Professor David Harris, Phd describes the Test, Trace, Treat Strategy that was implemented at the University of Arizona in the Fall of 2020.

Professor David Harris and his team at the University of Arizona in the USA have provided proof of concept of Dr Michael Mina’s research and advocacy of Rapid testing as a means of reducing SARS-CoV-2 transmission of infection during the pandemic.

They have also shown how the 360 degree solution to pandemic control can work in a real life scenario by actively implementing most of the risk reduction methods, facilitating a path of living with COVID-19 safely whilst getting back to a form of normal life again.

Watch the full interview here: https://youtu.be/XF5dHEgxYfg

Learn more at: https://kojalamedical.com/covid19theanswers/

Kojala Medical presents COVID-19 the answers the  show that delivers the scientific evidence-based

knowledge that can safely return us all to our  pre-COVID lives. My name is Dr. Funmi Okunola and

I'll be hosting the show every week you can listen  to me interview a highly respected professional

about the science that can reduce your risk  of becoming infected with this coronavirus.

Hello and welcome to COVID 19 the answers, Episode  8 Part 2 - Accounts of rapid testing in the field.

Today I'd like to introduce you all to Professor  David Harris, PhD. Professor Harris is the

Executive Director of the University of Arizona  Biorepository, a Professor of Immunobiology,

Medicine and of the B105 Institute at  the University of Arizona in the USA.

Professor Harris is a graduate of Wake Forest  University in Winston-Salem, North Carolina where

he obtained Bachelor of Science degrees (cum  laude) in Biology, Mathematics and Psychology

in 1978. He earned a Masters of Medical  Sciences (summa cum laude) from Bowman

Gray Medical School in 1980 and his  Doctorate in Microbiology and Immunology

(magna cum laude) from Bowman  Gray Medical School in 1982.

Professor Harris’s research interests  include stem cells and regenerative medicine,

cancer research & stem cell transplantation  and gene therapy. He established the

first cord blood bank in the USA in 1992. Welcome! Thank you very much for inviting me.

David out of interest and for the audience  could you please explain what a biorepository is

and what is the b105 institute? Sure, the  biorepository is a large collection of

biospecimens like blood serum plasma biopsies  tissue in our particular instance it's all

clinical related, so we don't do animals or plants  or only from patients in our particular instance,

it's clinically annotated biospecimens so that we  have the electronic health records that go along

with specimens so we can look longitudinally  to see what is going on in terms of patient

diagnosis, patient treatment, patient response  and correlate that with the biospecimens that

we have in our facility and essentially the  facility is a large collection of freezers and

liquid nitrogen doers and other types of apparatus  for storing those samples in an organized fashion,

so that we can provide them to individuals who  are interested in research as well as provide them

with de-identified data that goes along with those  particular samples. Now the bio5 institute is

a sort of a consortium across disciplinary  consortium of investigators at the University

that goes through five different disciplines,  which is clinical plant, animal research and

some others molecular biology and they're sort  of placed in one large building so they have

an opportunity to run into each other and  then potentially talk about collaborations

and facilitate the type of interactions that would  normally come in a departmentally based setting.

So that's fantastic and pioneering research there. thank you for sharing that.

Ok, so let's continue.

So we've talked about rapid  testing with Dr Michael Mina,

today I want to show an example of how a program  of mass testing worked in a real life situation.

Between the fall of 2020 and April 2021 using a  test trace and treat strategy, under the leadership

of Professor David Harris the University of  Arizona went from four percent of people on campus

testing positive for COVID 19 to less than half a  percent. This corresponds to 4,172 people testing

positive in August 2020 to four people in March  2021. The University began the pandemic with 45,000

students and 20,000 staff working  online to resumption of in-person classes with one

hundred people in attendance per classroom within  seven months. This was a remarkable achievement

because if you can remember the COVID vaccines  did not become available until December 2020

and a lot of national and international  universities remained closed to in-person

classes for up to a year or longer on march the  11th 2020 the world hall health organization

declared the novel Coronavirus COVID-19 outbreak  a global pandemic so David could you please tell

the audience what happened at the University  of Arizona after that announcement and what

you and your colleagues decided to do? Right, it actually seems that's a long time ago now

when you when you talk about 4% actually there was a time when it was above 11%

positivity at the beginning and then dropped  down below 1%, but I can remember

that March of of 2000 of 2020, when the  results were coming back from the rapid spread

of the infection the health consequences the  astounding number of deaths that were occurring

we didn't really have any antivirals, we didn't  have any real treatments, didn't have a vaccine,

so where we, like everybody else was trying to  decide what to do and the University stepped in

and decided to go to remote learning. As you didn't  want to shut the University, but you actually

couldn't take the chance of doing teaching in  person, so everything went to remote learning.

We, at the buyer repository were asked to come up  with testing kits to be able to test the campus

community, so we spent a lot of time  in the early days constructing PCR

kits, collection kits going out and collecting  samples and looking at prevalence of the

of the virus in the community and that was the  point where we decided that was not going to be

an easy way to mitigate the infection because  it simply took too long to get results back

and so we we then spent a lot of time trying  to decide what kind of rapid tests we could,

could develop or could implement to  be able to get results back quickly

because obviously, I don't think people realize  that if you have no students, you have no money.

If you have no money, you have no University.  Regardless of how many good people you have

at the University and so if you send everybody  home and they're not paying for for books, or for

rent, or for their their classes, essentially your  Universities can go bankrupt very quickly and

we're talking about tens, to hundreds of millions  of dollars per University that that they're losing

and so we were trying to implement as as  much as possible a way to get classes open

in some respect and that's where we we came  up with this test and treat plan to be able to

slowly reintegrate the community back so that  we could have people on campus individuals who

were working in laboratories that would be able to  come back nih grants would continue to go forward

but in a safe manner to be able to protect those  individuals who would be most likely to come in

contact with the virus that unfortunately was my  group at the beginning when we say unfortunately

because we didn't really know how serious that  was going to be and so we from march until today

we've been at the university doing  that sort of work fantastic so

in the fall of 2020 well I thought it was  four percent you're saying actually ten percent

actually it was over 11% at one  point, there was a couple weeks

when the kids were coming back that it got up  over 11%, it mirrored the surrounding community

90% of the of the students live off campus inside  of the city's community, so you expect their

incidents to be very similar and it was at the  beginning until we could go in and test and trace

and emphasize to people how to take the  precautions to prevent spread of the virus.

so I mean so over 11% out of a population of  65 000. So at that time SARS-CoV-2 had an

R0 of 2 to 3 so every one person  infected would go on to infect another two to

three people. Could you please give us some idea  how quickly things would have got out of control

without your test, trace, treat strategy? Well  that was what we realized at the beginning we

brought together Epidemiologists, Public Health  specialists, the former Surgeon General of the

United States, as well as the researchers on campus  to try to determine the best approach to try to

mitigate it really simply wasn't enough to be  able just to measure prevalence because the R0

was so high that by the time you knew who  was infected, or not, they'd already infected

other individuals. So the idea was how could we  implement a testing strategy where we could get

results back within an hour or so, so that an  individual could come in, they could be tested

and they could be held sort of in isolation until  the test results came back within the hour and

then you could then let them go with that, at that  point, so we looked around at that point because we

needed to replace the PCR results which generally  would take 24 to 48 hours to get results back

even though you could if you could upscale it to  be able to do thousands a day it was just that

lag time to be able to get results back and when  you talk about 20 year olds that's a long time.

They don't want to be kept in isolation for 24  to 48 hours. So we looked at the rapid tests that

were coming out at the time we evaluated various  manufacturers and we went went out and purchased

tests to be able to do our own in-house validation  and we settled upon the cadell the rapid antigen

test we liked it for a variety of reasons you get  results within 15 minutes but more importantly it

was designed to scale up so that we could do  the thousands of tests today that we needed to

it was connected to the to the web so  that we could upload data into patient

records so their test results would  be in their electronic health record

and we could download the data into our own  databases to be able to follow the course of the

of the infection and see how infected individuals  were so we decided on that that was a strategy we

set up during that that first summer so when you  think about it of of that first spring semester

everybody was still sort of fumbling through it  trying to do the best we could it wasn't until

we got into the summer that we could  take the strategy that I talked about

we first implemented it with the athletic teams  that were at the university the football team

the basketball team sort of on a small scale  we're only dealing with hundreds of people

how would that work how many days a week did you  have to test how quickly did you have to get test

results back so that when the kids came back in  in the fall of that that year we were set up to

be able to test thousands a day and so we decided  on the strategy of test everybody as they came

back to campus get the results back to them so  we were testing two to three thousand a day and

get results back to them immediately those that  were infected immediately pull out the quarantine

those that weren't you were allowed to go to their  dorm come back to class come into a research lab

and then implement a strategy where okay you're  you're not infected today but what about tomorrow

and so it was the strategy of testing once a  week going forward to be able to catch those

individuals who previously were naive and now  they'd become infected before it could get out

of control and part of that had to do with tracing  so that if we knew that you were positive we don't

know who you talked with the last the last couple  of days and so through a de-identified smartphone

app we could tell when your smartphone  get that coast to another smartphone

although we didn't know who owned the smartphones  but we could tell the other smartphone that

you just were around an effective person and  you should get tested and that allowed us to

trace those individuals and encourage them to  take steps to protect their own health and then

we followed that up by doing wastewater testing of  the individual dormitories in congregate settings

where it was not really feasible to go in and  do that every day but at least to give us sort

of an idea of is there virus present in the  building and how much virus and then we could

go in and target those areas like the fifth floor  of the dormitory or the cafeteria clean that out

test all those individuals and then re-educate  them as to best ways to prevent infections so

it was a multi-pronged approach that that really  I can't emphasize enough that really depended upon

the sort of the push or the motivation of higher  administration because it takes a lot of people

and it takes a lot of money and a lot of effort to  be able to do that where a lot of the universities

were simply closing their doors and going home  or just going online our our university made the

decision that we would actually try to stay  as true to a normal university as possible

and through federal funding for mitigation and for  testing we were able to do that in a much better

extent than many of the our fellow universities  both here and elsewhere were able to do.

It was an amazing feat really and to be it's  something that needs to be emulated globally

in my opinion, that's why I'm featuring it  this your whole experience on this podcast

so you've really told the whole  story but I'm going to go through

I'm going to go through a series of questions that  kind of expand on on what you've what you've said.

So basically you and your colleagues  devised a timeline for the University of

Arizona to get back to full in-person learning.  Can you please describe this to the audience?

So the idea was, when your infection  rates were high up in there 10%- 11%.

Obviously everything is closed down other than  the essentials, like the testing laboratories

and what you want to be able to do is as  people come to campus and it was requirements

you want to come on the campus for any purpose, whether it was research, classrooms, work, whatever.

You had to be tested and then you had to be  follow-up tested through the course of the year

and so the idea was if we could find the effective  individuals at first glance when they came on we

could isolate them and provide them with all the  necessary things they needed like internet access

meals that sort of thing until they recovered and  we needed to be able to do that fairly rapidly

and so that was where the rapid test came  in that we could we could set up a testing

venue over in our student union where we  could handle thousands of people a day

some of them would get PCR just to give us an  idea of the prevalence but the rest would get

a rapid antigen test to look for a mitigation  strategy and our and what our results our papers

had shown was that PCR was great for detecting  the virus but it's not great for telling you

who's at risk of infecting others because it's  so sensitive so we were using PCR as sort of a

prevalent strategy where is it or where has it  been what should we be looking for and that goes

with the wastewater testing as well and we use the  rapid engine test because we and others had shown

that it doesn't pick up everybody who's positive  but it picks up the ones who are contagious

and that's what we were concerned about is to  isolate those who are contagious and then let

them recover and once they recover they'll  still be positive by PCR which is a problem

because they're no longer have active virus and  that's where the antigen test came in so we did

we just looked at it the other day probably during  that time period well over 300,000 tests

and so when you think every one of those tests  cost $23. That's a tremendous investment to be able

to keep the university open, by the university. As  well as not not even counting the personnel costs

that are involved, so we made that decision that  if we could keep them as as unaffected as possible

and that worked out pretty well, or at least find  them pretty quickly. We could see the infection

rates come down and that's what we saw over the  of that that year, was that the infection rates

gradually got down to where they were below  what you would find out in the community

which was still averaging in the 7%- 8% range  and we were well below 1%, so

the education actually worked because they were  still out living in the community there still

was no vaccine at the time or antivirals but  I think they had taken it to heart that if you

do something stupid and people will you will get  infected. We will catch you when you come on campus

and you'll no longer be able to go to class,  or go to the lab or do the other things

that that you're paying to do as a college  student so I think that was sort of the

the stick and the carrot thing that we expect  you to act like adults but if you don't, then

we will we will catch you during the testing. Yeah  I mean, the whole program was ingenious frankly.

It's something as I've said I'm repeating  myself that needs to be emulated, so

yes there were costs, but the cost of that  that you the cost of implementing the strategy,

were far below the cost of loss and I think  that's what people struggle with getting their

head around. You have to pay for things like  testing, air filtration, ventilation, whatever

in order to stay open, so that in the long run you  don't economically lose and also so that you keep

your population safe. So you you've really shown  here a true proof of concept. Well I think when we

looked at this early on, before employment. We were  expecting the university that year would lose

somewhere upwards of $40 to 60 million dollars and  it turned out at the end of the year with doing

this type of strategy. We still lost money, but it  was less than $10 million. Wow. Now we're it's kind

of like monopoly money oh it's only 10 million  but so I mean it really did cut our expected

losses. We still lost, but not as much as if we'd  done nothing and more importantly it it sort of

showed the students and staff and the  faculty that the university was it

was concerned about their health, was making  every effort and so people were more willing

to come back. Because then people get to the point  where they go well if 'I'm doing everything online

why pay all the money to do that why not go  somewhere else,' but here they could actually

start to come back and the classes would open up  in small numbers first essential laboratories then

small classes where you had 25 or 30, then you have  classes of 50 to the point finally you get to full

size classes where there's no restrictions. But it  was great it was phased in and there were metrics

that had to be met and if you didn't meet the  metrics you could go backwards or forwards depending

on what the results were. So how did you get the  university staff and students on board with your

your plans? Could you tell us about things like the  dashboard of testing results? Well the dashboard is

is sort of the community facing the public facing  website to be able to show what's going on at

the university and what the infection rates are,  because parents are concerned about their kids as

as well as the students themselves are concerned  and then you have the interaction with the state

officials the governor the Public Health that sort  of thing. So the dashboard is more or less set up

to show what's going on on a day-to-day real-time  basis are we having a surge like out in the

community or are we doing well so that was good pr  that worked very well people went to that we held

press conferences with the president every day  during the hot year and the high part of this

so that he would answer questions with the media  and with the government that we did a lot of of

outreach to the students over that summer to say  we're going to open back up this is how we're

going to do it this is how you're going to do the  testing etc and if you want to we can't make you

but if you want to live in the dorm if you  want to come back on campus you want to see

your friends again these are the things that  you're going to have to do and if if you get

infected we've got a dorm over here that we'll  move you into for the next 10 days, provide you

with your internet, provide you with your meals,  everything you would if you were in your own dorm

and when you recover and test out you can go back  knowing that you're you're actually have some

immunity and you should be okay. So again it's it's  sort of a stick and carrot that here you want to

come back here's how we're going to do it and then  the most important thing was the dashboard would

show that it was working so I think that's key I  mean you don't want to be draconian about it then

then have it not work now it actually  showed that with these sort of reasonable

interventions on a day-to-day basis you could  actually see that that the case rate was going

down hospitalizations were going, down deaths were  going down and people didn't start to believe it.

So you basically showed openness and  honesty and that's how you got people on board

participating and you educated them? A lot  of outreach I think obviously, this is a community

that's always very open. The university community  of people talk a lot they want to be broadcast,

their findings, their results, so if you  tried to hide it it was not going to work.

So and particularly the people who work for  me and for some of the other places things

were going badly that meant we were at risk  of getting sick and or having bad outcomes so,

we definitely weren't going to hide it if things  were going south we'd know it very quickly and

we would say hey let's close up shop and maybe  we do have to to sit it out for a while luckily

that never happened. Good. So the next stage of  your program you've, I mean you touched on this,

was a decision of who to test and when so  different groups of students pose different risks

of infection to themselves and others dependent  on their activities can you please share how you

identified groups to be tested and the frequency  of testing? It goes back to our first proof

of concept with the athletic teams. We had the  football team, which had a couple hundred people

on it and we broke those up into small pods we had  seen what had gone on at the University of Alabama

where all their players would congregate together  to do their weightlifting, their training, that sort

of thing and when one ended up getting sick they  infected 50 or 60 others. So then everything shut

down. So we broke them up into small manageable  groups of 10 and they stayed with their pot of

10 as we followed them through the summer and  did testing almost every day for these people.

So we could show that if you if you would test in  the groups you could quickly find who was going to

be positive or who was going to be a problem and  that was sort of the approach that that we took.

Was that high congregate settings like dormitories,  or like the cafeteria, those are your highest risk

places and so you have to go in and test everybody  and you have to test them every every other day

for those who lived off campus after we initially  did the screening they only generally were seeing

two or three other people whether it was their  girlfriend or their spouse or their roommates

there you could test them about once a week and if  you had three or four people and they would test

on different days you could sort of cover the  entire apartment by by doing a kind of testing

and then you could back this up by doing  random PCR testing out in the community to

see if there are any hot spots and then you could  do the waste water testing because if somebody

in the building was infected it would show  up in the wastewater that's highly sensitive

and so you could again use a sort of a preview  and this was always the goal was to was to

know what was going on before it got to the  hospitals because the hospitalization rate

was was somewhere around two weeks behind the  infection rate and then the deaths were another

10 days or so behind that so if you merely were  tracking hospitalizations or admissions you were

really behind the curve and trying to get a handle  on how to mitigate this disease.

Ingenious. Your whole method of  organization and approach to this was truly excellent.

Could you also talk about the importance of turnaround  time with relation to the time you would aim to

deliver a result in this population well that  was the key thing was that if you if you tell

the kids when they come back to class and before  they come to move into the dormitory we're going

to test you have to be negative you can't tell  them but you're going to have to wait somewhere

for two or three days till we get the results so  not only is that unfair but it's impossible with

18 to 20 year old people and so that's where  the rapid test comes in if you can scale it up

where you can do thousands of tests a day so each  of our dormitories holds somewhere between two and

five thousand kids so we could bring the  entire dorm in on a monday test them all

get the results back if we if we staggered  them each of them would have results back

within the hour and so they would know and so  when they would test with with our approach

if there was a positive result it notified the  students so that they and their parents knew

that they were infected it notified campus health  so they could immediately go and isolate and then

see if they needed to have some sort of health  care and then notify the university to know

don't let them in the dorm room, don't let  them in a congregate setting, because they're

infected or vice versa. Everything's all  clear and it's ready to go, so that was sort of

the key thing there so that we could bring in  about 3 000 a day and through the course of an

eight hour day we could test all those and get  everybody's results back to them within an hour

which allowed them to stagger come in and be  tested immediately go into the dormitories. Yeah

it's fantastic, because I read somewhere in your  literature, that with the student population you

could have one person who came into contact with  up to 200 people within a 24-hour period. So you

have this kind of mantra didn't you that 24 hours  to deliver a result to a student population is too

late. It needed to be delivered sooner? Well, unless  when we looked at this and again it's all done

in a de-identified fashion so that we can track a  cell phone we don't know who the phone belongs to

you would find that there are in reality social  butterflies The majority of people on campus come

into contact with five or six people a day. But  then there are others who come into contact with

hundreds a day those are the social butterflies  and those are the ones you're really worried about

because if one of them is positive, they could  essentially infect and we saw that from our own

experience that one of my technicians. I had a  family member passed away due to something else

and so they went to the funeral, this was during  2020 and one of his relatives was not feeling

well, but didn't want to miss the funeral  and came and she infected 23 others. She

was positive and resulted in deaths as well. So  in a congregate setting with somebody who's hot.

It's not just two or three like you said with an R  zero of two or three I mean you go around and you

hug and kiss the people at the event  you could easily get a super spreader event, so

we were concerned about those those  individuals, who were those social butterflies

but you're also concerned that if one person gets  five or six others, they get five or six others

and the window between getting exposed and  showing up as infected is probably three days.

So that's where we sort of  made the decision to stagger

the repeat testing to make sure if we missed it  on day one. We'd catch it again by day four if

they were truly infected. And back then as we've  said the R0 was two to three and with Omicron,

we're looking at an R0 of eight to fifteen.  You can see how quickly and why it spreads, so

devastatingly across the planet. Really. Yeah,  and part of that also is is the fact that

the uptake on the vaccination was less than  hoped for, or are expected, based on the

on the demand for it. Now when it was being  developed and the more unvaccinated people

you have, the more likely you are to develop  variance. Now because I think if more people

would vaccinate you wouldn't have Omicron, or  if Omicron had happened before the original one,

the Wuhan strain, this sort of mitigation  effort would have been more successful.

Now people are so pandemic fatigued they,  they really are not concerned, they see

that it's not any anymore. It may in fact be less  virulent than the original strain and so they've

more or less, if you haven't been vaccinated,  they've given up the sort of the fight.

Okay, that's another debate that we'll have at  another time. So exploring what you did, so what

incentives, I mean that's a good point actually  to bring in this question. What incentives did you

build into the strategy to encourage people  to keep getting tested when they need to?

How did you overcome pandemic fatigue?  Well, I mean, early on in the testing phase

that first year there wasn't fatigue  there was a story in the paper every day,

or on the news every day, about people dying and  we saw lots and lots of them dying in the ICU

and so people were very concerned. They  were very afraid, they weren't necessarily

going to get vaccinated but, there wasn't  the fatigue the fighting is wearing masks

and that sort of thing. Again what you're fighting  against with with the younger population is

the short-sightedness of 'I'm negative  today, that means I'll be okay tomorrow'

and you try to get them, say this is just  a point in time. Tomorrow may be different,

or two days from now maybe different, , it's, but  if you're living in a dorm, you have no choice ,

if you didn't get tested every couple of  days you could get expelled from the dorm and

you would lose your money and you weren't giving  your money back if you didn't follow the rules.

If you wanted to be in a lab or on campus  you had to do the testing what it was,

you wanted to have those who only occasionally  came on maybe once every couple weeks who are

doing most of their their learning from home,  you wanted to get them tested and that's where

these sort of motivation strategies of bookstore  discounts, tickets to the basketball games,

there was a few grand raffles before  you get a tuition for the semester free,

that sort of thing. And a raffle to try to  keep people going and during that first year.

That worked very well. I think between ,  the fear and the motivational strategies,

it wasn't a big deal. It's only as it gets  into the second year, , and you notice that

people don't want it. Some people don't want  to get vaccinated and they don't want to

take /make efforts to protect themselves that  they become concerned.

Interestingly for your PCR test you  use the saliva direct protocol with the saline

gargle from British Columbia in Canada which you  found more accurate and faster than a conventional

nasopharyngeal PCR test. Another proof of concept  we interviewed Dr Anne Wyllie last week about the

evolution of this protocol. Are you able to tell  us about your experience with this? So one of our

investigators, researchers, Michael Warby here  comes from British Columbia and so he knows all,

the all the people up in British Columbia and has  worked with them and so the idea was , so what

we did when we were doing proof of concept and we  were comparing antigen tests with PCR tests it was

all N.P swaps , we tried to do, throats swabs, we  we tried to do nasal swabs, we tried to do cheek,

just to do anything other than N.P, because people  hate to do in N.P swabs. It's just uncomfortable

and it's also dangerous to the individuals who are  making the collection. So we taught thousands of

people how to do their own N.P swabs and so that, I  said , I don't know how long your nasal cavity is,

so if I just stick that back in there I may injure  you. You can slide it back it you won't feel bad,

but it'll feel better than if I did it for  you. But then the publication of the

swish gargle, saline gargle came out Michael  Warby brought it back to us. We evaluated it,

compared to the N.P. Turned out to be just  as sensitive, if not a little bit more. I think

it depends on what day and the infection you do  that, and so people were very compliant with that

to swish you a little saline around in their  mouth and spit it into a tube it was very easy

to implement that and so that that really helped  in terms of the PCR testing. Now people didn't try

to cheat on the test, they didn't try to skip their  tests they were quite happy to come in and swish a

little saline around their mouth and get the test  results, yeah. And you combine that with the saliva

direct protocol because in BC we still use the  traditional RT PCR but you combine that with the

new protocol that Anne Wyllie developed. So you have  the best of both worlds. That's speed and accuracy.

Right and we had to validate all of that and again  when you're doing those things up front they have

to be validated, they have to be approved by the  CAP and the CDC to let you do that diagnostically

so it's not something that you  can turn around and do overnight.

But I think having this research community  together we would meet three times a week

to try to decide what's going on in a different  University or State or a different Country and

what have you heard so that we can start to  look at some of these things very early on

and if something looks like it could be  promising we can start to validate it

so that it doesn't take us six months to turn  around but maybe just three or four weeks

and I think that that was key. Again that needs to  happen in the real world and that enabled you to

have a much faster turnaround time with PCR from  what I saw reading? Oh yeah so it cuts a good 24

hours off of of the time frame, so that since you  don't have to go through and and do the isolation

of the message beforehand, but you can  immediately go to do an amplification.

It's tremendous. Yeah you lose a little bit of  sensitivity. Maybe one or two cycles on the PCR,

but that doesn't seem to have impacted  the biological significance of the asset.

Yeah I still fail to understand why  that isn't so much more widespread.

So there's a difference between being infected  with SARS-CoV-2 and infected and contagious you've

touched on this that it's important to isolate  a contagious person as they can spread the virus

to others. An infected person who is no longer  contagious will not spread the virus. PCR tests

are notorious for giving positive results for  weeks after a person is no longer contagious.

Could you please explain to the audience what a  CT value is and how you use these values alongside

rapid antigen tests to identify contagious people  and isolate them? Yeah so CT values are I mean

are the way that you determine how much virus  is present when you do a PCR test so cycle

time so do you have to go through the assay 10  times 20 times 30 times before you can detect

the virus and obviously the easier or the sooner  you can detect it the more virus there is so a CT

value of 30, means there's very little virus but a  CT value of 10 means there's a whole lot of virus.

Complementary to that you we also get similar  values on the antigen test so that we can

determine how much virus is present when you  do the rapid test. So now what we were

concerned with and it came from our proof of  concept, was that we had we had a couple of

people during the athletics contesting, who tested  positive week, after week, after week for months

and so only by PCR because if we tested them with  nasal swabs or N.P swabs but it was with with PC

swabs like or with the NP swaps and PCR they kept  testing positive and surely if you're positive for

this virus six months, you should be dead. I mean  it's not that you continue to be environmentally

infected, it's a so for whatever reason is unusual  RNA virus with an envelope that may hang around

for a while, or there may be some cross-reactive  proteins in your body that that happen but, again,

it's sort of pointed out that  it's the PCR test is so sensitive

that it's great for looking at prevalence testing  but it's not great for mitigation because then

you're isolating people who aren't infected . Now on the other side with the androgen test

you may get a false negative, but if you  test two days later you'll you'll find that

person will show up as positive what you're  concerned about is the false positive that

somebody tests positive, but they're actually  negative and then you isolate them in a big

dorm full of real positive people and then  they might get sick and so we put together a

testing strategy that allowed us to identify the  false positives by by using a threshold of how

how positive you had to be on the energy test to  really be a positive so we were able to eliminate

false positives and use that as our strategy  for looking at who was contagious and then we

could use the PCR for looking at where the virus  has been and where we think it it may be next.

So with CT values, I think you had a cut off if  that your CT value was below 30, then you were

contagious and that would often correlate with the  positivity of the antigen test because they work

during it they register positive when you're  actually contagious. They won't tell whether you've

ever been infected and then if your PC your CT  value was above 30 on PCR then even if it kept

testing you kept testing positive on PCR you would  know that that person is no longer contagious?

Right and we looked at that in terms of trying  to isolate live virus from these individuals

we could never get live virus to isolate or  grow out of people with CT values above 30.

that helped us to make that decision because  it's not something we make lightly that you're

infected but you're not or contagious, that we  could actually have real data to show if you

had a CT above 30 you had been infected you're now  recovered or almost recovered you're not a concern

to the public. Whether it's grandma if you see them  at home or your roommate in the dorm, but if you're

under 30 then yes we were concerned and we wanted  not only to pull you out of of the community, but

we actually want to put you in a place where we  can watch you to see if you have a bad outcome

because if you start to go south, we want to be  able to intervene and if we don't know who you are

or where you're at we can't do that. Fantastic.

So what did you learn from the whole experience can you  summarize the important points that you learned?

Well I think collaboration of people who have

multi-disciplinary expertise really was sort  of key to this that actually has allowed us

to set up what we call the Aegis Institute at the  University to in expectation of the next pandemic

we expect either this one will continue somewhat  or be another one so everybody has different

expertise and if you're able to bring them to  collaborate work together you can do a lot of

of incredible things the test the treat the trace  is sort of key it's it's not a cheap endeavor

but it really does make I think a significant  be a difference by being able to do that sort

of thing so, we think the testing obviously tells  you who's infected or not who might be contagious

the tracing to let who they might have been  exposed to or exposed themselves to so that

we can now know who needs to be isolated and or  treated and I think that that's the other thing

as well as we want to make sure that we identify  those who might have a bad outcome and try to take

advantage of that early decision to be able to say  okay we think we can help you through our approach

so where are you now how did COVID vaccination  change your approach to reducing the risk of

infection on campus well we've done a lot of  vaccinations and actually we've probably done

now again over 300,000 back vaccinations but  we we are the biobank of the biorepository

is also the place that receives distributes  and attracts the vaccination in our our

our community so we're at the point now  where the university is back to 100 no

masking now is required even indoors because the  infection rate is well below a half percent and

part of that and that's also true of the  community so if the community goes above

I want to say it goes above a half percent or  so, we would have to go back to masking indoors

but at present both the university  and the community have such low

positivity rates, whether it's true  infections or breakthrough infections,

that we're no longer required even  in the community as well as on campus,

to have masking. Some people do and I'm sure some  people will continue to do that for a long time,

but we're continuously monitoring on campus, as  well as wastewater, as well as in the community,

just to try to be ahead of the curve if there is  a surge coming but at this point after two years

either from caution vaccination  or infection, we think probably

eighty percent of the people have been exposed in  one fashion or another and that probably helps to

explain why we can now get back to almost what it  was before pre-pandemic so what's the vaccination

rate on a COVID vaccination rate on campus at  the university of Arizona of the students this is

completely optional what I thought. The students  is probably 85% or higher. The people who I thought

would be most at risk in which we tend to be  faculty and staff it's probably 60 percent.

And what's the rate of vaccination in the wider  community outside of the university? It's about

60%- 65%. Okay so are you still rapid testing and  PCR testing? Yeah but just not at the numbers. So

most of it is if there is a surge or if there  is an outbreak, we'll go in and specifically test

those areas like say the athletic teams,  or it's volunteer testing. Somebody says

I was away for spring break, or I came back from  visiting so and so, my throat is sore today,

I'll get a test before I go on the campus. But the  mandatory testing is no longer required and that's

another important question that I forgot to ask  was the testing always free for the students? oh

yeah. Right. That's where the university spent all  that money was for the free testing because again

you had to pay to go through an NP swab you  probably wouldn't show up to do it, so we

wanted to make it this we have testing sites all  over campus want to make it as easy to do it,

it's free to do it and you'll get the results back  rapidly. So it was an extremely convenient and easy

process. Yes and do you have any other mitigation  methods in play? Do you have anything like air

filtration ventilation? So all these air supplies  going into the buildings is through HEPA filters.

We have what's called a germ buster team that that  goes out that's part of facilities. Anytime there's

a positive infection in the in a building a room  or a dorm they go out and sanitize there is a

team of individuals who will then escort positive  individuals over to the quarantine facility so

nobody else is exposed so there is quite a bit of  of of thought in terms of how to make this work

with such a large space particularly  once you're outside the classroom it's

extremely difficult to do much if people won't  wear masks and that's really where that the

masking rate was extremely good in that first year  year and a half. Well in my opinion, I mean you've

created a fantastic infrastructure for reducing  the risk of infection to this coronavirus, which

is incredibly important because up to a third  of people can go on to develop long COVID or

post acute sequelae, which really results in  organ damage. I mean all the research that's

coming out now with even one infection I mean  vaccination is thought to possibly reduce that

risk by half but that's just still huge numbers of  people. So you've really put a whole infrastructure

in place that is protecting people from chronic  illness in my opinion your whole team should be

running the pandemic. Well we have one of those  those recover grants to look at long COVID so,

I think we're supposed to look at 9,000 and  I think overall they're looking at a hundred

thousand or something but we do think that  vaccination definitely does decrease the risk

of developing long COVID, but, and that's sort of  the emphasis to tell people that you're young and

healthy you probably won't have a bad outcome.  I know, I've known a few have had bad outcomes,

but a bad outcome is something other than death,  a bad outcome is lose 20 iQ points, or have a bad

liver, or have cardiovascular problems.  Those also are bad outcomes , particularly

if you're a 20 year old and you're going to  spend the next 80 years with this problem

and that's been sort of a difficult  cell to convince people that

there are bad outcomes, other than dying from  the virus that you should be concerned about.

Yes and I don't think it's been highlighted  enough in the media. I think we need to have

really long COVID, post-acute sequalae, results,  rates posted, as well as hospitalization rates and

death rates so that people understand that this is  something that that can really do damage and they

need to protect themselves from infection, I mean  that's the whole point of this series to highlight

cases like yours and the technology that's out  there to keep people safe from chronic disease.

Yeah I think with you after the first year or  so of these NIH grants to look at the long COVID

we'll have a better idea of what the rate is for  for that and it probably is going to depend on

a variety of patient demographics as well  as viral loads and things like that so it's,

we've seen it reported anywhere from 3 percent  to 30 percent so there's there's other factors in

there that we haven't identified yet but it I mean  there's still going to be enough people who get it

that it's a problem otherwise the NIH wouldn't be  spending almost a billion dollars to look at this

so again people don't want to hear bad news  anymore, so I understand but we're going to

have to develop better outreach, or at least  strategies that we can can educate without scaring.

Yes and what I think what you've achieved is  actually good news you've proved that with the

right infrastructure. Incredibly intelligent and  clever people ,motivation and actually caring that

we you can get back to some form of near normal  life safely by putting all of those mitigation

factors in place. I think that's what's really  key about this this this whole experience. Yeah

I agree and I think again I have to always  give thanks to to our upper administration

started with the President that he was willing  to make that investment and spend those dollars

and to put in the effort that he was in on many  of our our weekly meetings just to get this going.

Yeah I mean it starts at the top and goes all the  way down to the students so all of them have to

be willing to do it yes so when you say president  you mean president of the university don't you? Yes.

Yeah okay, I'm just going to share something very  quickly with you because we're nearly running out

of time because I'd like the audience to see  this, so basically this is the 360 solution to

pandemic control and you and I have talked about  this before that I think needs to be implicated

implemented globally we won't get out of this  pandemic by boosting our way out of it through

vaccination. Vaccination is the most important  mitigating tool that we have for COVID

19 but it's not the only one and I think you've  proved that. And you really now you've I would

say you've done proof of concepts of 90% of this  you had regulatory support with your President

a testing strategy, wastewater monitoring and  infrastructure that you created you provided

support, during isolation. Contract tracing, education  and now the environmental medication with the air

filtration and ventilation that you've implemented  and you've pushed vaccinations. So it's incredibly

commendable what you've done. I appreciate  that and luckily it worked. I mean that was

actually you can actually show that by doing all  this, you can actually get back to almost normal. In

fact, where our I would say by the fall it will  be back to normal unless something happens but

yeah. I know, I would say it was not luck.  I would say that it was high intelligence, care

and meticulous planning. And I just want to say,  because I know we've reached the end of time,

thank you David for you and all the team that  your work has done and for really showing us the

way out of managing this pandemic by your  wonderful and excellent example of COVID

mitigation at the University of Arizona. It's been  a pleasure and a privilege to interview you today.

Thank you very much for the invitation,  happy to do it. And please join us next

week for episode nine SARS-CoV-2 is airborne  part 1 with Professor Jose Louis Jimenez

Thanks for listening to this week's episode of  COVID-19 the answers if you enjoyed the episode

please SUBSCRIBE, RATE and REVIEW, and do visit  our website kojalamedical.com/covid19theanswers