillaga Alumni Center by Monday, said James Jacobs, associate vice provost for student affairs and executive director of Vaden Health Services.
“At the end of [Tuesday], 1,200 samples had been collected and almost all test results have been received, and there are no positives,” Jacobs said. “Testing will escalate markedly over the next 10 days, as one might expect as additional cohorts of graduate students return to campus and testing for the fall will begin this Saturday.”
Rich Wittman, medical director of Stanford’s Occupational Health Center, said pickup and testing of self-swab kits for faculty, staff and postdoctoral scholars began in a pilot phase on Aug. 26, with additional groups and departments added weekly. All eligible individuals are expected to be enrolled in the program by Sept. 18.
“We started with a closely monitored sampling and swabbing process for the initial pilot group to ensure the process and online registration went smoothly,” Wittman said. “Yet the process is designed to be independent. We found this component, the swabbing and subsequent components of the process, to be smooth.”
Responding to a question concerning why testing is required for students and voluntary for faculty and staff, Drell noted that a higher level of potential for spread is associated with congregate living environments for both on- and off-campus student housing and that postdoctoral scholars living in university housing have the same testing requirement.
“The living situation for faculty and staff is not the same congregate living environment, so the indication for mandatory testing is just not there,” she said.
Asked how long surveillance testing will need to continue, Minor noted that “for all of us, our crystal ball has been cloudy the past six months” and said: “I think we will conduct surveillance testing as long as there is a need to do it.” He added that the university will be evaluating the best structure for the program beyond the autumn quarter.
Another questioner asked what – in addition to testing – the Stanford community can do to speed a return to campus. Drell reiterated the importance of basic, frequently stated precautions including use of face coverings, physical distancing, frequent hand washing and compliance with state and the county public health orders.
“It all sounds simple,” she said, “but these are the most important things to controlling the virus and we are all very, very eager to control the virus and get back to some ‘new normal’ of operations at Stanford.”