On December 7, 2020, President-elect Joe Biden announced Dr. Rochelle Walensky as his nominee for director of the Center for Disease Control and Prevention (CDC), the federal organization primarily responsible for controlling the introduction and spread of infectious diseases including COVID-19.1 Dr. Walensky currently serves as the chief of the division of infectious diseases at Massachusetts General Hospital and is a professor of medicine at Harvard Medical School.
Dr. Walensky and her colleagues have been outspoken critics of CDC guidance for colleges and universities during the COVID-19 pandemic.
As co-author of a COVID-19 epidemic modeling study assessing strategies to permit the safe reopening of college campuses in the United States, Dr. Walensky took the position that more testing is necessary for institutions of higher education to safely reopen. The study, published in the JAMA Network Open on July 31, 2020, finds that symptom-based screening alone is insufficient to prevent spread on college campuses. The study suggests that students should be tested every two days with a low-sensitivity rapid test. If a test is positive, a student should be isolated and retested with a higher sensitivity test, after which they would continue isolation or be reintroduced into the general population. The researchers recognized that “this sets a very high bar – logistically, financially, and behaviorally – that may be beyond the reach of many university administrators and the students in their care.”
Despite the self-professed high bar set by their research, Dr. Walensky and her colleagues have leveraged national and international platforms to tout the conclusions of their campus COVID-19 epidemic modeling study. In an August 3, 2020, opinion piece co-authored by Dr. Walensky for CNN, Dr. Walensky highlighted her research and touted the merits of rapid COVID-19 testing every two or three days paired with isolation for those who have a positive test. The opinion article concludes by challenging whether institutions that cannot follow prescribed prevention strategies should reopen. “Colleges and universities can’t afford to reopen based on random testing or symptom based monitoring. At the end of the day, given the dangerous risks involved, a school that cannot test all its students regularly or maintain control over good prevention practices must ask itself whether it has any business reopening at all.”
In a September 1, 2020, editorial co-authored by Dr. Walensky published in the British Medical Journal, Dr. Walensky set further standards which institutions should meet before reopening. The opinion piece provides the author’s “lessons” learned from tracking fall outbreaks of COVID-19 at institutions in the U.S. The editorial suggests that community transmission must be curbed before reopening; requiring states in which the institutions operate to meet a seven-day rolling average of four or fewer new cases per one hundred thousand, and have a test positivity rate of less than five percent.2 The article also suggests requirements that students observe a 14-day quarantine period before starting in-person classes.3
To date, the CDC’s guidance on COVID-19 prevention for colleges and universities has come in the form of options and considerations for administrators rather than issuance of global requirements. Given Dr. Walensky’s clear and consistent advocacy for enhanced testing protocols on campus, there is a good chance the CDC will become more hands-on by issuing specific directives which include enhanced testing and isolation procedures. If the CDC’s guidance looks anything like the testing suggested by Dr. Walensky’s research and opinion articles, it could mean that colleges and universities are required to test students multiple times per week.
Given the significant cost of testing and limited test availability, enhanced testing mandates could effectively force institutions to move online until the mandates are lifted. Institutions that want to move to in-person instruction in the spring semester should set a testing budget that accounts for testing all on-campus students multiple times per week. Perhaps institutions will want to act now to secure contracts for enough testing kits.
1 Dr. Walensky’s appointment to the CDC director role does not require Senate confirmation.
2 As of December 8, 2020, the NY Times reports Ohio cases at 77.3 per 100,000, Michigan at 67.7.
3 In addition, the editorial suggests that punishing students for violating COVID-19 restrictions is an ineffective strategy. Instead, the authors suggest institutions use harm reduction strategies that provide alternate low risk options for students to engage in socialization.