Gov. Kay Ivey of Alabama made a daring educational decision in June: She would fund a statewide student testing and technology program to help public universities and colleges reopen for in-person classes.
Now, as Alabama college students start those classes this week and next even as local virus rates remain high, that program — one of the nation’s largest campus reopening efforts — is facing the ultimate test.
The sweeping endeavor, led by the state’s public health department, along with the University of Alabama at Birmingham, a leading academic medical center, focuses on testing more than 160,000 students for the virus before they arrive at 59 local colleges and universities. The students must also wear masks and follow social-distancing guidelines, and many will be required to use a daily symptom-checking app developed by U.A.B. On Monday, the university released a second app, which can alert students to possible virus exposures.
But even university leaders acknowledge the effort is a high stakes experiment that could set off new outbreaks in a state with one of the nation’s highest per capita infection rates.
The public universities and colleges in Alabama, including the flagship University of Alabama in Tuscaloosa, by contrast, are among the schools still forging ahead with reopening and conducting large-scale student testing to try to mitigate the risks.
But while many other colleges are depending on third-party virus-testing and symptom-checking services, Alabama is largely relying on testing methods and technology built within the state, at the University of Alabama at Birmingham.
Alabama is hoping its statewide experiment will help answer one of the most pressing questions about reopening colleges — and the country: Can a combination of aggressive testing, virus safety apps, mandatory mask-wearing and reduced classroom occupancy make it safe enough for on-campus learning?
As of Friday, U.A.B. said it knew of 99 students — about half a percent of its total student population of 22,000 — who had tested positive for the virus this year.
“It’s this comprehensive plan that gives us confidence,” said Dr. Ray L. Watts, the president of U.A.B. “If there is a flare-up, a small one somewhere, we can find it early and we can quarantine, treat and reduce the exposure to others.”
If the new statewide effort stumbles, however, Alabama could face scrutiny for using students as guinea pigs in an unwarranted experiment.
“I think it’s just going to be a disaster,” said Karnetris Langford, a parent in Huntsville, Ala., whose daughter is a junior at the University of Alabama at Birmingham. “I even told my daughter, ‘We’re not moving all of your stuff back, because I do not believe you all are still going to be down there in December.’”
U.A.B. began working on a student re-entry plan in March. By then, the university had developed its own diagnostic test for the coronavirus and instituted a testing program for employees at its medical center. Next, the university wanted to reopen campus to thousands of others, including researchers and graduate students.
“The platform we have for testing, we developed ourselves and we depend only on ourselves, and that’s unusual,” said Dr. Watts, U.A.B.’s president, who is also a neurologist. “I can see how many colleges and universities who don’t have that expertise find it very difficult to return.”
Soon university experts had developed Healthcheck, a web app that asks if users have been exposed to the virus or have symptoms like loss of smell.
U.A.B. football players, who began returning to campus in June, were among the first cohort of more than 3,000 students on campus who have used the app. This semester, all students will be required to use it daily. If a student answers yes to any question, it alerts staff at student health services, who may offer virus tests.
U.A.B. has made the Healthcheck app free to educational institutions in Alabama and is marketing it to employers.
In June, Governor Ivey, a Republican, awarded $30 million in federal virus aid money to support the student testing program along with virus safety apps, announcing the effort just as President Trump was publicly pushing schools to reopen.
The result, called GuideSafe, aims to test up to 200,000 Alabama college students this month up to two weeks before they arrive on campus. To pull it off, the U.A.B. Pathology Lab created its own testing kits and set up 13 student testing sites across the state. It also helped the University of South Alabama build a testing lab. Together they can now process some 9,000 student tests per day, with results returned in 24 to 48 hours.
U.A.B. plans to run the majority of the tests itself, using a method called pooling. That involves combining the samples of, say, eight students and testing them together. If the pooled results are negative, students are considered to be negative. If the results are positive, each student’s sample is tested again individually.
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Pooled testing can be useful when most results are expected to be negative. It is often used to screen donated blood for the presence of H.I.V. But U.A.B. is among the first academic labs in the United States to develop a pooled testing method for the coronavirus.
This semester, U.A.B. also plans to test a random sample of 4 percent of students and employees on a weekly basis, numbers that are based on the university’s virus model and may change depending on local conditions. Some other public health models have suggested that universities may need to test all of their students more frequently to control campus outbreaks, perhaps as often as every two days.
Separately, U.A.B. worked with the state’s public health department to develop a virus exposure alert app, using new software from Apple and Google. The app uses Bluetooth signals to detect users who come into close contact for more than 15 minutes. If users later tests positive for the virus, they can use the app to automatically notify other users who crossed their paths. The app is free for the public and optional for students.
Dr. Scott Harris, who oversees the Alabama Department of Public Health, said he hoped the virus alert app could help address a serious notification problem: Some Alabamians have ignored calls from human contact tracers.
Dr. Harris added that once the statewide student testing was completed, U.A.B. would have the capacity to test tens of thousands of other Alabamians. “It’s just helpful for our state in general to have this additional capacity that’s developed here locally and can be used locally,” he said.
Critics say the U.A.B. model has serious weaknesses. For one thing, they note, apps like Healthcheck can catch only people who have symptoms and are willing to disclose them. And as many as 40 percent of people with virus infections have no symptoms.
As for Alabama’s two-week window for student testing, they warn that many college students who test negative a week or two before their semester starts may develop the virus a few days later.
“If you test everybody within two days of coming to campus, you would have a better shot at getting an uninfected student body,” said Dr. Julia Marcus, an epidemiologist at Harvard Medical School. “But a two-week window is bordering on useless.”
Dr. Vickers of U.A.B. said the statewide program could not test students at scale without a two-week window, noting that students with negative results were asked to stop socializing before returning to their campuses. “It’s a trade-off,” he said.
Dr. Vickers added that, combined with measures like testing, social distancing and mandatory mask-wearing, the Healthcheck app could help hinder the campus spread of coronavirus.
Even so, some students said the university seemed to be sending contradictory messages — reassuring them even as it issued stern virus warnings to the public.
“You have U.A.B., the medical end, saying the virus is out of control,” said Kadie McDowell, a senior majoring in political science and criminal justice. “But then you have the school end of U.A.B., the university, saying, ‘We’re doing everything possible for you to come back to campus.’”
With classes scheduled to begin on August 24, it is too soon to know whether U.A.B.’s high stakes student re-entry program will be able to keep the virus in check. If does not, university officials said they have a variety of contingency plans.
“We are prepared, of course,” Dr. Watts said, “for any scenario.”