Nerve Center monitors COVID-19 threshold indicators


Photo credit: Danielle Rodriguez

Photo by Danielle Rodriguez

The first and second rounds of university surveillance testing are complete, bringing the total number of surveillance tested to 350. Result trends are being monitored by the Nerve Center and compared to the thresholds set in August, meant to serve as limits that would spark alterations to campus operations if neared.

Threshold indicators were chosen based on research by public health officials and then adapted to suit Trinity’s needs.

“The university followed the lead of the Metropolitan Health District in terms of what public health indicators they would prioritize. We had to add some additional measures that Metro Health wouldn’t look at, specifically our capacity and our capabilities around quarantining and isolating on campus,” said Tess Coody-Anders, vice president for Strategic Communications and Marketing and co-chair of the Nerve Center. “We used the standing epidemiological research on public health indicators in a pandemic, plus indicators that would help us track our capacity and capability to manage the presence of the virus on-campus, and that’s how we arrived at those triggers.”

In order to define thresholds, the university had to wait to see how many students would be living on campus to determine how many rooms were available for quarantine and isolation.

“Physically, we’re bound by the fact that we have only so many rooms on campus available. For example, we have roughly twenty-five rooms in Murchison for isolation and then about a dozen rooms for isolation at City Vista,” said Coody-Anders. “We do have some capacity limitations that have nothing to do with process and have to do with how many rooms we have on campus available. That being said, so far, we’ve found that we are able to allow the majority of students to quarantine in their own room, and that gives us more capacity.”

“You can think of what we did in terms of a ‘mitigation’ strategy: How to modify operations in response to the degree of COVID-19 prevalence in the community in order to reduce the chances of widespread campus outbreaks,” Marcy Youngdahl, university physician and member of the Health and Wellness working group, wrote in an email interview.

As of now, only 12 students have used the rooms in Murchison for quarantine or isolation, the rest have used their own suites. Although students are able to quarantine in their suite, doing so presses on the university’s services capacity.

“The complicating factor of that, though, is that it means that when we have to deliver services, those services have to be delivered all over campus,” said Coody-Anders. “Right now what we’re saying is that we think our capacity and capabilities combined, we can handle about fifty students in quarantine and isolation getting full-on, fully-delivered services. I think that as we move into the semester and practice at this, it’s possible that that number could increase, but that’s sort of what we’ve set as a marker right now.”

Five threshold indicators are currently listed on Trinity’s COVID-19 webpage: Doubling rate, positivity rate, health system stress score, numbers of on-campus student cases, and numbers of on-campus employee cases. Not all indicators hold an equal weight in the Nerve Center’s decision to alter campus operations.

“If we start to see positivity rates among cohorts or overall for the university campus that are approaching 5%, that’s a definite, ‘We’re going to change operational activities on campus.’ It’s in that kind of 2-5% range, you know, we don’t want to knock on the door of 5%. And secondly capacity, just our capacity to manage the numbers of people in quarantine and isolation if that starts to reach that, if it gets above 25, then we’re watching carefully to see if we need to do anything so that we don’t hit 50, and we haven’t stopped yet,” said Coody-Anders.

The Health and Wellness working group meets twice weekly to monitor threshold indicators and discuss potential changes.

“Each meeting begins with an epidemiological report from one of our two contracted epidemiologists. We review the Bexar County positivity rate, hospital ‘stress scores’ and the number of deaths. We have not had to adjust the current strategy due to the improved case numbers in San Antonio,” wrote Youngdahl. “If we did see a significant increase in cases either on campus or in the community we would discuss within the group, make a recommendation to the Nerve Center which would then be communicated to the Nerve Center for decision.”

The Nerve Center is preparing for a potential second round of mass testing following the Oct. 9 fall recess, the only three-day weekend of the fall 2020 semester, due to the likelihood of students leaving campus.

“The good news is, it’s not a holiday for the rest of the world. But certainly, when people travel home and come back, or travel anywhere and come back, we increase the potential that they’re going to a place or location that has a higher positivity rate than San Antonio, which has been doing really well,” said Coody-Anders. “My other concern is that K-12 schools will really have been back in-swing by that fall break, and my concern in talking with the public health officials and clinicians is that the real threat coming our way is the return to K-12 and the spread of the disease. We’re afraid that we could see another spike within a few weeks of that happening.”

Due to the intertwining of the Trinity and surrounding Bexar County communities, Coody-Anders explains that the opening of local K-12 schools to students and teachers is a reason for close monitoring of Trinity’s campus.

“I think none of us are on an island with this disease, is it pernicious and relentless, and so if one person becomes positive, you can count on them infecting three to five other people. It just spreads so exponentially, and it takes only one little crack for it to get in,” said Coody-Anders. “It wouldn’t take much to make its way back onto campus. Our job at the Nerve Center perhaps is to be overly-cautious and sensitive about the potentiality, and so maybe we’re a little overreacting about it, but better safe than sorry.”

The implementation of mass testing or increased surveillance testing would take some of the guesswork out of monitoring community health as K-12 schools reopen.

“We may not know we are in a ‘spike’ for several more weeks due to the high degree of patients in these age groups who are asymptomatic during a COVID-19 infection. We will need to watch the hospitalization rates very closely. There won’t be a ‘letting up’ of the guidelines anytime soon,” wrote Youngdahl.