Cases isolate safely, investigation identified exposures, and contact tracing identified contacts who were instructed to monitor for symptoms

Paper 5 (Meredith et al. 2022)

Meredith GR, Diel DG, Frazier PI, et al. (2022).  Routine Surveillance and Vaccination on a University Campus During the Spread of the SARS-CoV-2 Omicron Variant. JAMA Netw Open. 5(5):e2212906. doi:10.1001/jamanetworkopen.2022.12906

State the research question motivating the current study.

State the main independent variable(s).

State the main dependent variable(s).

State the research hypothesis.

State the null hypothesis.

What is the study design?  Please briefly discuss.

How was the data collected?  Please briefly discuss.

What are the study findings?  Please briefly 

What are the study limitations?  Please briefly discuss.

cases isolate safely, investigation identified exposures, and contact tracing identified contacts who were instructed to monitor for symptoms, test, and/or quarantine. From November 28 to December 31, 2797 COVID-19 cases were identified (mean [SD], 82.3 [82.4] cases/d; 3.1% positivity; 89.0% students, 11.0% employees), eclipsing previously measured incidence. Most cases (82.2%) reported mild symptoms (no reported hospitalizations). Despite high vaccination rates (97.9% of campus*), 98.6% of cases were breakthrough infections, and proportionately more named close contacts who became COVID-positive in this period (22.6%) than previously (4.4% between August 23 and November 27). Something had clearly changed in the university setting, as similar outbreaks were not yet being seen in the off-campus community or neighboring counties.* From mid-November, positive samples were screened for S gene target failure as a marker of variant Omicron. Whole genome sequencing confirmed the presence of Omicron in samples from December 1 (1 sample), December 2 (1 sample), December 3 (2 samples), and December 4 (4 samples). By December 11, 155 of the 174 positive samples (89.1%) were confirmed as Omicron; the Delta variant was detected in the remaining samples. Given identification of Omicron and the noted speed of transmission, on December 10 university leadership limited in-person interactions, and on December 14 student gatherings were prohibited, examinations were moved online, and an exit testing process was implemented. The de-densification process decreased student cases numbers, but incidence among people who stayed locally remained higher than before Thanksgiving (December 26 to December 31: students, 11.5 [9.4] cases/d; employees, 16.0 [12.9] cases/d; 4.8% positivity). Discussion The Omicron variant is highly transmissible, particularly in high-density social settings.5. Based on analysis of routinely collected population surveillance data, Cornell’s experience shows that traditional public health interventions were not a match for Omicron. While vaccination protected against severe illness, it was not sufficient to prevent rapid spread, even when combined with other public health measures including widespread surveillance testing. Generalizability of the study finding might be limited due to the demographics of its sample (the majority of participants were undergraduate students) and by the study’s single institutional setting. As SARS-CoV-2 continues to adapt, surveillance and case-series studies that look across different populations and settings will be helpful in identifying sentinel events and guiding actions to mitigate harm. ARTICLE INFORMATION Accepted for Publication: March 31, 2022. Published: May 18, 2022. doi:10.1001/jamanetworkopen.2022.12906 Open Access: This is an open access article distributed under the terms of the CC-BY License. @ 2022 Meredith GR et al. JAMA Network Open. Corresponding Author: Genevive R. Meredith, DrPH, MPH, Cornell University, Schurman Hall, $2-005, Ithaca, NY 14853 ([email protected]). Author Affiliations: Department of Public and Ecosystem Health, College of Veterinary Medicine, Cornell University, Ithaca, New York (Meredith); Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York (Diel, Warnick); Department of Operations Research and Information Engineering, College of Engineering, Cornell University, Ithaca, New York (Frazier, Henderson, Wan); Provost’s Office, Cornell University, Ithaca, New York (Koretzky) Author Contributions: Drs Meredith and Warnick had full access to all of the deidentified data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

JAMA Network Open | Public Health Surveillance and Vaccination on a University Campus During the Spread of the SARS-CoV-2 Omicron Variant Methods For the Fall semester (August 26 through December 18, 2021), all undergraduates (15 503 students), 2873 graduate students (28.5%), and 2803 employees (20.9%) were required to register for and participate at least once a week in free, on-campus polymerase chain reaction COVID-19 surveillance testing." Using a case series approach, all deidentified university surveillance data (ie, test registration, result) were reviewed daily to detect sentinel events and outbreaks and to guide public health responses; testing compliance rate, test positivity rate, and incidence were monitored. Routinely, positive specimens were sequenced for genetic characteristics. As part of Cornell University’s institutional operations, this public health surveillance effort was not subject to institutional review board review, and informed consent was not needed because data were nonidentifiable counts. This study followed the reporting guideline for case series Results When students returned to campus (mid-August 2021), reentry testing was used to identify COVID-19 cases (Figure). Isolation, case investigation, contact tracing, quarantine, and targeted supplemental testing limited the outbreak to 480 cases (August 23 to September 10: mean [SD] 22.9 [18.8] cases/d). Thereafter, routine surveillance and public health measures limited transmission (September 12 to November 27: students, 1.9 [2.2] cases/d; employees, 2.4 [2.5] cases/d; 330 total cases; 0.1% positivity) (Table). After Cornell’s 5-day Thanksgiving break, surveillance outcomes changed dramatically among students (Figure): 75 cases from November 28 to December 4 (mean [SD], 10.7 [6.9] cases/d; 0.5% positivity), 655 from December 5 to December 11 (93.6 [75.7] cases/d; 2.9% positivity), and 1559 from December 12 to December 18 (222.7 [138.7] cases/d; 5.7% positivity). Support teams helped Figure. Identified COVID-19 Case Trends and Key Events, Cornell University, Fall 2021 450- Arrival Academic semester Examination period period 400- Student cases Employee cases – 7-d positivity rate 6 350 Campus policy shift un 300 . No in-person gatherings . Examinations online only . Exit testing (do not travel with COVID-19) 250 Impact of Omicron variant: . First case detected: December 1 Surveillance test positivity rate, 7-d rolling mean, % Case count, No. per . 89.1% of cases Omicron variant: December 11 200 w 150 . Campus policy shift In-person gatherings limited Examinations end – 2 Students return to campus . Dormitories 100 – . Reentry PCR test close Classes end Thanksgiving break 50 . No classes for 5 d 29 12 19 26 10 17 24 31 14 21 28 12 19 26 August eptember October Novembe December

Research Letter | Public Health Routine Surveillance and Vaccination on a University Campus During the Spread of the SARS-CoV-2 Omicron Variant Genevive R. Meredith, DrPH, MPH; Diego G. Diel, DVM, PhD; Peter I. Frazier, PhD; Shane G. Henderson, PhD; Gary A. Koretzky, MD, PHD; Jiayue Wan, MS; Lorin D. Warnick, DVM, PHD Introduction Author affiliations and article information are listed at the end of this article. As SARS-COV-2 was detected in the US, emergency public health measures took effect, including shutting down schools.’ As prevention and control measures improved, emergency response policies were rolled back.’ Cornell University opened for residential instruction in Fall 2021 using an extensive testing, contact tracing, and isolation program in partnership with the Tompkins County Health Department (Table).2 Vaccination was mandated for all students and encouraged for employees. Masks were required on-campus, and isolation orders and contact tracing occurred within hours of any positive result. We hypothesized that these measures would limit COVID-19 spread on campus and sought to monitor this with a case-series study of university testing records. Table. Public Health Measures Implemented in Fall 2021 to Mitigate COVID-19 Transmission and Morbidity on Campus Public health measures Focus Outcomes Mask wearing Prevention Layer of protection against Required inside all buildings on campus, all COVID-19 transmission semester (except in private office space or in designated eating areas with distancing) Vaccination Prevention, Protection against COVID-19 transmission and/or . Required for students mitigation impact: . Strongly encouraged for employees . 97.9% of campus fully vaccinated Daily symptom screening and telehealth Detection, Layer of protection against COVID-19 appointments (for questions or concerns with mitigation transmission and/or impact symptoms) . Required for employees . Strongly encouraged for students Free mandatory PCR surveillance Detection Early detection of COVID-19; detection of 100% of undergraduates asymptomatic/mildly symptomatic cases: . 28.5% of graduate and professional students . August 18-December 31-mean tests/d, 3335; . 20.9% of employees median, 3109 tests/d (range, 14-6959 tests/d) Free PCR testing to anyone, 6 d per wl . >60% of campus community tested each wk . Multiple locations on campus, in community Testing noncompliance monitored; nudges issued; noncompliance resulted in limits to campus resources Expedient testing and follow-up Mitigation, Within 24-48 h of sample: Test results within 24-48 h prevention . Test result in portal Case investigation within hours of test Phone-based case support to assure resulting understanding of positive result, connection to . Contact tracing within hours of test resulting health care resources, isolation instructions, . Contact notification within hours of case isolation support (off-campus hotel if needed, investigation food if needed, academic or work leave plans), and to initiate contact tracing . Contacts notified; instructions provided to monitor symptoms, access testing, quarantine (if symptomatic and/or not fully vaccinated) Integrated data system (with county health Detection, Case data inclusive of positive samples taken/ department, student health, local hospitals) mitigation tested off-campus: Testing registration . Support for isolation, workplace leave, and . Push message reminders academic accommodations provided to . Test resulting individuals testing positive . Case management Contact tracing Contact notification Abbreviation: PCR, polymerase chain reaction.

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