Measures against the novel coronavirus infection at the Gifu University

A novel coronavirus infection was reported in Wuhan, China in December 2019. Nodrugs or safe vaccines have been established thus far. Nonetheless, the accumulationof clinical data and epidemiological findings has gradually revealed characteristics of thevirus. To protect the health of students, faculty, and the community, the Gifu University
has established a crisis and risk management system at the highest level to implement
the best measures based on these scientific grounds.

(1) Characteristics of the novel coronavirus and countermeasures for infection at
the Gifu University
The routes of the novel coronavirus infection are either droplets (small water droplets
or aerosols) or contact, and it has been shown that wearing a mask and washing hands
are extremely effective in preventing infection. Therefore, we believe that all students
can maintain zero infection on campus by maintaining a distance of 1 m from each other,
wearing masks, and washing hands thoroughly.
The novel coronavirus has a longer incubation period than other viruses and is known
to infect people even during this period. In addition, some infected people that areasymptomatic and end up with no symptoms (the virus disappears from the body) caninfect people. The fact that people without symptoms can infect other people has beenfound to be important in the prevention of this viral infection.
At the Gifu University, we take measures to prevent infection on the premise that“anyone may have the virus.” Students and faculty members are instructed to avoid the3Cs (closed spaces, crowded places, close-contact settings) environment so as not to
be infected by the virus and bring it into the university unknowingly. All members areinstructed to monitor their physical condition by measuring their body temperature everyday. If a member has symptoms, even if the symptoms are slight and regardless of adiagnosis of this infection, the member is instructed to wait at home for 2 days after their
symptoms disappear. The Gifu University also guarantees that such correct healthbehaviors will not interfere with academic work.

(2) PCR testing for the novel coronavirus
PCR testing is one of the most reliable diagnostic methods for novel coronavirus
infections. PCR can amplify and detect the genes of the novel coronavirus, to determine
whether the patient has the virus or is infected. Samples (throat wash, sputum, saliva,etc.) are collected from sites of suspected infection, and the gene is extracted; only thegene of the novel coronavirus is amplified to confirm the presence of the virus. If the test
is positive, there is almost no doubt that this virus is present (99% specificity). However,even if the virus is present, there are cases wherein the test can yield negative results.
There are 20-30% false negatives that cannot be detected (70-80% sensitivity) owing tovarious factors such as the time of sample collection, method of sampling (e.g., sufficient
samples or viruses were not collected), and testing environment and conditions (e.g.,
components that prevent virus amplification were accidentally mixed). In other words, if
the PCR test is positive, the diagnosed can be infected with the novel coronavirus.
However, it is not possible to completely rule out the infection simply because the PCR
test is negative.
If a latent infected person who has become a false-negative acts freely on the basisthat the test is negative, there is a possibility that the infection will spread. In addition, anegative result at the time of the test is actually negative but does not negate subsequent
infection. The proof that the “PCR test was negative” is only proof that the virus could not
be detected, and it is not possible to prove that the individual does not have the virus orthat he or she “will not infect others.” On the contrary, it is feared that the carelessness
caused by negative results may increase the risk of infection.

(3) How PCR test results are used
PCR tests are performed in three major conditions.
Diagnostic tests (in clinical practice): Patients suspected of having the novel
coronavirus infection, owing to symptoms such as sudden high fever, prolonged fever,
impaired taste and smell, general weakness, cough, and shortness of breath, aresubjected to PCR tests for a diagnosis. If the result is negative, treatment is started whiledetermining the possibility of other diseases, and careful examination is continued, suchas a chest CT scan for pneumonia symptoms, blood oxygen concentration measurement,and PCR re-test, while carefully considering the possibility of a false negative. Treatment
and follow-up observations are continued with great care.
Tests to check and control the spread of infection (at the Health Administrationsite): If a person is found to be positive for the PCR test, from 2 days before thesymptoms appear until positivity is evident (at the start of isolation), people who were inclose contact with that person are identified and PCR-tested to confirm whether they
have been infected with the virus from the person that tested positive. This is performed
regardless of the presence or absence of symptoms because the aim is to check whether
the virus has spread by any close contact, such as having a conversation without a mask.
Even if the PCR test results are negative, as there is the possibility of a false negative,
there is no proof that the tested person does not have the virus. Therefore, anyone
identified as a close contact is instructed to stay at home for 10-14 days from the date ofcontact.
Efficient identification of virus-infected individuals in high-risk areas (in pandemicsites): Owing to the high incidence of patients, in cities and regions that require
immediate detection, treatment, and isolation of infected persons among the population,
strategies have been put in place to conduct PCR testing on as many people as possible.
It is still fresh in our memories that PCR testing was carried out for all those who wanted
it in cities in foreign countries and in the night streets of Tokyo. However, if PCR testing,which is expensive and labor-intensive, is performed where the frequency of occurrenceis low, it is a waste of labor and money to detect only a few positive cases and it will put
an excessive burden on the site of infection control.
In the current situation, wherein the virus has spread across borders, PCR testing isrequired at the time of entry in many countries, and upon entry, it is mandatory toquarantine at home for 14 days; Japan is no exception.

(4) Should PCR tests for the novel coronavirus be performed on healthy
individuals?

For example, there are people who ask "how about PCR testing for all university
students?" Tests targeting healthy groups of university students must be considered after
understanding the features of the aforementioned PCR test. Even when performed for acertain group of people, it is not possible to prove that everyone does not have a virus
nor does it prove that everyone will not infect people or that a mass infection (cluster)
will not occur.
One can find a very small number of infected persons who are asymptomatic. However,
if university students are strict about avoiding the 3Cs on a daily basis, it is unlikely thatthey will acquire the virus unknowingly. A high test fee will have to be paid (not coveredby national health insurance) to detect a very small number of virus, resulting in a burden
on the testing site. Even if there are infected individuals that are asymptomatic among
the students, if all students wear masks, wash their hands, etc. to avoid the 3Cs, there
will be no close contact and infection on campus can be prevented. In other words, one
can say that continuing to carry out these infection prevention actions is a more effective
infection prevention measure than performing PCR testing.
Considering the labor and costs involved in PCR testing, one can realize that testing
healthy subjects is not practical from a cost-effectiveness perspective.

(5) Should antibody tests for the novel coronavirus be carried out on healthy
subjects?
It is currently possible to measure the level of the IgG antibody against the novel
coronavirus in the blood. The level gradually increases in the blood after infection andremains high for a while. Therefore, if the antibody level is measured and the value ishigh, antibody positivity is judged, and the understanding is that the individual wasinfected by the novel coronavirus in the past. However, there are still unclear points suchas when the infection took place, whether the presence of the antibody implies no future
infection, for how long this antibody will remain, etc.
For example, in infectious diseases wherein the nature of the antibody has alreadybeen revealed and a vaccine has been established, the antibody titer in the blood ismeasured. People with insufficient antibody titers can be given additional immunizations

to boost their immunity. If this is performed in a group, group immunity can be acquired,and even if a highly infectious pathogen enters the group, mass infection can beprevented. The Gifu University measure antibody titers for measles, rubella, mumps, andchickenpox for all first-year students. Students with insufficient antibody titers gain
lifelong immunity through additional vaccinations and do not have to suffer from such
infections. It also helps to prevent mass outbreaks at the Gifu University because mass
immunity can be acquired. Every year, all first-year students can check their immunity
status, and more than half the students receive additional vaccinations owing to lack ofantibodies. We believe that it is cost-effective and useful to conduct antibody tests formeasles, rubella, mumps, and chickenpox for all students as it promotes the students’lifelong health as well as the safety and security of the Gifu University.
However, much remains unknown about the antibody test for the novel coronavirus;
whether the appropriate antibody can be measured, whether a lifelong immunity can beattained, what the adequate antibody titer is, how the antibody titer changes after
infection, etc.

(6) The most effective way to prevent infection on campus is to ensure thatstudents adhere to correct infection prevention practices.
Even a healthy university student can catch a cold or become unwell. Even with minor
symptoms, we do not know what kind of pathogen the person has and one cannot saythat it is not a novel coronavirus infection. The Gifu University instructs all students totake the correct action of staying at home without attending school if they experience any
symptoms and to seek medical help at home or at a medical institution. All faculty
members take care not to force or hide their symptoms.
We believe that our students can adhere to correct infection prevention practices
based on scientific evidence. The Gifu University pledge to do our best to ensure thatour students have sufficient self-health care capabilities.
September 24, 2020.
Mayumi Yamamoto, MD, PhD, MBA.
Director / Professor, Health Administration Center, Gifu University.