Q&A: Asymptomatic Testing with Dr. Robert Schooley

UC San Diego’s fall plan continues to evolve, informed by the university’s Return to Learn program. We invited students, faculty and staff to submit their questions about the purpose of asymptomatic testing, how testing can be accessed, what happens if a positive result is received, and more.

To address these important topics, we spoke with Dr. Robert “Chip” Schooley, professor in the Department of Medicine at UC San Diego School of Medicine and a leader of UC San Diego’s Return to Learn program.

Q. Why is asymptomatic testing important?

A. Asymptomatic testing is important because most of the transmission of the virus is done by people who aren't having symptoms. People who do develop symptoms begin to shed virus from the nasopharynx two or three days before those symptoms appear. These individuals feel fine, yet they are shedding larger amounts of the virus at this stage of the illness than after they become ill. This happens because in the beginning stages, the virus turns off the “first response” elements of the immune system. These responses are responsible for the flu-like symptoms we experience in most viral infections. The virus grows unimpeded and leaves us unaware of our infection. This phase of the illness is known as the “pre-symptomatic phase.”

As we have learned more about the virus, we’ve determined that, in addition to these pre-symptomatic patients, more than half of the people who get infected develop no symptoms at all and, thus, never know they are infected. Nonetheless, these asymptomatic patients shed virus and infect others.

It's important to try to understand how much virus is being transmitted in the community by doing asymptomatic testing. If we just wait for people to arrive with symptoms, we'll only be looking at the tip of the iceberg. Asymptomatic testing is a way to find people at a time when they can be spreading the virus to others without being aware of it.

Q. Is asymptomatic testing available now for employees and students?

A. Yes, employees who register for the Symptom Screening and Exposure tool will be offered a one-time asymptomatic COVID-19 test at a UC San Diego Health location at no cost to employees, regardless of health care provider. Employees will be contacted via email to self-schedule their test appointment at a UC San Diego Health drive-up location. Employees should wait to be emailed—do not call directly to ask for an update.

Undergraduate students arriving Sept.19 through Sept. 28, 2020 who will be residing on campus for the fall will participate in free COVID-19 testing as part of the move-in process. The goal is to identify and isolate any asymptomatic individuals who could unintentionally spread the virus. Testing during move-in week will take place at a drive-up testing site located on campus, and we plan to administer approximately 1,000 tests per day. Students will sign up for a specific testing and move-in time. Test results will usually be available within 24-36 hours in their MyStudentChart. Graduate students arriving on or after August 12 who will be residing on campus for the fall are expected to complete free testing within 48 hours of arrival as part of their move-in process. More information can be found on the Return to Learn Testing and Screening page.

Q. How will asymptomatic testing be conducted in the Fall and how long does testing take?

A. Broad asymptomatic testing of students who come to or reside on campus will begin in October. We're planning on using a self-testing approach, very much like we did in our pilot test in May. We want to make it as easy as brushing your teeth. Students will be able to test themselves after receiving a swabbing kit. Testing will initially be done using swabs that sample only the front part of the nose. We are still working on other testing approaches including ones that use saliva; these methods may evolve over the fall. Those undergoing testing will scan a barcode on the swab using the UC San Diego mobile application, which will electronically link the swab to their private medical record. Results will be received within 24 hours. The whole testing process itself should take less than five minutes to complete.

Q. Will antibody testing be available?

A. While we have the capability, we will not be focusing on this as it does not contribute to our ability to control outbreaks. While most people do make antibodies after they become infected, most don’t have antibodies when they first become ill and, thus, they are not helpful in our efforts to identify people in the early shedding period. We need to use nasal swabs to directly identify the virus for this purpose. Antibodies generally peak at week five or six after infection and then begin to decline. A negative result doesn't necessarily mean that you haven't had COVID-19 because your antibodies may no longer be detectable. We also don't know that a positive antibody result means that you can't become infected again.

Q. Is asymptomatic testing required of all on-campus community members?

A. Testing is not required for everyone at this time, though we do strongly encourage all students, faculty and staff on campus to take part when invited. This is because we need at least 70% to participate to give us the best chance to detect outbreaks on campus early. We’ll likely invite people in groups—say a particular residential hall—so that we don’t overwhelm our laboratories. The appointments will be flexible and convenient, because we know that not everyone will be on campus every day. As we begin, our process will evolve.

Q. What happens if a student or employee tests positive?

A. Students who test positive for COVID-19 will be notified by their MyStudentChart app about their results, and will also be contacted by Student Health Services for consultation and care. In accordance with State and County public health orders, students who test positive may not leave their residence or suite, and may be moved to designated on-campus isolation housing, where basic needs will be met and food will be delivered to the unit. Employees who test positive for COVID-19 may not report to work on-site. They will be instructed to self-isolate until they are cleared to return to work. Per mandate of the County of San Diego, all positive test results must be reported to the County of San Diego Public Health Department.

Both students and employees who test positive for COVID-19 through UC San Diego Health will be contacted by a campus case investigator to determine if there are other individuals who may have been exposed. Learn more about contact tracing on the Return to Learn Testing and Screening page.

Q. What do you recommend for those who believe they may have been exposed to someone with the virus?

A. A close contact is defined as someone who has been within six feet of a COVID-19 positive person for more than 15 minutes, has had direct physical contact, or has provided care for a COVID-19-positive person without wearing personal protective equipment.

If you are an employee working on campus and believe you were exposed to a COVID-19-positive individual, you should contact UC San Diego Health’s Testing Support Line at (619) 543-8260 which will make a clinical determination of exposure. Students should contact Student Health Services at (858) 534-3300. If you are deemed exposed, you will be told to quarantine for 14 days and monitor for symptoms. Do not come to campus. Five or more days after your exposure date, you may take a test at UC San Diego Health to determine if you are positive and should isolate. However, even if your test is negative, you will have to remain in quarantine for the entire 14-day period. These instructions are in accordance with the San Diego County’s guidance.

Q. Why is it important for those who are working and studying remotely in the San Diego area to do the daily symptom and exposure screening?

A. In accordance with the current San Diego County Health Order, all UC San Diego staff, faculty and student employees who are reporting to campus or any other physical UC San Diego location for work must conduct a self-screening for COVID-19 symptoms and exposure. If you are working or studying remotely in the San Diego region, you are also strongly encouraged to complete the daily symptom and exposure screening. Daily screening by remote employees and students will help the university identify and anticipate potential outbreaks off-campus, which can inform our planning for repopulating the campus.

Also, it's good to be aware of your own health during these times. If you start having symptoms, you should take extra precautions to reduce the chance that you transmit the virus to family members or roommates. The symptom and exposure screening is a good way to monitor how you feel. Those who are symptomatic can report their symptoms through the screening tool in order to get contacted to schedule a COVID-19 test.

Have more questions? We invite the campus community to submit your inquiries online. A new Q&A with a Return to Learn expert will be published each Thursday in “This Week @ UC San Diego” for the next several weeks.