Public health experts question U-M leadership's comments on testing

Wednesday, August 26, 2020 - 12:42am

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Allison Engkvist/Daily

Recent comments from University of Michigan leadership regarding procedures for COVID-19 testing this fall have left some public health experts and students skeptical and unsatisfied. Critics say the plan is “wishful thinking” and call the reasoning behind it unsound. They also take issue with the arguments used to justify it.

The University plans to implement surveillance testing of approximately 3,000-3,500 community members a week, according to an Aug. 18 email from University of Michigan President Mark Schlissel and Provost Susan Collins. All students living in dorms will be tested prior to their arrival on campus. The University will also test those with symptoms or those who came in close contact with someone who tested positive. 

Schlissel has pushed back against suggestions that the University needs to implement universal testing. In the email, Schlissel said conducting widespread asymptomatic testing would place “a drain on our case investigation and quarantine capacity.” During a faculty town hall earlier this month, Schlissel compared the COVID-19 pandemic to the HIV epidemic and said large-scale testing could lead to an increase in risky behavior. 

“Sometimes testing can give you a false sense of security,” Schlissel said. “That happened in the HIV epidemic when people got a negative test and they presented it to their sex partners and spread disease nonetheless, so testing is challenging at the scale you’re talking about.” 

In a letter to the Queer Advocacy Coalition, Schlissel apologized for his remarks and said the analogy was only meant to question the effectiveness of testing all students. 

In using this analogy to make my point, I unintentionally reinforced stereotypes that have been historically and unjustly assigned to the LGBTQIA+ community as well as other communities and persons affected by HIV and AIDS,” Schlissel wrote. “Again, for this I apologize, especially as it relates to groups that have been historically maligned and stereotyped. It was not my intention to disparage any community or person affected by HIV and AIDS.”

The Daily spoke to three public health experts to assess the validity of Schlissel’s claims. They all said he was perpetuating the stigma surrounding the spread of HIV to justify the lack of a mass testing program and to assign blame to students if there is a coronavirus outbreak on campus.

“Overall, my sense is that the CDC (Centers for Disease Control and Prevention) guidelines on COVID-19 testing for college campuses, which mention the ‘false sense of security’ narrative, are giving universities an excuse to opt out of testing that is actually needed to contain outbreaks on campuses,” Julia Marcus, infectious disease epidemiologist and professor at Harvard Medical School, said.

David Paltiel, professor of public health at the Yale School of Medicine, said while Schlissel’s claim about false reassurance is not entirely incorrect, it detracts from the fact that increased testing is one of the strongest tools available to prevent disease. 

“Behavioral disinhibition or risk compensation or false reassurance, as he called it, I get it,” Paltiel said. “I’d be crazy to suggest that there’s none. But, from an analytic point of view, what you really want to ask yourselves is ‘how much of that would I be willing to tolerate in exchange for all the benefits that I get from the testing program?’”

Gregg Gonsalves, professor of epidemiology at Yale University and co-director of the Global Health Justice Partnership, wrote in an article published in The Nation that the “most egregious case” of wishful thinking he has observed is “University of Michigan President Dr. Mark Schissel, who suggested that students would use testing as an excuse to behave badly.”

In an interview, Gonsalves said being tested and knowing whether or not a person has HIV can change behavior and slow the spread of the disease, and the same logic applies to the coronavirus.

“The idea that HIV testing was used as a ‘get out of jail free card’ to have sex is ludicrous. HIV testing is the core of HIV prevention,” Gonsalves said. “We tell people to know their status. And research has shown that people who know their status are much less likely to engage in unsafe sex.”

Paltiel said one of the reasons many activists previously opposed HIV testing without sufficient treatments was because testing could publicly disclose a person’s sexual orientation, which is not the case with COVID-19. When antiretroviral therapy was introduced in the 1990s, Paltiel said increased testing became crucial in fighting the spread of HIV.

“There was a major push, and I was part of that major push, to expand HIV testing,” Paltiel said. “There were a lot of people pushing back on it saying exactly the sorts of things that President Schlissel said — ‘Oh, you know these gay men, they’re nothing but a bunch of horny toads, and if you test them, all it’s going to do is fuel a greater amount of anal sex and risky behavior.’”

Marcus told The Daily she thinks Schlissel is using the idea of “false reassurance” to justify the University’s reopening plan. This idea is not new — in a column about the HIV epidemic for The Guardian, Steven Thrasher wrote that societies “like to blame individuals (especially queer folks, women, immigrants and people of color) for diseases.” Recently, Marcus wrote that colleges will begin to participate in a similar kind of scapegoating with their students.

Marcus said Schlissel’s statement both reinforced negative stereotypes about the spread of HIV and was simply false –– mass testing does prevent the spread of disease. 

“What felt particularly egregious about this comment about HIV testing is that it not only reinforced the (false sense of security) narrative, it also perpetuated HIV stigma by suggesting that people get a negative test so they can feel free to spread disease, which is really inaccurate and stigmatizing,” Marcus said. “HIV testing, just like COVID-19 testing, is an essential part of prevention. A test does not prevent an individual person from being infected, but it prevents them from transmitting the virus because they change their behavior accordingly if they test positive.”

LSA junior Parker Kehrig said Schlissel’s comments also reflect a problematic belief that individuals are responsible for systemic problems like epidemics and disease prevention. 

“It’s one of these things that I’m just not surprised Schlissel is saying or doing, the whole individualism, putting individual responsibility on students as opposed to talking about how the University actively brings students to campus without adequate resources,” Kehrig said. 

Schlissel’s comment about testing during the HIV epidemic isn’t the only statement drawing ire. In a town hall with residential staff Monday night, University Health Service Director Rob Ernst said testing will not stop students from contracting the coronavirus.

“We don’t test the health care workers, nurses and doctors and things, who are really seeing folks — they’re not tested, I’ve never been tested,” Ernst said. “(I’ve been going) to the hospital every week since March, and many of my peers also have never been tested ... Having a test doesn’t prevent you from getting COVID.”

While Marcus said that Ernst is not technically wrong –– testing will not prevent an individual from getting COVID-19 — she explained that mass testing is crucial to preventing the spread of the virus and dictating students’ behavior.

“This is a fundamental misunderstanding of the purpose of testing,” Marcus said. “The only way to ensure that people who have the infection can isolate from others and prevent transmission is through testing. And so, of course, testing an individual does not prevent them from getting the infection, but it may prevent them from spreading it to others. It is absolutely essential for containing outbreaks on college campuses.”

When The Daily reached out to Ernst for further comment on his remarks during the town hall, he referenced CDC guidance for institutions of higher education, noting that testing can help prevent disease if done alongside adequate social distancing, mask wearing and hand washing. 

“Testing of asymptomatic individuals with recent known or suspected exposure to COVID may also be recommended as part of case investigation and contact tracing in an effort to control transmission,” Ernst wrote in an email. “The comment about testing, by itself, not preventing infection, is based upon the generally accepted construct that a layered approach of consistent masking, social distancing and avoidance of crowded conditions is important to prevent the person to person spread of the virus.” 

Gonsalves said if the University doesn’t have the means or the desire to mass test regularly, it should not be reopening or inviting students back to campus.

“It’s a big justification for his lack of commitment to keep everybody safe,” Gonsalves said. “If university presidents can’t keep students, faculty, staff and the community at large safe, then nobody has any business reopening.”

Gonsalves predicted the University administration will later blame students for their behavior if an outbreak occurs rather than owning up to the fact that they did not adequately prepare. 

“The question is, what is the president going to do now when there’s an outbreak at the University of Michigan?” Gonsalves said. “Is he going to turn around and blame the students and say, ‘The students were behaving badly and that’s why we have an outbreak’? No, it’s because he didn’t prepare his campus for the coming storm all of us saw on the horizon.”

Despite the pushback, Schlissel and University leadership have defended the reopening plan’s chance of success. In an interview with The Daily last week, Chief Health Officer Preeti Malani praised the University’s thorough preparations to contain the spread of COVID-19, but conceded that the outcome of the semester will depend on external factors. She pinpointed off-campus behavior as an unknown variable, echoing some experts’ predictions that universities are preparing to blame their students. 

“We have a lot of detailed plans around quarantine and contact tracing, and we’re set up better than a lot of schools in that way,” Malani said. “But if everyone comes here and just decides, ‘I don’t care. I miss my friends. You know, screw it, I’m just gonna go and do whatever I want,’ then I think it’s really gonna fall apart quickly… this is really going to come down to students.” 

Some students are willing to partially accept blame if the semester goes sideways but note it won’t be entirely their fault. LSA senior Sasha Tretyakova said the current situation could have been avoided entirely if the University had opted for a fully remote semester from the start.

“Kids are still stupid, but it’s like blaming a kid for eating a chocolate cake when you put it right in front of them,” Tretyakova said.

 Daily News Editors Emma Stein and Liat Weinstein can be reached at enstein@umich.edu and weinsl@umich.edu.