It sometimes seems a million doesn’t command quite the same attention that it used to. It isn’t mathematically special. And in today’s society, it isn’t even unusually large. We now live in a world where the population is measured in billions, economies are scaled in trillions and computer calculations are counted by the quadrillion.
But it takes on a very special significance when you’re talking about looking after the well-being of your community in the middle of a globally devastating pandemic.
This past week, here at the University of Illinois Urbana-Champaign, for the one millionth time, we administered the saliva-based, rapid-result PCR COVID-19 test that we developed. Our pioneering SHIELD program made a lot of headlines during the summer and early fall with the massive deployment of our faster, cheaper and more accurate PCR test that uses saliva rather than the more-common nasal swabs.
In the space of just a few months, we built a comprehensive testing, tracing and monitoring infrastructure and ecosystem that is unmatched anywhere in the country.
In the spring, the ongoing and extensive threat to the university’s ability to deliver on our land-grant educational, research and service missions became increasingly clear. We created a new, large, transdisciplinary committee of faculty, staff and students to develop a plan to protect those missions and to allow our university to bring students, faculty and staff back to campus in ways that emphasized safety, compliance with state government guidelines and commitment to supporting our students’ educational experience as best as possible under the COVID-19 circumstances. Our committee would come to be known as the SHIELD Team here at Illinois.
The group started by inventing a new, low-cost COVID-19 test that delivers extremely accurate, same-day results, and we are currently conducting a clinical study to apply for FDA emergency use authorization for the test to support its wider distribution throughout our state and the nation. We developed and deployed a digital app to nearly 50,000 users to assist in exposure notification and to control access to buildings and classrooms. We established a rapid-alert system that directly notifies individuals within 30 minutes of their test result if they have tested positive, so they can immediately isolate and reduce any spread of infection. And we used our university supercomputing resources to create real-time models to quickly identify and contain emerging outbreaks before they can get out of control.
Professor of Chemistry Paul Hergenrother, who led the test development, described the critical differentiator of our test this way. “Our saliva test was innovative, because it allowed a processing pipeline that short-circuited the RNA-purification steps conventionally used. This made our tests faster, cheaper and not reliant on reagent supply-chain bottlenecks – all while providing greater safety for the laboratory personnel.”
Professor of Veterinary Clinical Medicine Tim Fan, who, along with Dr. Rick Fredrickson, led the deployment of the testing laboratory in the University’s Veterinary Diagnostic Laboratory (VDL), explained how we were able to quickly move from bench to production. “We were delighted to leverage our experience in animal COVID-19 testing for the benefit of the entire university campus, and in rapid order develop an unprecedented testing platform that was staffed by a hard-working and dedicated team working around the clock.”
Over the summer, Senior Director of Special Events Laura Wilhelm-Barr and her staff led the effort to establish and staff the structure to collect as many as 70,000 saliva samples from students, faculty and staff each week. For most of the fall semester, saliva samples were collected from as many as 18 stations around campus, seven days a week, and rushed to the PCR laboratory every hour.
Professor of Chemistry and Associate Dean for Research of the Carle Illinois College of Medicine Martin Burke, who leads the SHIELD team, explained how a unique spirit of innovation and collaboration across our campus made SHIELD possible. “At Illinois we love to innovate, and we love to work together. Inspired by urgent necessity, the SHIELD team made many innovations in a very short period of time that collectively allowed us to achieve fast, frequent testing at scale and embed this testing into a multimodal ecosystem that powerfully defends against COVID-19 transmission. Failure was not an option – and our entire campus rallied together to succeed.”
Pathobiology Professor Rebecca Smith, the epidemiology lead on our SHIELD team, said the speed of our test processing was critical in our ability to contain the virus. “Our goal was to cut transmission within our community, and our modeling clearly showed that this can only be achieved by minimizing delays in processing, delivery of results, isolation of cases and quarantining of contacts.”
During the fall 2020 semester, the university typically conducted about 10,000 tests each weekday and about half that number during weekend days. The high frequency of testing meant that new cases were detected very quickly after infection occurred, and those individuals were quickly isolated and their close contacts identified and asked to quarantine. This strategy, along with universal masking on campus, small in-person class sizes, and the availability of remote learning in parallel with in-person instruction, meant that the case positivity rate for the university was usually well below 0.5%, with new cases sometimes lower than 10 per day.
Physics Professor Nigel Goldenfeld, who leads the modeling for the SHIELD team, said one of the most daunting challenges that team recognized from the beginning was the reality that a university environment is an ideal one for the spread of COVID-19. “You have a significant proportion of asymptomatic cases, high-density living, gatherings for classes, exuberant social life and frequent travel on weekends back home. Only with an aggressive program of testing and most importantly, appropriate follow-up once cases are identified, is it possible to prevent runaway exponential growth of the pandemic on campus and into the community. And we achieved all this, even when the cases in the Midwest were rising out of control.”
During the fall semester, the SHIELD team was challenged on multiple occasions, and it was continually learning, re-evaluating and adjusting its operations and thinking. Just like other universities that reopened in-person and conducted systematic surveillance, many incoming Illinois students tested positive at the beginning of the semester. These cases partially spread, especially during early semester social events, which led to a spike in cases at the end of August.
The spike in daily case positivity for the university was 2.86% on one day. This was a factor of 10 smaller than the peaks in positivity reported by many other institutions at that time, but it was nearly a fivefold increase over our own opening week rates. Quick university responses guided by SHIELD program data, included a two-week “essential activities” order on Sept. 3, prioritized undergraduate testing and established even faster isolation methods and succeeded in flattening that first spike to below 0.5% after a week, with the daily case positivity falling to 0.05% by mid-October.
Weekend social life and travel led to predictable small spikes in cases on Mondays and Tuesdays, which were quickly contained and had died down by the end of the week. During late October and November, the COVID-19 pandemic surged out of control across the Midwest, including in east central Illinois. But even during that time, and with an increasingly active social calendar that included Big Ten football, Halloween, the U.S. elections and Thanksgiving, our positivity rates generally remained below 0.5%, a factor of 10 (or more) smaller than those seen in the surrounding region.
One of the priorities for all of us from the very beginning of the SHIELD program was to ensure that our operations were in complete coordination and alignment with the Champaign-Urbana Public Health District (CUPHD), the organization that has the ultimate authority in managing this public health crisis. This collaboration has been extensive and seamless, and our CUPHD colleagues are involved in virtually every significant conversation we have and in every decision we make.
CUPHD Administrator Julie Pryde has been a vocal advocate for our university efforts throughout. “We have been excited to work as partners with the university on this groundbreaking effort to mitigate the spread of COVID-19, and we look forward to working closely with them as the SHIELD program is rolled out to the community in the future.”
CUPHD Epidemiologist and Director of Planning and Research Dr. Awais Vaid said our campus program had significant benefits to the broader community as well. “By reducing transmission of COVID-19 within the university so effectively, the SHIELD program prevented transmission to the outside community too. In fact, from our case investigation, we have found no evidence of transmission to the community from the university. Furthermore, we have no evidence of transmission within the university classroom setting either.”
The SHIELD program introduced many other innovations apart from its saliva test. We helped ensure a safe campus environment by restricting access to university buildings to those compliant with testing requirements and COVID-19 negative. A custom smartphone app, Safer Illinois, was the most popular way for students and staff to display the “access granted” credentials upon entering a building. The Safer Illinois app also provided a convenient way for users to receive their test results and check the wait times at testing sites. The app also provided exposure notification functionality. Without using GPS or location monitoring, it could alert a user if they had recent extensive exposure to a positive case in a way that protected privacy.
William Sullivan, professor of landscape architecture, who led the Safer Illinois team, said a number of unique features contributed to the rapid and enthusiastic use of the tool. “The convenience features built into the app helped its adoption by nearly 50,000 unique users on campus, representing the highest adoption rate of any COVID-19 app in the world. During the semester, it provided thousands of exposure notifications to users, with a positivity rate of 15%. Because of the high adoption rate and the design choices we made based on modeling, if you get an exposure notification from the app, it is a strong recommendation that you should immediately quarantine and get tested on the fourth day after exposure.”
Another innovation was a vigorous program of student engagement led by Vice Chancellor for Student Affairs Danita Brown Young. This program not only formed partnerships and outreach with student-led organizations on campus, but also initiated a series of safe social events including movies and concerts that were widely attended and very popular. She and her team recognized that providing safe socialization options for our students and taking care of their mental health were as important as the purely technical aspects of testing. She said, “We were thrilled by the ways that our volunteers and Wellness Ambassadors came forward, advocated for the SHIELD program amongst their peers, took care to support the students who developed COVID-19 and had to be isolated, and for all their many great ideas that helped our campus community manage in real time the challenges of coping with COVID-19.”
And our students tell us the SHIELD ecosystem worked. Corey Herrman, a senior in Community Health - Health Education and Promotion, said when the semester started, he and his fellow students were unsure what to expect, and the SHIELD program provided some level of normalcy, “The university managed to create an environment that gave us stability in an unpredictable world. Our rapid COVID-19 testing allowed us to resume in-person, socially distanced classes when most universities could not. I am so glad that we were able to stay connected with our peers and instructors in a safe way.” Herrman, who also works as a Wellness Ambassador, said “I got to see firsthand how willing the student body was to keep our community safe. We don’t know what the coming months will look like, but I know for sure that the University of Illinois will be ready for it.”
This colossal and collaborative effort has truly demonstrated the power of our transdisciplinary expertise here at Illinois to find important and unexpected solutions on an unimaginable timeline. Our Building Service Workers, Dining Service Workers and Housing staff worked even throughout the state’s Stay-at-Home order to continue delivering essential services and support to students, faculty and fellow staff members. Our counseling and health center professionals have had to reinvent their work and services. Our human resources and technology services operations have been asked to develop entirely new frameworks for support and services that did not exist. Virtually every member of our faculty and staff has been asked to rethink, realign and reimagine their roles and responsibilities to help us find ways to support our students and to keep our university moving forward when it matters the most.
One million tests is truly a milestone for our university and we truly believe it is appropriate to celebrate the spirit of innovation, the creativity and the selfless, tireless and collaborative efforts of thousands of individuals across the entire campus over these long months.
And the possibility of effective vaccines on the horizon is certainly a welcome glimmer of light at the end of the tunnel.
But all it takes is a look at the alarming increases in COVID-19 cases, hospitalizations and deaths happening in our own region, our state and across the country to remind ourselves that we are still in a long, dark tunnel. And it will take patience and the power of our commitment to the shared responsibility to look after the health and prosperity of our community for us to navigate, with confidence and determination, our way to the end of the tunnel.
We have been fortunate here at Illinois to have access to free, fast and frequent testing during this pandemic. It has given many of us a welcome peace of mind and margin of safety that is sadly, not available to most in this nation today. We are proud of every member of our university community who led by wearing face coverings, maintaining social distancing and following all of the safety protocols we asked of them. That collective effort – and the willingness to sacrifice many aspects of the “normal” university experience – saved lives and allowed us to maintain a portion of our fall schedule in person.
One million tests here at the University of Illinois Urbana-Champaign is a big deal and a point of pride for everyone who participated.
But in a time when this pandemic is infecting 200,000 people a day and taking 3,000 lives a day in the United States alone, one million suddenly seems like a number that is much too small. We are determined to expand our testing approach to our community, the state of Illinois, the nation and the world. We have proved that large-scale testing in an ecosystem that allows us to isolate and quarantine quickly after a positive test is the key to economic recovery that reduces risk of the spread of this disease.
We consider this challenge to be the 2020 version of President John F. Kennedy’s moonshot. When he gave his famous moonshot speech, many called his pledge to send someone to the moon within just a few years after the first U.S. manned spaceflight to be audacious and impossible. Over the past six months, we have proved that problems that seem insurmountable are exactly what world-class research universities like Illinois exist to solve.