- If a faculty/ staff/ student has mild symptoms, can they get a test? What if they are offsite?
Yes, even mild symptoms, if they are symptoms often associated with COVID-19, will generate a request to be tested. This is true even if they are fully remote.
The highest priority of our testing strategy is to identify people with symptomatic infection. We have a low threshold to test those with COVID symptoms. All faculty and staff who develop any concerning symptoms, or symptoms they think may represent COVID, should call the COVID call center at 314-362-5056. The staff are highly trained to gather the correct information and follow protocols to ensure that everybody with a reasonable suspicion of COVID-19 is referred to testing, which can usually be performed the same day with results in 24-48 hours. Students may call either the COVID call line or Student Health Services/ Habif as appropriate to the SOM or Danforth campus respectively.
- If a faculty/ staff member/ student has a known exposure but is asymptomatic, could they get a test?
Prior to December 8th, Occupational Health was not performing asymptomatic exposure testing. This was largely because it did not change the plan for the individuals. However, in the first week of December, the CDC changed its guidance on quarantine allowing for testing to decrease duration of quarantine. Currently, neither the St Louis City nor St Louis County Departments of Health are allowing use of this decreased duration of quarantine, but we believe a testing based quarantine strategy may emerge. This testing will be ordered through the call center when you call or through Occupational Health/ Student Health if you are identified through contact tracing.
If you are an essential healthcare worker (meaning you have a required role in a clinical environment that is not exclusively research), you can return to work after an exposure, including a household exposure, if you are asymptomatic. However, you must always mask and perform active symptom monitoring through the Redcap system for a total of 14 days after last exposure. Also, you must continue to quarantine outside of work for 14 days after last exposure regardless of testing result.
If you are not an essential healthcare worker, you cannot come to work and you must quarantine for 14 days from the time of your exposure regardless of your test result.
Note that if you develop symptoms after exposure (regardless of your role), you must immediately isolate and call the Call Center for testing. A positive test whether symptomatic or asymptomatic will result in isolation for 10 days from symptom onset (symptomatic) or positive test (asymptomatic).
- What is the procedure for a confirmed contact?
When a person tests positive they become a case. Occupational Health/ Student Health interviews every case to re-trace their steps and identify all people who were potentially exposed. Those who are identified as having a high-risk exposure are considered contacts, who are then called to inform them they are considered a contact. Once confirmed, the process of quarantine is initiated. This includes a set of instructions to the individual and establishing a health monitoring plan with Occupational Health/ Student Health.
We use the following definition for exposure: contact between two people where at least one is unmasked or incorrectly masked for a total of at least 15 minutes in one day in a proximity of less than 6 feet. There are also specific definitions for exposure in the clinical environment based on the risk and type of contact.
At this time, we are not investigating properly masked interactions because we want to focus our attention on interactions that carry a significant risk of transmission. We have substantial evidence that masks, including cloth masks, work. There are published studies on the CDC website (https://www.cdc.gov/coronavirus/2019-ncov/more/masking-science-sars-cov2.html) that include an MMWR report from WashU that demonstrated that when actively symptomatic hairdressers were wearing a mask and their customers were wearing a mask while in close proximity for more than 15 minutes, there was NO transmission of disease. However, each situation is reviewed independently and certain dually masked contacts if close enough for long enough may also result in concern regarding an exposure.
These published data have been further corroborated by a marked absence of transmission in our lab or classroom settings on both campuses when this definition of contact was used (https://coronavirus.med.wustl.edu/resources/covid-testing/washu-med-testing-data/). When we see evidence of infection in more than one person in a given location where a clear exposure cannot be documented, we do more widespread testing using something called a cluster investigation. These cluster investigations have not uncovered any transmission while masked.
- Why aren’t School of Medicine faculty, staff and students included in surveillance testing?
We (Infectious Disease, Occupational Health, and Medical School Leadership) have and continue to discuss the value of surveillance testing. We recognize that there are widespread misunderstandings of its utility. The purpose of such testing is primarily to monitor the prevalence of disease in a high risk population (not in individuals).
Routine surveillance testing of asymptomatic undergraduate students is part of our institutional testing strategy because their more communal living and potentially lower compliance with public health measures, such masking and distancing, makes them the highest risk population for large clusters of transmission. The intent of the surveillance testing is to serve as an early warning signal. Thus far, it has been of limited benefit. This is because, even in high risk populations during periods of high community transmission, the rate of positivity rarely even reaches 1% and on Danforth we have never exceeded 0.6%.
While a positive test in an asymptomatic individual can be helpful for the initiation of isolation and contact tracing, we have actually seen no transmission in classroom or lab settings on the Danforth campus when everybody is masked, even when a student tested positive. As one might expect, these individuals generally appear to have lower viral loads and are thought to be less likely to spread disease.
In addition, there can be false positives resulting in inappropriate isolation and quarantine of truly uninfected individuals. Importantly, a negative test has very limited value to you as an individual. It reflects a point in time – the shedding of virus on that day and for approximately 18-24 hours from the time of taking the sample. By the time the test result comes back, the situation could be quite different.
There are false negative results attached to asymptomatic testing as well. We have seen both of these scenarios play out in the White House (X3) and in the NFL where daily testing is performed. At least in part, that appears to be due to a natural relaxation in fastidious attention to the effective public health measures we know work when someone receives a negative test. We have seen some anecdotal evidence confirming relaxation of masking and physical distancing following a negative test result on the Danforth campus.
The University is continuously monitoring the data to determine if this strategy needs to change.
- Why does the medical school not have a COVID dashboard with faculty, staff, and student test results similar to the Danforth?
The SOM now hosts a dashboard with total and active cases, available here: https://coronavirus.med.wustl.edu/resources/covid-testing/washu-med-testing-data/
- Why are only essential healthcare workers included in the current paid testing at the Kingshighway site for exposed employees and their symptomatic and exposed family members?
We are experiencing a huge spike in community spread of COVID-19 cases in the St. Louis region, and we have to do all we can to try and maintain the health and availability of our healthcare workers, who are essential to treating and controlling this pandemic. Family illness and exposures are increasingly limiting the ability of our healthcare workforce to return to the patient care setting. We want to take this small step towards helping address this issue. We realize this does not solve all the concerns. Please remember to access childcare resources available at https://hr.wustl.edu/worklife/family-care-2/
All other WashU personnel should continue to monitor for symptoms, self-screen before coming to campus, and if experiencing symptoms or had an exposure, stay home and call the COVID hotline at 314-362-5056. Depending on availability of essential testing for symptomatic employees and healthcare workers, we will reassess offering this test more widely to the rest of the Wash U population.
- Why isn’t a lab shut down when someone in it tests positive?
If someone tests positive in a lab environment, a contact tracing is initiated through interview with the positive individual. In the vast majority of cases, no exposures are identified- meaning no one was in close unmasked contact with the individual for more than 15 minutes. Contact tracing is limited by the truthfulness and memory of the person being interviewed. Therefore, we also monitor for evidence of multiple infections in the same space. If this occurs, we will shut down an environment and test all individuals. For most situations, these measures are not indicated and not recommended by Infection Prevention/ Occupational Health.
- Why do I need to complete a screening survey prior to coming to campus? Won’t people just lie?
The Screening Survey is intended to remind everyone of their obligation to not come to work while ill and to create a culture of being continuously aware of COVID symptoms. While it is certainly true that an individual may lie and still come on campus, we hope that people will take their pledge seriously. We also measure the only objective symptom, fever, through thermal cameras and checkpoints, but recognize that should a person choose to be deceptive and avoid these measures, they could. This is, however, why we also require universal masking on campus.
- Why don’t we test people before letting them back on campus if they have had COVID?
The tests we utilize for both symptomatic and exposure testing are molecular tests which use PCR-based technology. These tests may remain positive for up to 120 days even though the individual is no longer contagious. Multiple well-designed studies have confirmed that shedding of live virus is extremely rare beyond 8 days after symptom onset. Based on this data, the CDC no longer recommends a negative test to end isolation and return to work.
- What should I do if members of my lab, class, or members of the School of Medicine community are not following the masking or density policies and procedures?
Concerns such as these are really important for us to know about. In addition to directly speaking to your supervisor, program director, department chair, school leaders, or other trusted members of your community, there are two possible places to report your concerns. Any concerns can be noted in the COVID Concerns Portal whether they occur on the Danforth or SOM campuses: https://covid19.wustl.edu/health-safety/covid-policy-concerns-portal/. In addition, for research and lab specific concerns, you can report on the OVCR website: https://research.wustl.edu/covid19/report-concerns/. The more detailed and specific your responses are, the more likely it is that we address them.