On Jan. 12, Brown University updated COVID-19 policies for the spring semester. With two days’ notice, the PCR testing program for vaccinated community members was replaced by self-administered rapid antigen tests. The University discontinued the “Healthy Brown'' dashboard, which had been showing campus asymptomatic test result data since Aug. 2020, at a time where it hit a record-high campus positivity rate of 7%. By the time of these decisions, local hospitals had reached a state of crisis: Rhode Island would go on to become one of the first six of twenty states to which the federal government is providing military medical support in response to a rise in COVID-19 cases, and deaths in Rhode Island are projected to rise over the next month. Brown’s modified COVID-19 policies are insufficient within this context, and as a result, the Graduate Labor Organization — our graduate student union — has demanded Brown restore PCR testing, publicize test data and allow grads to work remotely if they choose.
Rapid antigen tests do not detect SARS-CoV-2 infection as well as PCR tests, correctly giving positive results for asymptomatic people 58.1% of the time and for symptomatic people 72% of the time, according to a review of 48 studies. CDC guidance says that antigen tests are “generally less sensitive,” and FDA guidance states they are “less likely to pick up very early infections compared to molecular tests” and “may have reduced sensitivity” against Omicron. While the University has cited a single preprint to defend antigen test sensitivity, this study only assessed one brand of test which is not among those we have seen being provided by Brown; a senior author reports a conflict of interest with the test manufacturer; the study examines a population that does not reflect Brown’s demographics; and 39.8% of participants sought out a test because of symptoms or a suspected COVID-19 exposure, while Brown directs any symptomatic students to contact Health Services to seek symptomatic testing.
The shift from PCR tests to rapid antigen tests also contradicts the University’s stated priority to identify when individuals are actively contagious. A peer-reviewed study of both types of tests concluded that “RT-qPCR tests are more effective than rapid antigen tests at identifying infected individuals prior to or early during the infectious period and thus for minimizing forward transmission.” Health experts and preprint studies report that “most Omicron cases (are) infectious for several days before being detectable by rapid antigen tests,” making rapid tests potentially unfit for “routine workplace screening to prevent asymptomatic spread.” Reporting from this winter also provides real-world evidence of antigen tests creating “a false sense of security” prior to gatherings that led to infection. Unpublished data from Emory University using live Omicron virus reported by the Wall Street Journal showed that “rapid tests produced false negatives for two days following a positive PCR test, even though most people had high-enough levels of virus to infect other people,” and that “people transmitted the virus to others during the three days it took to yield a positive result on a rapid test.”
Therefore, it is not surprising that the University is currently detecting an unexpectedly low level of cases compared to other institutions (though positives have almost doubled in the last week). This change in testing methodology is likely to create a scenario where community members are in classes, labs, libraries, dorms and dining areas for multiple days in an infectious state prior to triggering a positive test, and we personally know multiple graduate students who have reported this exact situation on campus. Given this data, many peer institutions are continuing with PCR testing — for example, Harvard, where undergraduates took a rapid test followed by three PCR tests weekly at the beginning of this semester.
While Brown has intentionally shifted away from identifying COVID-19 cases in order to focus on “serious illness and hospitalization,” this downplays a variety of risks to the Brown community. Several scientific studies have found that anywhere from 10 to 20%, 30% or more than 50% of people have medical problems extending beyond their original infection, dubbed “long COVID.” Recovered patients can develop long COVID even after experiencing mild or no symptoms. The School of Public Health has launched an initiative to study this condition which they state “affects millions of people around the world but remains poorly understood.” While vaccinations have been stated by Brown to be “very effective at preventing Omicron infections from developing into serious illness,” studies indicate that, for breakthrough cases, “vaccination might only halve the risk of long COVID — or have no effect on it at all.”
Allowing COVID-19 to spread more readily on campus is also inconsistent with Brown’s commitment to equity. COVID-19 disproportionately affects marginalized groups due to medical, social and economic barriers which predate the pandemic, as well as potential genetic risk factors which can make those in certain ethnic groups more susceptible to infection. There are students, faculty and staff at Brown who have medical conditions that put them at higher risk for severe outcomes in the case of infection. Brown’s focus on acute outcomes in healthy individuals suggests a lack of consideration for the safety and well-being of at-risk communities on-campus and in Providence.
Dean of the School of Public Health Ashish Jha stated in a faculty and staff town hall that "we’re obviously in the middle of a surge" and are experiencing "an astronomical level of infection." In such an environment, it is not safe to alter the testing protocol to one that has been documented to be less sensitive in detecting the most communicable variant so far. If cases are indeed about to rapidly decline, as Jha has suggested, this is all the more reason to delay in-person operations until case numbers are low. Unfortunately, Brown has mandated that courses originally planned to be in-person “will be taught in-person from the start of the semester, including shopping period,” despite also acknowledging that “we will likely see a high number of students test positive for the Omicron variant of COVID-19.” This decision was said to be due to accreditation and federal reporting obligations — however, subsequent messaging announced that “instructors may also choose to teach their class sessions remotely for the first week,” and asked for “all instructors to take steps to ensure that students are able to access course materials online.” This is an admission that flexibility is possible for instruction modality, especially when community infections are so high.
Students and faculty have expressed concerns in town hall meetings and through more than 500 signatures of GLO’s Open Letter. Despite our mutual hope that the end of the pandemic will come soon, reducing vigilance now could bring us further from that goal. Regular surveillance testing should include PCR tests to ensure the earliest possible detection of cases. The testing dashboard should be restored to communicate on-campus risks. Instructors should be given the flexibility to instruct remotely, with additional precautions during the first weeks of the semester. When lives are on the line, it is better to be safe than sorry.
Anders Ohman GS can be reached at firstname.lastname@example.org, Melanie Ortiz-Alvarez GS can be reached at email@example.com and Corinne Hutfilz GS can be reached at firstname.lastname@example.org. Please send responses to this opinion to email@example.com and op-eds to firstname.lastname@example.org.