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COVID-19 Testing

Wisconsin colleges say rapid COVID-19 tests have worked. Can they help slow the state's surge? The CDC is here to find out.

Madeline Heim
Appleton Post-Crescent
Clinical staff employees dress in personal protective equipment in the Culver Family Welcome Center Tuesday at the University of Wisconsin-Oshkosh to administer COVID-19 testing for the community with 15-minute turnaround time on results.

Only about 3% of the COVID-19 tests taken by University of Wisconsin-Oshkosh students are coming back positive. In the city that surrounds them, the rate is several times as high. 

The school's top testing official thinks that shows the school's testing approach — using rapid antigen tests to regularly test students — is working.

Now, through a first-of-its kind partnership between UW System schools and the U.S. Department of Health and Human Services, these free rapid tests are being rolled out to the broader community.

Can they help rein in rampant spread in places like the Oshkosh-Neenah metro area, which as of Thursday ranked among the 20 U.S. metro areas that had seen the most cases per capita, according to The New York Times? Experts say they might, but rapid tests have their drawbacks, too. 

UW-Oshkosh tests 2,400 students weekly from residence halls and off-campus housing using antigen tests, which detect certain proteins in the novel coronavirus. At about $23 apiece, they're cheaper than PCR tests, which look for the presence of the virus's genetic material and can run over a hundred dollars each. 

Importantly, the antigen tests produce faster results – UW-Oshkosh students get results back in an hour, while Wisconsinites who visit a National Guard testing site elsewhere in the state typically wait three to seven days, according to press releases issued by local sites.

Speed is of the essence to control outbreaks with testing. Even a three-day delay between symptom onset and receiving results can cut in half the number of future transmissions that can be prevented with contact tracing, a July study in The Lancet showed. Plus, it's much easier for a person to put life on hold for an hour while waiting to see if they tested positive than for several days.

HHS has shipped more than 600,000 of the antigen tests to Wisconsin nursing homes and assisted living facilities, and announced Oct. 26 that 1.8 million antigen tests were en route to Wisconsin to help K-12 schools stay open and health care workers and first responders get back to work faster after an exposure.

And most recently, they sent 250,000 more to UW System campuses to pilot a specific test that can deliver 15-minute results to anyone who wants them. 

With antigen tests more widely available across Wisconsin, hopes are high that their speedy results could help tamp down the state's surge in cases. 

"Everybody's wondering if this can be the new saving grace," said Alana Sterkel, an assistant director at the state hygiene lab who advises Wisconsin's emergency operations staff on lab testing.

That includes the White House Coronavirus Task Force, a group of top federal officials who author weekly reports about how each state is faring with the pandemic. In Wisconsin's Nov. 8 report, which described the state's "unrelenting rise" in cases and test positivity rates, they wrote that expanded and strategic use of the antigen tests should be used to control the surge. 

The report mentions neighboring Minnesota, where Gov. Tim Walz rolled out a massive testing initiative of asymptomatic 18- to 35-year-olds on Oct. 28, using the quick-turnaround tests, to better gauge how the virus is spreading among that age group. Details about the initiative are scarce, but Walz told reporters that the instant results can "start to break" their surge. 

At UW-Oshkosh, Centers for Disease Control and Prevention researchers are trying to find out if the antigen tests can deliver what's being asked of them. They launched a study Monday of the school's surge site, said Kim Langolf, who oversees risk management for the campus and has led its testing initiatives.

If the site produces successful results, the method could expand across the state and nation. The CDC did not respond to a request about when results would be known and what key measures researchers are examining.

Even prior to the community site opening, though, Langolf said the fact that the campus has held its test positivity rate so low proves the rapid strategy they've developed is effective. 

"We know our students very well and we know that this age demographic can be difficult to get in to test," Langolf said. "(We knew) the more efficient and quick we could be, the better compliance we would have."

U.S. Army specialist Riley Koehler puts together collection swabs for distribution to residents at a federal COVID-19 surge testing site at ThedaCare Physicians-Neenah on Oct. 21.

But the campus has some tools that the community doesn't. The key one? Leverage. They can require students show up for their weekly test – and many do, with more than 95% complying, Langolf said. Schools can oversee students' isolation or quarantine periods, and on the front end, they can require them to wear masks and practice physical distancing. 

Frequency is critical, especially because antigen tests are less sensitive than PCR tests. The CDC rates PCR tests as having "high" sensitivity, while antigen tests are "moderate," meaning more cases of disease might be missed with the latter. An antigen test may not pick up trace amounts of the virus on the first try, Langolf said, which is why it's important the students come back week after week. 

As the tests become more widely available, Sterkel, with the state lab, said she's heard suggestions to put them in dentist's offices, in workplaces or even at home.

But the tests aren't yet high enough quality and can't be easily performed by the non-professionals. Even seemingly minor mistakes – like not following the instructions of the test, not following safety procedures or contamination of surfaces on which patient samples are handled – could produce false results, she said. 

The quality of the test matters more to Sterkel than anything else, she said, because people need to be able to have confidence in their results. 

"If we have too many of these lower-accuracy tests available in unregulated settings, we’re going to see false results and it’s going to erode public trust in these tests," Sterkel said. 

The U.S. Food and Drug administration warned health care providers in a Nov. 3 letter that any deviation from the detailed instructions for a rapid test – like reading the results before or after the specified window of time – could produce false positives. Scientists and lab administrators have criticized the federal government for not presenting more clearly how the tests should be conducted. 

Sterkel compares an antigen test's usefulness to pregnancy tests: A person might get their first notification from two thin lines on a plastic stick purchased at the drug store, but most follow up with a doctor for confirmation.

She helped author statewide guidance on how best to use the rapid tests, suggesting that both people who test positive but don't show symptoms, as well as symptomatic people who test negative, get a follow-up PCR test to confirm their results. Later, the CDC recommended the same approach.

UW System President Tommy Thompson said he's proud of the low virus prevalence on college campuses and pleased they were chosen to beta-test the strategy.

He said he'd love to see them be the "successful example" that ultimately curbs Wisconsin's spike in cases and leads to use around the country. 

The sites will provide real-time data to the CDC to assess how well the test is performing and what circumstances it would be best used in. It would be nice to move from mathematical models to having actual data in hand, Sterkel said.

Langolf isn't sure that one testing approach could be the thing that finally cuts off the virus's exponential growth. But she's hoping the results of the CDC study will prove something. 

"I think our community is suffering so much that it’s going to be hard to determine what turns it around," she said. "What we will know is how effective and valid this approach is."

Contact reporter Madeline Heim at 920-996-7266 or mheim@gannett.com. Follow her on Twitter at @madeline_heim.

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