A day after second-year Emma Johnson* took her first COVID-19 test since the start of the school year, she got a call from administration — her test was positive. And so were her two roommates’.

Johnson is living off-campus with two friends this quarter and has no in-person classes. She took a test in mid-September, despite being asymptomatic.

“It wasn’t required for us to get tested,” Johnson says. “We just decided it would be a good idea. Turns out it was.”

Following her test results, the school instructed Johnson to quarantine for 10 days in her apartment. Each morning, she received a symptom-tracking survey that let testing services know how she was feeling. Northwestern and Evanston Health Services reached out to all three roommates for the names and contact information of those that they had recently been in contact with, and handled contact tracing from there.

The University has distributed 71,754 cumulative tests since August 15, and confirmed cases per week were steadily rising until the week of Nov. 13. The total case count from Nov. 13 to Nov. 19 was 98, a significant jump from the first weeks of school in September, when confirmed cases were hovering between 24 per week at the highest and 14 at the lowest. Most recently, weekly cases have declined to a total of 18 for the week of Dec. 4, and this change can likely be attributed to students’ return home for the holiday season.

As of an email from Northwestern President Morton Schapiro on Oct. 28, underclassmen are scheduled to return to campus for the winter quarter. This news came as the country entered a third spike in COVID-19 cases and infection numbers nationwide, which have since continued to rise. In Illinois, cases have dramatically spiked since Oct. 28. Schapiro wrote that students will have to “remain flexible” and adhere to health and safety guidelines in order to ensure a safe return. He cited a consistently low positivity rate among Northwestern students as crucial to the decision, but added that, “higher levels of local prevalence have contributed to an uptick in positive cases among graduate students, faculty and staff.”

Procedure at Northwestern is the same for all students who are accessing University amenities, whether or not they live on-campus. Senior Associate Vice President and Chief Risk & Compliance Officer Luke Figora says these students must receive a COVID-19 PCR test once a week or risk deactivation of their Wildcards. Results are typically expected within 1 ½ days following the swab.

McCormick first-year Jenna Kim says that Northwestern’s communications surrounding testing are mostly consistent with what she has experienced so far.

Kim is currently living in a suite dorm on-campus with two suitemates. She doesn’t have any classes in-person as an underclassman, but is required to get a COVID-19 test once a week since she is on-campus. So far, she’s happy with most of the measures the school has taken.

“I think they’ve been doing pretty well,” Kim says. “Testing always goes smoothly, and you get your results back very quickly.”

She does have one major concern, though. According to Kim, the daily symptom survey that Northwestern sends out could be completed in “less than two seconds.” It asks several short questions, and doesn’t require quantitative information such as the student’s temperature. This questionnaire is important, too; it’s what students use to be admitted to communal buildings. To go to classes, the gym or the library, students must show the green screen on their phone that indicates the clearance granted to them by the survey.

Kim believes that the simple questions on this symptom tracker could provide a “loophole” for students who submit their answers without much consideration, or worse — students could simply lie in order to gain access to buildings.

Although the survey may not always be effective, it does provide next-steps for some symptomatic students. Figora says that a red “badge” on the test alerts Northwestern’s COVID-19 response team, at which point a case manager will reach out to the student and suggest a course of action. This could include both a symptomatic test and a COVID-19 PCR test.

COVID-19 PCR swab tests collect material from the nasal passage and search for the presence of the ribonucleic acid, or RNA, of the virus itself. However, according to Elizabeth McNally, Director of the Center for Genetic Medicine at Feinberg, these tests can sometimes miss positive cases if the concentration of virus within the nose is not high enough.

“Some people have more virus in the back of their throat,” McNally says. “Some people have more virus in their nose. Some people have more virus in their lungs. We’re all different people, so where the virus accumulates from person to person can be very different.”

McNally and a team of several other researchers at Northwestern began work this summer on a study to collect and map data illustrating the spread of COVID-19 across the Chicago area. If they are able to draw important patterns from this data, it could have implications for best practices going forward.

The study relies on a self-administered test, developed by Thomas McDade, Carlos Montezuma Professor in the Department of Anthropology at Weinberg, that allows scientists to detect the presence of antibodies associated with COVID-19.

The test, which requires a dried blood sample, is best for gauging the presence and spread of COVID-19, and especially to establish trends — it is not intended to diagnose participants with an active case of the virus.

Of the approximately 3,000 samples that the lab has tested thus far, McNally says the rate of positivity lands near 20% across most zip codes in the Chicago area and in the tests taken by volunteers at the Feinberg School of Medicine.

“The likelihood of being positive on our antibody test, indicating some degree of prior exposure, didn’t differ across the neighborhoods,” McDade says. “The overall rate of positivity was about 20% across all neighborhoods [that we tested], even though some of these neighborhoods had COVID-19 rates that were four times higher than [adjacent neighborhoods].”

It’ll be several months before McNally and McDade can finalize the results of the study. They will collect second samples from survey participants in order to determine whether or not antibodies are protecting people from future COVID-19 cases.

In the meantime, back-to-school procedures that started in August have made it more difficult for hospitals to obtain viral testing. Illinois’ current surge in infection and demand for testing has only magnified that problem. Because manufacturers of COVID-19 tests rely on the same materials and chemicals, McNally says, the companies that Northwestern Medicine sources tests from are all impacted by higher demands.

“[Return to school] resulted in a high uptick in testing in August, and even in the first part of September when a lot of people went back to campus. We’re experiencing a second surge now. That’s been one of the many hard parts of this, making sure we have the things we need to carry out our research on COVID,” McNally says.

It’s not hard to imagine why this might be the case, considering that Northwestern alone has distributed nearly 72,000 tests since August. In order to carry on with in-person classes and on-campus living for some students, testing has had to be stringent. Certain practices, however, have required greater resources than others. The Big 10 Conference’s decision to resume some sports this fall has necessitated an impressive degree of testing measures for student athletes.

According to Medill first-year and lacrosse player Leah Holmes, COVID-19 testing procedures for athletes have been thorough since her arrival on campus.

“When we first got here on campus, we got tested within an hour,” Holmes says. “Then we got tested a couple days later. We had to get a double negative within Wildcat Wellness before we could even start practicing.”

Following those first few tests, the team avoided contact during practices as an added precaution. Because her fellow athletes have “been very safe and abided by the rules,” Holmes says, none of them have tested positive during the school year.

Once the team began practicing with contact, they started testing twice a week. Holmes schedules her 15 minute testing appointments online and bikes to the Jacobs Center, where she stands in line with other students waiting for their time slots.

Paul Kennedy, the Associate A.D for Athletic Communications at NU, says that most sports still in their practicing phase are following similar protocols as lacrosse — twice-a-week testing supplemented by contact tracing for any student who tests positive. Sports entering their competitive season are subject to more rigorous protocols.

“[In September], the Big Ten Conference, a collective 14 institution unit, decided that if we were going to go forward and play sports, we needed to do daily antigen testing,” Kennedy says.

That means that, for the football team, players, coaches and staff file into the Ryan Fieldhouse six days a week for their antigen tests. Kennedy says the whole swabbing process is “really, really fast,” and players receive their results within 15 minutes following their analysis. Recently, women’s and men’s basketball have also begun daily testing protocols. Any player whose test shows a possible positive then follows up with a COVID-19 PCR swab test, which will help to solidify their results and recommend a course of action for the student.

The problem with antigen testing is that, to a greater extent than PCR testing, it may not detect all active infections of COVID-19.

According to the FDA’s website, antigen swabs prioritize fast results by searching specifically for the presence of the virus itself in samples, which delivers less accurate readings than the COVID-19 PCR tests that isolate the virus’ RNA on cells.

Although positive test results on NU’s teams are reported to the school and local health authorities, Kennedy says the information is not being released to the public, “for the same reason that we’re not making the chemistry department or the journalism school’s results public.” Nevertheless, there have been some positive results across teams since practice began this summer.

“There have definitely been student athletes and staff who have tested positive and have been isolated or quarantined for two weeks and then returned safely to activity,” Kennedy says.

For Holmes, the added testing has meant a better sense of safety amongst her teammates and has allowed them to return to a state of semi-normalcy on the field.

“We also want to be aware of any potential positives right away, so if one person goes down, the entire team won’t have to quarantine,” Holmes says.

Although she’s excited for her peers to return to in-person classes, Holmes says, she fears that contracting the virus will become more likely when she’s moved to a busier dorm in the winter quarter now that all students will be allowed on campus.

“A lot of the athletes have been super respectful, and then a lot of the kids who aren’t athletes are here for academic purposes, so they’re taking it really seriously,” Holmes says. “I’m a little concerned about some of the general population. [. . .] I just think that, if I weren’t an athlete, I would be approaching college very differently. So I’m concerned that maybe they won’t follow the guidelines. Who knows.”

Nick Francis, a Medill first-year who has been taking classes alongside Holmes, agreed that there will likely be many minor infractions of COVID guidelines when undergraduates return to campus. Still, he feels that the majority of Northwestern students are responsible, and will be motivated to make sure that the campus is safe.

“I’m really excited at the thought of coming back to campus,” Francis says. “I’m cautiously optimistic, especially considering all the new lockdown orders and case rates that are popping up everywhere. All eyes are on Illinois right now in terms of case rates going up. Part of me is nervous, but I’m able to compartmentalize that and just focus on the excitement of being back.”

*Names have been changed to preserve anonymity