Following news that Cambridge University would be conducting weekly, in-college testing of asymptomatic students, many students at Oxford have expressed concerns as to why their university had not announced a similar policy. The University has now offered an official response exclusively to The Oxford Student, explaining their testing system, and why they do not have the same policy.
We spoke to Professor Chris Conlon, a Fellow and Tutor in Clinical Medicine at Oriel College, and Chair of the Royal College of Physicians Joint Specialty Committee for Infectious Diseases, among other things. Crucially, he currently chairs the Health Medical Advisory Group, which gives advice on the health aspects, but not necessarily the behavioural aspects, for Oxford University’s response to the Covid-19 pandemic. This group has largely been tasked with the testing side of things, but also in making sure social distancing and face-covering policies are okay and giving general health advice.
Highlights of the full interview, shown below, include Professor Conlon calling Cambridge’s testing policy an “experiment” expressing doubts that Cambridge would be able to maintain its ability to test its own students, as it was relying on 300 tests per day provided by an NHS Lighthouse Lab on University land. According to Professor Conlon, if that lab is overwhelmed by NHS tests, Cambridge will lose access to these.
“The problem everywhere really is testing capacity is quite limited, and so these Lighthouse Labs are in quite a bit of trouble keeping up with stuff, so I’m not entirely sure how long the Cambridge experiment will be able to go on for.”
Oxford University is not restricting those within the University who are able to access a test
Oxford University is not restricting those within the University who are able to access a test. “If you happen to be a [Cambridge] college member who lives out somewhere, you don’t have access to that, and the staff don’t have access, so neither the academic, administrative or domestic staff have access to testing.” Oxford’s two testing centres “provide symptomatic testing for all students, whether they live in College or not, whether they are graduates or undergraduates, and we’re also providing testing for all staff, whether academic, administrative or domestic staff.”
Professor Conlon has also answered some common worries about housing bubbles, how the University testing centres work with local contact tracing faster than national Track and Trace, and what students who are unable to physically travel to test centres should do.
The big question right now is, following Cambridge’s announcement that they are offering weekly, in-college testings, why has Oxford not announced a similar policy?
“Cambridge has a plan to test college students [who live] in colleges, but not college students who live out of colleges, that’s the first thing. And they’re not testing staff in colleges or out of colleges. They have what’s called a Lighthouse Lab with AstraZeneca, which is one of these big NHS labs, (there’s one in Milton Keynes for example) so they have access to that. Although, it’s an NHS lab so it’s testing symptomatic patients. However, because it’s on University land, they’ve done a deal to get 300 tests a day from that lab [to test asymptomatic patients if they wish], but if the lab itself has reached capacity with NHS work, they lose that capacity for Cambridge University.
What they’re doing is, it’s an interesting experiment, but it is an experiment.”
Professor Conlon goes on to elaborate on how Cambridge’s testing ‘pooling’ will work.
“If you imagine you’re in a household in a college, let’s say a staircase and there’s say 6 or 7 of you in that household, then each week you’re given a swab and a sort of bottle or transport medium. You’ll swab yourselves, and all stick the swabs in the one bottle, and that then gets sent to this lab (and we don’t know the turnaround times for that). If your household is negative, then you can relax. If somebody in the household is positive, then you’ll be told your household’s positive and you’ll have to isolate, but you’ll also have to get confirmatory tests in the normal system so it’s a bit of a delay in that, and it’s not clearly linked with the local public health in any way, it’ll be linked to the national Test and Trace type stuff.
If you happen to be a college member who lives out somewhere, you don’t have access to that, and the staff don’t have access, so neither the academic, administrative or domestic staff have access to testing. It’s an interesting experiment in terms of household testing and spread, and how colleges contain outbreaks in that sense.
We can’t do that [order tests into Colleges] because we don’t have a Lighthouse Lab in Oxford. What we are doing is we’re providing symptomatic testing for all students, whether they live in College or not, whether they are graduates or undergraduates, and we’re also providing testing for all staff, whether academic, administrative or domestic staff.
We’ve set up two testing sites, one’s in the Radcliffe Observatory Quarter and one’s up at the Old Road Campus. People can book online and get a test done. The real issue is to try and make sure we don’t get too much transmission of disease within the University, so those tests at the moment are being done at the local hospital lab with a pretty quick turnaround, usually 24-48 hour turnaround time, and that means we can get a result back quickly for those who are symptomatic and make sure they get isolated and, if they’re in a household, the household gets isolated.
We’ve also linked in with local Public Health, so they can then help with contact tracing quickly rather than waiting for the national Test and Trace system to kick into place.
What we think we’ve done is set a system up which is universally available and which is reasonably responsive to cases when they arise.
The problem everywhere really is testing capacity is quite limited, and so these Lighthouse Labs are in quite a bit of trouble keeping up with stuff. I’m not entirely sure how long the Cambridge experiment will be able to go on for.
I’m not entirely sure how long the Cambridge experiment will be able to go on for.
What we’re doing is hoping we can manage demand with the system we’ve got up, and make it pretty responsive to what the need is. But it’s like everywhere else, it’s also possible that our lab might get overwhelmed if there are zillions of cases of people demanding tests.
We want is to make sure that people seek a test only if they have symptoms, we don’t want lots of anxious people seeking tests because that would waste resources. The University has already put in about £1.5 million to get this going, so it’s not a trivial exercise. The other nice thing in a way is that we’ve got clinical and medical students doing the swabbing so you’ll be seen by somebody in your peer group who can help with advice.”
One thing that Cambridge said is they are offering tests to asymptomatic students because they argue it’s possible for these people to spread the virus and infect others, even if they were unaware. Are we not doing that purely because of resources that we can’t afford to?
“It’s not so much afford to, it’s the logistics of doing it. At the moment, the NHS rules are you can’t have a test if you’re asymptomatic, so if we’re using NHS facilities, we can’t do asymptomatic testing.
You can only get an asymptomatic test if you live in a care home, that’s the NHS plan at the moment. If that changes, then we might be able to change but we’d have to increase capacity for that.
We think that asymptomatic people can spread the virus, but most probably don’t spread it very much, whereas the biggest risk of spreading is probably the first 24-48hrs of getting symptoms, and maybe the day before. Let’s say you got symptoms tomorrow, then your test might be positive today, but if you get the symptoms tomorrow you’ll get tested, and then the contract tracing’s really people you’ve been in contact with in the last 48hrs. So it covers, if you like, the day before you got symptoms and the day before that. That’s the reasonable public health approach to it.”
We think that asymptomatic people can spread the virus, but most probably don’t spread it very much
Having testing sites in two places means you have to travel to these places with symptoms. How is the University minimising the risk of transmission in this period?
“The idea is not to take public transport but walk or cycle if you can do, and we know that the risk of spreading the virus in the open air is really low, assuming people A. use social distancing in their trip and B. wear a face covering. Of course, even the national test you have to travel somewhere to get. The idea of having something in town, for example, is that people should be able to get there reasonably easy by bike or walking.”
If there’s a situation where, say, a student has disabilities and so can’t make their way to the testing site, would they be able to get the test within their college room?
“They would probably end up having to use the mail system at the moment, we haven’t got a good system for delivering swabs to people’s houses because it’s just logistically not part of the deal, but we would hope that most people would have access to that.”
One thing that’s widely different with Colleges is household numbers, do you have any insight into the maximum limit of what a household could be, besides practical considerations of shared facilities, and is there any real science behind what is too many people?
“There’s no particular science behind it. The difference really is that the more people there are, clearly, the higher the risk of people being isolated is.
We thought the maximum probably would be about eight and that vary for practical reasons. Let’s imagine you have a household of twelve, that’s twelve people at risk if they go out and about of getting the virus, so if one gets infected then twelve isolate. Where if the household’s smaller then obviously fewer people isolate and there’s less disruption: it’s a purely practical thing. In practice, most spread is within households because you’re not distancing, so we’re trying to limit the number of students who have to isolate at any one time.”
Would Track and Trace trigger household isolation if someone got notified by it?
“You won’t get isolated unless you have somebody with a positive test.”
So if you got a notification from Track and Trace and you then had to go and get a test, your household wouldn’t be put on isolation before then?
“If somebody in your house is positive, then you and the household would be asked to isolate. Another advantage of having our testing service is that immediately you get a [contact tracing] result back. The Track and Trace may take another 24hrs to contact you in reality. We want to make sure if somebody has a positive test they know as soon as we know and that means that they isolate, and that’s for 10 days, and if they are in a household that household has to isolate for 14 days. It sounds a bit bizarre, but it’s because of the incubation period of the virus for those who haven’t got symptoms yet. The Track and Trace thing will reiterate the isolation bit and notify people outside your household.
Another advantage of having our testing service is that immediately you get a [contact tracing] result back
We’re hoping that if students are positive they will help the local Track and Trace folk and the Public Health guys with contact tracing, but also be responsible and say if you know you had a contact yesterday, tell them yourself.”
Moving on to isolating, there are concerns that if you’re in a household of say 8 or so people, there’s almost the idea you have to accept that you’re going to all get ill when one person does. Is there any University policy to protect people once someone’s positive?
“The first thing to say is surprisingly not everyone in the household gets infected, even in families, and it looks from most of the data from around the world it’s about a one in six hit rate in a household, but the idea would be that let us say you have a staircase or a household, and one of you has a positive test, we would want that person to self isolate [in their room] within the household as much as they could do to minimise the risk to others.
They’re probably most infectious within the first two or three days and that would wane as the viral load goes down. We want to make sure people are safe so we hope that household members wouldn’t completely shun them, but would check on their wellbeing, as well as their college doing that. We hope that once someone knows they are positive they would restrict themselves to their room with a bit of help for food and stuff like that.”
For vulnerable students who are in a household, there hasn’t really been much guidance on being able to opt-out, and there are some worries that you’re forced to isolate with positive cases if the household gets ill and you’re particularly vulnerable.
“I’m not sure what the policy on that is, to be honest. I think the sensible thing would be for, if people were vulnerable, they should obviously let their College know, and therefore they may be given their own ensuite type rooms rather than be in a household, but that would vary from college to college in terms of availability.
We wouldn’t want truly vulnerable people to be in a large household where there’s a risk of getting infected from others.”
Going back to the Student Responsibility Agreement, in the first line of the agreement it says “I will also follow the University and/or colleges’ specific guidance…”
Does that mean if the College’s guidance does not line up with University guidance if it was less strict perhaps, would a student at that College be denied sharing University teaching spaces with other students who are at a College that’s in line with University guidance?
“My interpretation would be that there are University Rules, for when you are in University facilities around town, and Colleges might have slightly different rules for some things and that would pertain within the College. Not necessarily contradictory but that’s how I would interpret that.”
There has been lot’s of emphasis on surface contact and the University said they are cleaning surfaces quite regularly, but there’s still a bit of up in the air about how risky surface transmission actually are, with an article in The Atlantic not too long ago. Is the emphasis on this taking away from areas of real risk, for example, good ventilation isn’t something that has been as mentioned as much?
“The evidence for this stuff is quite difficult, to be honest. The overwhelming risk of transmission is through the air so breathing it in is how we’re gonna get this virus by and large. Surfaces have been implicated occasionally, and that’s why the cleaning bit is emphasised quite a bit, but it’s all difficult to know how A. important it is and B. effective it is. Anything we can do to reduce transmissions is clearly important. Ventilation stuff really depends on the buildings. If weather permits, opening windows increases ventilation, if you have a bigger room that’s better for ventilation. But it’s all practical stuff and there’s not a huge amount of science behind some of it, but there’s a lot of theory.”
In terms of how Colleges are creating bubbles, do you personally think it’s a necessary thing to have a bubble that shares a kitchen space, but no bathroom facilities, if they could instead stagger usage periods and clean it afterwards?
“It becomes practically quite hard to be honest. The bubble system is probably a better way of thinking about this in terms of contacts and risk. There’s gonna be no perfect solution for every setting, and I think people are trying to be pragmatic in terms of the best way to deal with stuff. So if you have shared facilities you have to say, it’s not just the surfaces you’re worried about but people will run into each other in shared kitchens and stuff like that. It’s an increased risk compared to other settings.”
There’s been a fair bit in the news about false positives. Will the University after 24 hours be guaranteeing people a second test to prevent a false positive?
“False positives are really, really rare. It’s false negatives that are the concern. If somebody was symptomatic and their test was negative, and they continue to get worse symptoms, then we would offer them a retest. It’s not for false positives, it’s for false negatives. False positives only become an issue if you screen thousands and thousands of people all at once. But for symptomatic people, not a problem.”
If you’re symptomatic and they get a negative test, you recommend they still isolate?
“We recommend they still isolate and then as part of the process in the pods, those people we think should get a second test will be advised to get one 48-72 hours later.”
You yourself teach lectures and seminars, will you be going back to face to face teaching?
“I’m probably the wrong person to ask as I teach in the hospital and we wear protective gear. I think there’s a mixture of people who are happy to teach face to face and indeed people who aren’t happy and I’m sure the same is true for students. Nobody is going to be forced to have face to face teaching, but clearly people are keen to as part of the Oxford experience. With proper social distancing in tutorials, it shouldn’t be a problem.”
Going on from that, you say nobody should be forced to have face to face teaching but there’s not really been much about students being able to opt-out. Does that mean if the tutor wants to do face to face the student can say “I don’t want to do this I don’t feel comfortable.”?
“I’m not sure the policy about that, I think anything like that is probably going to be likely but you’d have to take it up with the people who are organising teaching.”
A University Spokesperson added that on the Coronavirus advice pages, in the teaching section, people can put their case forward if they’re vulnerable or have mitigating circumstances as to why they can’t do it in person.
“Nothing will be forced on anyone because it is a safety issue at the end of the day.”
Is that the same for a tutor that they have to put a case forward as to why they can’t teach in person? Or will Colleges let them if they just don’t want to?
“I think[s] a tutor would probably be in the same position as a student. If they are in a vulnerable group, they can opt to do their tutorial virtually. I’m not aware of guidance about tutors who don’t want to teach in person if not in a vulnerable group, but colleges might have rules about this. However, from first principles in these difficult times, I think it will come down to personal views of risk and nobody will be forced to do things they are not comfortable with.”
In the United States at the moment many universities have gone back and then suddenly thousands of cases have appeared. What is the real strength of Oxford to make sure we don’t have the same thing happen?
It’s two things, one is behavioural. A lot of these things have come from fraternity parties and the same has happened in the UK with various raves and things like that. That’s probably different than what we’d expect to happen in Oxford. But its also part of the risk of young people getting together. Of course, what you have to understand as well is that the risk of being infected in the States anywhere is much much higher than the UK at the moment because there’s no real public health response and you have to pay to get tested in most places, so it’s quite a different scenario. I think it’s unlikely we’ll see the huge numbers here, but it’s also naive to think it will be nothing.
I think it’s partly why the government brought this number 6 thing in because I think they can see universities getting back together again and they want to try and minimise that as much as possible, particularly in public areas where there’s lots of mixing.
For results then the maximum time for testing is about 24 hours?
Realistically probably 24-48 hours, but we’re trying in the testing pods to have slots every ten minutes to do a test and its easy to get onto the system.
Would you like to add anything else?
“The other thing I would say is to make sure people are aware they can get a test, and also not to abuse it. Only use it if they have genuine symptoms, and not just use it just to find out, otherwise, we’ll be in trouble.”
An Oxford University spokesperson added that the University is constantly reviewing its policies and constantly looking at its approach and working on maintaining safety standards.
Professor Conlon added that “it also may be that testing gets better in some way, we could do more rapid tests or whatever.”
“I don’t think we’re ever going to be at the stage where everybody has a little test in their room to do, at least not for the next term or two, but we may get quicker turnarounds, more easy tests to do and so on. We have to live with what we have at the moment.”
The University’s full and up to date advice can be found HERE.