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From Brown to Broad and back again: the journey of the COVID-19 swab test samples

University medical professor discusses accuracy of COVID-19 testing process, Verily and partners trace test administration, travels of the tube

Each week, the University and its testing partners process over 10,000 samples, most of which are collected on campus, then shipped beyond the state to laboratories in Massachusetts. Despite the distance, results circle back to students in about a day.

University administrators and organizations involved with the University’s COVID-19 testing program spoke with The Herald about the various levels of the testing process, building a larger picture of the testing samples’ journey from campus to the lab. 

The University has been testing asymptomatic students for COVID-19 twice weekly since their return to campus this fall, as well as conducting separate symptomatic testing for self-reported cases. 

Preparing for the test

Students living on and off-campus are required to complete a daily online survey through the Verily portal to report “a comprehensive list of symptoms identified by the Centers for Disease Control and Prevention as possible symptoms of COVID-19,” according to the Healthy Brown website. Health Services is notified if a student reports positive symptoms on the Verily screening-survey, and they reach out to the student “to determine how best to manage the individual clinical scenario,” wrote Clinical Director of Health Services Adam Pallant in an email to The Herald.

After this assessment, students deemed to still be “asymptomatic” are asked to register for a test, according to the Brown website

When it is time for their test, asymptomatic students report to one of the two University sites: the Olney-Margolies Athletic Center or One Davol Square in the Jewelry District, The Herald previously reported. These students self-administer an anterior nasal swab test in both nostrils with guidance from health professionals. 

Students reporting symptoms that are consistent with those of COVID-19 are tested separately at the Health Services unit at Minden Hall, Pallant wrote. For these students, Health Service clinicians administer a nasopharyngeal swab and complete “a clinical assessment and management plan for the care and possible isolation of the ill student,” he added. 

Nasopharyngeal or anterior nasal?

Both the anterior nasal and nasopharyngeal swabs are reliable diagnostic tests that look for presence of viral genetic material. But they differ in comfort, test administration requirements and accuracy. 

Nasopharyngeal swabs are inserted deeper into the nose and are often uncomfortable for the recipient, whereas anterior nasal swabs are inserted closer to the tip of the nostril, decreasing that discomfort, said Angela Caliendo, Warren Alpert Foundation professor of medicine and executive vice chair of the department of medicine at the Warren Alpert Medical school. 

The nasopharyngeal swab also requires “a health care provider or someone trained to collect (the tests), and that person has to wear” personal protective equipment because collected virus particles can aerosolize, or scatter into the air, Caliendo, who has studied diagnostic virology for more than twenty years as an infectious disease physician, told The Herald. An anterior nasal swab, however, can be collected by the person themselves and has a lower risk of aerosolization, she explained.  

The tests also differ in accuracy as shown by “the sensitivity rate,” or the percent of accurately reported negative results. A lower sensitivity test has fewer accurate negatives. “The literature shows maybe about a 10 percent drop in sensitivity when you use (an anterior) nasal swab versus a nasopharyngeal swab,” meaning the anterior nasal swab produces more false negatives, Caliendo said. 

But this decrease in sensitivity rate should not alarm students who are undergoing the University’s rigorous asymptomatic testing, Caliendo added. The Rhode Island COVID-19 Testing and Validation Task Force, which Caliendo is co-chairing, has stated that nasal swabs are “acceptable (for diagnosing COVID-19) if you swab both nostrils and if you were testing people” frequently, she said. “Even though you lose a little bit of sensitivity, because you’re doing (the test) regularly, you would pick up the vast majority of people” infected. 

Arrival and check-in at the testing site

When students arrive for their asymptomatic testing appointments, they are greeted by testing staff from Verily’s partner Advanced Clinical, according to Executive Vice President for Planning and Policy Russell Carey ’91. 

Staff collect the test samples and create unique labels containing the student’s name and date of birth that are stuck to the sample tube. This information is “only accessible to qualified health care workers and the labs, which are bound by Verily’s BAA and HIPAA” regulations to protect patient privacy, Robin Suchan, public affairs and communications manager at Verily, wrote in an email to The Herald. 

These labels — also known as test IDs — are randomly assigned to students as a means of protecting their personal health information, Suchan added. The test ID and an additional barcode on the label are used by Verily’s clinical partner PWNHealth “to identify each participant and deliver results accordingly.” 

When an asymptomatic student checks in for their test, they are asked to present a Brown or government-issued ID so that staff can verify that the information they have in their system is consistent with that on the label. The medical technician administering the test once again confirms the information before sticking the label on the sample tube and sending it to the Broad Institute for test result analysis, Suchan wrote.

Collecting, processing and returning samples

Advanced Clinical also packages and securely stores samples until they are picked up by a courier service that takes them to the Broad Institute in Cambridge, Massachusetts. The sample pick up occurs twice a day during the week and once on weekends, Suchan wrote. 

The Broad Institute, which is affiliated with Harvard and the Massachusetts Institute of Technology, is providing COVID-19 sample processing support to more than 100 other colleges this fall, including Harvard, the Rhode Island School of Design and the University of Rhode Island, according to the Broad Institute’s website. “Broad facilitates the distribution of test components (such as tubes and swabs) from manufacturers, and schools follow protocols for proper swabbing and test kit handling to return the kits to Broad,” according to their site.

Meanwhile, symptomatic test samples are sent to Lifespan Laboratories, “who provide the high sensitivity test with rapid response,” Pallant wrote. 

For these symptomatic students, if the test result is positive, a University Health Services clinician will call them and also send an email if the call is left answered, Pallant added. 

Asymptomatic results from the Broad Institute return to Verily through PWNHealth and are made accessible to students, who are notified through email to check their Verily accounts for the result, Suchan said. 

If an asymptomatic student has a positive test result, a clinician from Health Services “calls them directly to help them answer any questions they may have, assist them with the isolation process (and) begin a program to keep an eye on the student every day until they're free to go back into the world at-large,” Pallant wrote.

Results from Brown’s asymptomatic testing can be found on its COVID-19 dashboard. The current numbers as of Oct. 3 are 24 positive cases out of 50,088 administered tests since Aug. 24, according to the University’s COVID-19 dashboard.

Correction: Due to an editing error, a previous version of this article incorrectly stated that a lower sensitivity test has fewer false negative results, when in fact a lower sensitivity test has fewer accurate negative results. The Herald regrets the error.


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