Twice a week, students at Williams College in Williamstown, Mass., go to a parking garage to blow their noses.
After clearing their nostrils, they douse their hands in sanitizer, then proceed to a tent where, under the watchful eyes of trained emergency medical technicians, they swab their nasal passages. Then they stick the swab into a vial, the vial into a box, sanitize their hands again, and head out.
Once the testing site closes each day, Rita Coppola-Wallace, Williams’s executive director of planning, design and construction, gathers the bounty — up to 1,100 test tubes — and loads them into a waiting car. The samples are whisked off to Cambridge, Mass., 150 miles away, and processed alongside tens of thousands of others overnight at the Broad Institute of MIT and Harvard, a biomedical and genomics research center.
A primary reason many colleges in Massachusetts, New York, Maine and Vermont have experienced few coronavirus outbreaks this fall has been frequent, widespread testing. At 108 colleges and universities, that testing is being done within a carefully orchestrated system run by the Broad Institute.
The testing, along with strict, state-level quarantine orders and low levels of community spread in the region, has helped keep infection rates at schools working with Broad below 0.2%.
Broad first planned to work with a group of Massachusetts private colleges that approached the lab in the spring. Then it added public universities around the state. Other schools in Maine, New Hampshire, Vermont, New York, Rhode Island and Connecticut caught wind, and Broad soon had 108 partners and a waiting list.
The nerve center for the operation is tucked inside a large, low-slung concrete building that once served as an Anheuser-Busch beer distribution warehouse where Broad’s Genomics Platform runs an automated, licensed laboratory for genome sequencing.
The lab had never run a viral diagnostic test before March 23. Under the supervision of Stacey Gabriel, senior director of the Genomics Platform, it now regularly processes more than 70,000 tests a day — about 45,000 of them from colleges and universities — and has the capacity to go up to 100,000. Other tests come from area nursing homes and hospitals.
Dr. Gabriel said she and other Broad leaders were dismayed by the state of testing back in the early spring and wanted to help respond to the public health crisis. Broad handles between 10% and 20% of all Covid-19 polymerase-chain-reaction tests done in the U.S., Dr. Gabriel said. Last week, it processed its three millionth test, and it has inspired others to pursue large-scale, low-cost testing outside commercial labs.
“We really borrowed a lot of industrial principles of how factories are organized and how factories plan their work,” she said. “It’s an automated assembly line.”
One of the biggest logistical hurdles early on was getting an IT system established that would enable Broad and its partner schools to track their supplies and testing results.
“The testing part is not the hard part,” Dr. Gabriel said. “It’s the surrounding activity of testing — the ordering of the tests, the collection of the sample, the accession, the bringing it into the lab, those are the bottlenecks.”
Because schools gather their samples during the day, dozens of couriers arrive with vial-filled coolers between 5 p.m. and 10 p.m. “There’s a crush of samples that shows up,” Dr. Gabriel said. “Our night shifts are very busy.”
Broad received funding from the state and a National Institutes of Health contract to scale up. The lab used to have 125 staff members; it hired another 250 in recent months to handle the load.
The Centers for Disease Control and Prevention at first urged schools to focus on testing symptomatic individuals and played down the need for entry or surveillance tests. In a late-September update, however, the CDC said those measures combined “might prevent or reduce” Covid-19 transmission.
It also said schools’ various approaches, from regular surveillance to no screening at all, “is an emerging area, and there is currently limited scientific evidence to guide decisions to use or not use one of these strategies.”
David Paltiel, a professor of public health at the Yale School of Medicine who ran an epidemiological modeling study on the new coronavirus this summer, called that latest conclusion “disingenuous and unscientific.”
His study, published in the Journal of the American Medical Association, found that testing all students every two days may be the threshold for safe college operations. Just screening for symptoms led to broad-based Covid-19 outbreaks in the model.
“Testing is like an early-warning missile system,” said Laurie Leshin, president of Worcester Polytechnic Institute. By identifying a positive case quickly, she said, schools can “manage it before it does a lot of damage.”
As colleges convened in the spring and summer to discuss their options for reopening, testing emerged as a centerpiece of many plans. But commercial labs quoted prices over $100 for each test, meaning frequent checks of large populations would sink many schools’ budgets. And those labs’ projected turnaround time, three to four days, was a nonstarter given the need for immediate isolation in crowded dorms.
Broad sold tests to school partners for $25 apiece. It initially promised test results in 24 hours; its turnaround time is now averaging around 14 hours.
That has allowed Bates College in Lewiston, Maine, to test students twice a week; its positivity rates remain around 0.01%.
More-urban campuses are faring well, too. Tufts University, with campuses in Boston and Medford/Somerville, Mass., has conducted more than 95,000 tests so far on roughly 11,000 students, staff and faculty, and reported a 0.04% positivity rate.
Worcester Polytechnic, located in downtown Worcester, Mass., has committed to a total 125,000 tests with Broad for the fall term. It recorded six positives in the past month, or 0.018% of all tests.
“For those of us that don’t have massive biomedical research complexes, for those of us that are smaller colleges, it’s been a lifeline to be able to reopen,” Dr. Leshin said of the Broad partnership.
Some other schools have created their own high-volume labs. Dr. Gabriel commended the saliva-based testing program of the University of Illinois, Urbana-Champaign, as well as the testing apparatus at the University of Washington and Boston University.
Williams was in talks to join with the local health system in late spring and early summer to handle campus testing. But a 72-hour turnaround time “was just a no-go,” said Fred Puddester, vice president for finance and administration and treasurer.
Mr. Puddester said he expects Williams to spend between $2.5 million and $3 million for tests from Broad, and up to $1 million more for related costs such as the tent rental, ID card readers, signage, paying EMT and other staff “and gallons and gallons of hand sanitizer.”
Williams, with about 930 full-time staff and 1,450 students on campus, tested students twice a week for their first two weeks on campus, then went to weekly tests for about a month. As it loosened some restrictions on student movements — allowing them to travel to a commercial strip with a pharmacy, barber shop and grocery store just east of campus — it returned to twice-weekly tests.
Since mid-August, when students arrived back on campus, Williams has conducted nearly 23,000 tests. Just 0.022% — five results — have come back positive.
Rob Copeland contributed to this article. Write to Melissa Korn at firstname.lastname@example.org.