PONE-D-21-05507

Launching a saliva-based SARS-CoV-2 surveillance testing program on a university campus

PLOS ONE

Dear Dr. Doudna,

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Ruslan Kalendar, PhD

Academic Editor

PLOS ONE

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IRB #2020-05-13336

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'We thank the Packard Foundation, the Curci Foundation, the Julia Burke Foundation, and other anonymous donors for their support of IGI FAST. We additionally thank the University of California, Berkeley for their financial support of IGI FAST.

A.J.E. is a graduate research fellow at the Greater Good Science Center at the University of California, Berkeley (https://greatergood.berkeley.edu/). J.R.H. is a Fellow

of The Jane Coffin Childs Memorial Fund for Medical Research

(https://www.jccfund.org/). A.M. is a fellow of the Damon Runyon Cancer Research Foundation (https://www.damonrunyon.org/).

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Reviewer #1: 

This is a well-written manuscript describing an important, comprehensive approach to wide-scale testing, communication and social norming campaign on a university campus to test for and manage COVID-19. The authors developed a sophisticated, encrypted smartphone app for registering and scheduling sample collection, and models to aid in identifying populations to test. They also developed an important advertising and compliance campaign that greatly facilitates recruiting, compliance and participation in saliva screening on campus. They followed these activities with surveys that aided assessment of their testing program.

However, the authors cite four references from medRXiv, including their own, non-peer-reviewed manuscript detailing the testing protocol. This is completely inappropriate. The authors should either 1)include the testing protocol and data in this current manuscript for peer review or 2)submit the testing protocol manuscript for peer review then, upon acceptance, reference that study in this manuscript. They should also remove references to the other medRxiv manuscripts, as they are not peer reviewed and therefore cannot be used to support this manuscript currently under peer review. I am sorry I cannot be more supportive of this manuscript in its current form, and look forward to a revision that addresses these important concerns.

Reviewer #2: 

Throughout your paper, you state that a testing program such as yours can reduce or prevent outbreaks but you do not provide any evidence that your program did, in fact, reduce or prevent outbreaks. You either need to include evidence from your study that you did reduce/prevent outbreaks, or you should reframe your claims.

Consider rewording the first sentence of the introduction. The mere presence of viral genetic material does not necessarily correlate with infectivity and can lead to loss of productivity and impact to physical and mental health through unnecessary quarantine periods in non-infectious individuals.

Page 5 – what do you mean by “minimize worker use of PPE”?

Page 6 – how quickly were positives/inconclusives contacted by phone? What if they could not be reached?

Page 6 – why is it now deployed in a limited capacity? If it can, as you claim, prevent outbreaks, why has your own university not rolled it out on a larger scale.

What percentage of eligible on-campus staff decided to participate in the study?

What percentage of participants actually completed a test every second week from the time of their enrollment throughout the duration of the study (ie, full compliance)?

Please elaborate on your supposition that the exposure risk of your study cohort is lower than the general population of Berkley.

Only 5 positives were seen during your study. Were these positives asymptomatic or presymptomatic? Were their follow-up confirmatory tests positive or negative? At the time they were contacted by study personnel, had they already taken another COVID test? Did any outbreaks or clusters result from these individuals? How many infected individuals were traced back to these 5 positives, and was that number higher or lower than the Ro in the general Berkley community?

How many outbreaks occurred during this time period from people not undergoing voluntary testing?

You state that the responses to your survey indicate that a sense of civic duty and a cultural norm of frequent testing was present among your participants – is it not likely that those that chose to participate in this voluntary testing program were already individuals with a strong sense of civic duty/desire to undergo regular testing? How do you account for this selection bias in your conclusions?

Did you use risk stratification to guide your testing model? IE, you suggest continued brief surveys to determine risk profiles of the campus population, but did you ever trial or implement this in your study? If not, how do you propose another university apply the results of such continued brief surveys?

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Reviewer #1: Yes: Mark Zabel

Reviewer #2: No

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Launching a saliva-based SARS-CoV-2 surveillance testing program on a university campus

PONE-D-21-05507R1

Dear Dr. Doudna,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Ruslan Kalendar, PhD

Academic Editor

PLOS ONE

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

Reviewer #2: All of my comments have now been addressed, thank you for your responses and revisions to this manuscript.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Mark D Zabel

Reviewer #2: No