Brown is testing vaccinated students. Should other RI schools do the same?

Days after Brown University students arrived on campus, most fully vaccinated and ready for a nearly normal year, the school reimposed temporary pandemic restrictions upon confirming 82 positive asymptomatic COVID-19 tests. 

As it turns out, the majority were vaccinated students. 

Brown, unlike other schools in Rhode Island, requires all undergraduate students on campus — regardless of vaccination status — to be tested twice a week, while graduate and medical students, along with employees, must test once a week. At other institutions, such rules would typically be imposed on those who haven’t been vaccinated or who have been granted an exemption.

Whether such rigorous screening should be mandated for those who have gotten their shots remains a point of debate among medical experts. Here's what four Rhode Island physicians who spend a lot of time dealing with COVID-19 have to say:

'You don't know what to do with it'

“I have mixed feelings about it,” said Dr. Ashish Jha, dean of Brown’s School of Public Health. “On one hand, it adds an additional level of safety, and I understand that. The problem is you don’t know what to do with it. Asymptomatic people who have a little bit of virus in their nose, it’s not even clear that they’re infected, but they will turn positive. And it’s not clear that they can spread, but they’ll turn positive.”

More:Dr. Jha discusses 'end game' of the COVID pandemic, sees better autumn than some predict

Dr. Vanessa Britto, director of Health Services at Brown, said its comprehensive testing program was put into place partly because of the residential nature of the school, classroom settings that vary in size, and students who are arriving from around the world. Add to that the delta variant, and the school feels that increased testing is warranted.

Britto said that level of testing would continue “at least at the beginning of the semester,” and that the school has had “active conversation about dialing back once we were clear and had more of a sense of the directionality of positivity.”

Aggressive testing guides the response

Dr. Mark Lurie, an associate professor of epidemiology at Brown, emphasized that the intensity of the testing program has revealed that “even places with relatively high vaccination rates can have outbreaks.”

“If Brown were not doing asymptomatic testing, it is likely that it would have taken longer to detect these initial cases, which would in turn have resulted in more people becoming infected,” Lurie said in an email.

On whether that asymptomatic testing should include vaccinated individuals, perspectives vary. 

It depends on the institution

Dr. Karen Tashima, an infectious disease expert and researcher at The Miriam Hospital and Brown, where she also teaches, feels that such widespread testing for the vaccinated and the asymptomatic is probably unnecessary.

“I think asymptomatic [people], if they haven’t been exposed, then they probably don’t need to get tested,” she said. “But I think it does depend on what is going on at each institution at the time.” 

What other protections are in place?

Dr. Leonard Mermel, another Brown professor and infectious diseases expert who serves as medical director of the department of epidemiology and infection control at Rhode Island Hospital, felt that universal testing could be “part of a group of ideas to try to mitigate risk of transmission.”

“I think it’s important either way,” Mermel said. “I’m not saying you have to do it, and it certainly would not be the cornerstone of a preventative strategy. It’s an additive intervention.”

However, Mermel later added that if schools have “done the basic infection-prevention strategies for COVID, there isn’t much utility of routine testing of all the college students.”

Another matter is cost. While Brown has no shortage of wealth, operating with an endowment well over $4 billion, other institutions have a far smaller pool of resources.

As Tashima explained, when it comes to the cost of a COVID-19 test, price tags vary. 

“If you try to go get your own test, if you get it at an airport, it’s going to be $250,” she said. “If you get it at the local urgent care, it could be $160. … If you pick up a [BinaxNOW] test at CVS, it’s $23 for two tests. So I think it is all over the place, but universities have basically taken that on as their responsibility to pay for the tests.”

Tashima said that the only way to reduce costs is to pool samples, testing them all at once.

“So you do 20 at a time,” she said. “If none of the 20 are positive, if it’s all negative from a batch, then you don’t have to go to the individual testing and do that.”

Rhode Island Postsecondary Education Commissioner Shannon Gilkey acknowledged that expense is a factor to be considered, noting that public schools have “a ton of financial need.”

“It is resource-intensive, and institutional leaders have to judge the financial implications as well as the health implications and enrollment implications of all these big-time decisions,” Gilkey said. “But if you can’t keep people healthy, or people can’t stay healthy for some reason or another, you’ve got to do everything you can to combat that to keep them on-site, in the classrooms.”

Breakthrough COVID cases not a major concern

All things considered, the chances of a breakthrough infection remain “quite low,” according to Mermel. 

Lurie put the odds between 1 in 1,500 and 1 in 10,000 per day, “and even lower for those who take precautions like masking and social distancing and who live in places with high vaccination rates.”

Instead of fretting over the possibility of breakthrough cases, Mermel said, the focus should be on getting everyone vaccinated.

More:Hundreds of URI students have requested religious vaccine exemptions by checking a box

While many colleges across the state have achieved student vaccination rates close to 100%, holdouts remain on some campuses, like the University of Rhode Island, where more than 1,000 exemptions have been granted, most on religious grounds.

Among those seeking to skip the jab for reasons of faith, Mermel pointed to “a lot of educational gaps.”

Certain Catholic leaders have pointed to Johnson & Johnson’s vaccine research, which involved cell lines that have descended from fetal tissue, as a reason to avoid that particular shot. To be clear, neither the Johnson & Johnson vaccine nor other COVID-19 vaccines contain fetal cells. 

Mermel, who has attempted to persuade those citing religious beliefs to get vaccinated, explained that such research methods are overwhelmingly common.

“So if someone says, ‘I don’t want to do it because it involves fetal cells,’ they should never take Tylenol, Motrin, Suphedrine, etcetera, etcetera, etcetera, or get any of the other vaccines that they already probably received at some point in their life,” Mermel said.

Tashima, praising colleges and universities for ensuring that nearly all students are vaccinated, acknowledged that it may be challenging to get past 90%, but that it doesn’t hurt to try.

“Definitely anybody that we can persuade to get the vaccine and that it is safe and that it’s worth it is worth every conversation.”

With reports from Providence Journal staff reporter Wayne Miller