University of Illinois at Urbana-Champaign COVID-19 response

In April 2020 a team was formed to develop and deploy large-scale COVID-19 testing for use on the UIUC campus. The possibilities of using a saliva test were explored; such a test may be a good indicator of how contagious a person is: it tests the fluid which is likely responsible for much of the transmission between people.[2] The team, headed by Paul Hergenrother of the UIUC School of Chemical Sciences,[3] included people in the university's Institute for Genomic Biology, the Carle Illinois College of Medicine, the Beckman Institute for Advanced Science and Technology, the Department of Microbiology, and the College of Veterinary Medicine where a veterinary diagnostic lab was repurposed for handling the demands of analyzing thousands of samples per day.

As this team began its work, reports of methods to detect the virus in swabs, without the time-consuming RNA-extraction step, were appearing,[4] and on April 10, 2020 Rutgers University received FDA emergency use authorization (EUA) for a saliva test (which included RNA extraction).[5] Within two months of the UIUC team's formation, a scientific paper documented the team's research on a rapid saliva test which does not need RNA extraction.[6] Less than a month after that the university began testing at an increasingly rapid rate.[7]

As a CLIA-certified lab, the campus's veterinary diagnostic lab was able to satisfy the Food and Drug Administration's test requirements within the FDA's LDT regulations.[8]

Widespread, but still voluntary, testing of students, faculty and staff began on July 6, 2020,[9] with, according to the UIUC COVID-19 testing dashboard, 2382 tests performed during the first week of operation. Over the next five weeks, testing numbers grew to 10,000 samples per week. Then, during the nine-day period from August 15 through 23, over 55,000 samples were processed, as students returned to campus in large numbers and mandatory testing began.[10]

Statistics derived from the near-universal testing of UIUC students are not comparable, in at least two ways, from statistics derived in most other testing regimes.[11]

• First, because many non-infected individuals are tested each day in the university's program, the UIUC daily case positivity percentage tends to be considerably lower than would be reported under more commonly-practiced testing regimes.
• Second, because many of the individuals who are identified as COVID-19-positive are non-symptomatic, the UIUC number of daily new positive cases is expected to be sizably higher than would be identified in a testing regime where relatively few non-symptomatic individuals are tested.

Starting in mid-March the university developed a smart-phone app to play an important role in the UIUC campus response to the COVID-19 pandemic. The "Safer Illinois App," which had a soft launch on June 8,[12] was built on the ROKWIRE open-source smart-phone platform, established at UIUC in 2018. This was a natural platform to use, since ROKWIRE was already serving the campus with its first product, the "Illinois App."

The Safer Illinois App was announced as operational on August 13, 2020,[13][14] two days before the saliva test lab started analyzing samples 7 days per week, and four days before students returned to campus in large numbers.[10]

A mathematical model was used to estimate the number of people who would test positive in entry screening during August 15–23, when most students would return to Champaign-Urbana for the Fall semester.[15] An estimate, made on July 24 using an existing UIUC model of COVID-19 dynamics in Illinois,[16] projected forward to mid-August to give an estimate of the percentage of infected people within the state of Illinois in mid-August: 0.44%. Based on this, the detection of roughly 200 positive infections was anticipated during entrance screening. (The assumption that 45,000 people might undergo entrance screening, times the model-derived 0.44% mid-August positivity rate, would give 198 infections.) The 95% confidence interval around this value ranged from 72 to 414 infections.

Two other calculation methods, described in the scientific paper,[15] used data available in mid-August 2020 to estimate the statewide infection rate then; they provide checks on the July 24 projections made using the first method, and they are in general agreement with the first method.

An "effectiveness of mitigation" mathematical model was developed for simulating how the adherence to a variety of mitigation options would influence COVID-19 spread on-campus and off-campus. The assumptions made in this model are noted in the second part of the "entry screening" scientific paper.[15]

On August 3, 2020 the university sent all students a massmail describing the campus preparations for the COVID-19 pandemic response.[17] This announced a requirement that all faculty, staff and students who participate in on-campus activities be tested twice per week, said that those testing positive would be in isolation for 10 days under the direction of the Champaign-Urbana Public Health District (CUPHD),[18] and said that people identified by the CUPHD via contact tracing were to go into 14 days of quarantine.

The university developed cleaning protocols, provided both standard and custom signage, and expanded counseling and student assistance services.[19][20][21] For students in University Housing, about 5% of the campus room inventory was reserved for isolation or quarantine,[22][23] and both dormitory rooms and common areas were configured for distancing.[24]

55,034 tests were performed during August 15 through 23, the period when most Fall semester students arrived on campus.[10] During these nine days 288 people tested positive, compared to the "entry screening" model's estimate of 198 positive cases. The detection of 288 positive cases falls within the model's 95% confidence interval of 72 to 414.

As of August 24, the first day of classes, the basic structure of the campus COVID-19 strategy was in place: testing, notifying, and isolation or quarantine where appropriate. But it was unknown whether students, faculty and staff would embrace the testing regime and use the App's features in ways that the "effectiveness of mitigation" model quantified.[25]

During the first week of classes, August 24 through 28, the rate of new positive cases held fairly steady at about one-half percent.[10] Then, starting on August 29, a sudden increase occurred reaching nearly 3% positivity on August 30. This was deemed to reflect risky behavior, particularly among undergraduates.[26][27] On Wednesday September 2 a campus massmail[28] announced a decision to increase efforts to identify and remove individuals who were creating an increased risk for the campus and the community, and an expectation that all undergraduate students limit, for two weeks, in-person interactions to essential activities only, namely:

• taking twice weekly COVID-19 tests
• attending class
• purchasing groceries and food
• going to work
• engaging in individual outdoor activity
• attending religious services
• seeking medical attention

During this September 2–16 "partial lockdown," New York Times writer Kenneth Chang credited the overall UIUC COVID-19 response as "one of the most comprehensive plans by a major college to keep the virus under control."[29] However, although the university had anticipated a considerable amount of student partying, it was expected that students who learned of a positive test result would cease to party. As Dr. Ahmed Elbanna said "If you know you are positive and you go to a party, that’s not just a bad act. That’s very, very dangerous."

During the two weeks of "essential activities only" guidance there was a decrease in the number of cases detected. In the first week (September 2 through 8) 536 infections were detected, with 228 infections during the second week (September 9 through 15), this in contrast to 762 cases during the week before (August 26 through September 1). On Wednesday September 16 Chancellor Robert J. Jones issued a campus massmail, ending the two-week essential activities only period with a caution to resume campus activities carefully and responsibly, summarized by these eight words: "No parties. Small, safe gatherings only. Smart decisions."[30]

Initially the UIUC plan was to test each individual once per week. However, based on modeling studies this was changed to twice per week before large numbers of students arrived on campus in August. This rate was characterized by Nick Anderson of the Washington Post as "a staggering pace for a large public school".[31]

After the first two weeks of class, when all individuals were tested twice a week, it had become clear that fewer than 5% of positive tests were from among faculty, staff and graduate students. So testing of these groups was reduced to once per week.[32] This helped reduce strain on the laboratory's ability to produce rapid results, and speeded laboratory turnaround times from as high as 48 hours early in the semester to a little over 8 hours by early October.[33] Undergraduates continued to be tested twice a week, and in some cases three times per week or every other day.

The Safer Illinois App continued to welcome suggestions for new features. For example, a suggestion made on August 24, for the Safer Illinois App to indicate how busy the testing locations near an individual are[34] had been implemented by October 1.[35]

The number of positive tests reached a semester-low of 85 new COVID-19 detections during the week of October 10 through 16, then increased weekly to 109, 248 and 336 cases during the following three weeks.[36] Based on the 7-day positivity rate for faculty and staff, 0.72% as of November 6, the university reinstituted twice-per-week testing for this group.[37] And, because the lower 7-day rate for graduate students (0.46%) was also increasing, they also were told to resume twice-per-week testing.[38]

Noting the rapid increase of cases since mid-October, the Chancellor emphasized that students should not "have or attend parties,"[39] and stated that students who plan to travel during the Thanksgiving break "must limit themselves to essential activities only" until then. Reiterating[17] that November 20 is the final day for face-to-face instruction during the Fall 2020 semester, the Chancellor stated that those who remain in Champaign-Urbana-Savoy or who must return after Thanksgiving are also asked to limit themselves to "essential activities only" until December 18, the end of the semester.[39][40]