One year after the COVID-19 pandemic, we know that the SARS-CoV-2 virus spreads easily through large indoor gatherings and community living spaces. A person can become infected, spread the virus to friends, family, teachers or co-workers and then start showing symptoms several days later or never show signs of infection.
With these kinds of risks, a college campus seems like one of the most dangerous places to spend time. In fact, U.S. counties with large colleges or universities that offered face-to-face instruction last fall saw a 56 percent increase in COVID-19 cases in the three weeks after classes, compared to the previous three weeks. Counties with large schools that offered only remote learning recorded a drop of nearly 18 percent, researchers at the U.S. Centers for Disease Control and Prevention reported Jan. 8 in the weekly Morbidity and Mortality Report.
Universities that opened their campuses in August and September faced an unexplored experiment of months of infection control. They had no manual or safe way to prevent students and staff from getting sick.
Science News took a look at five universities that opened in the fall. Each school put together some kind of test at various frequencies along with unequal rules on the use of masks and public meetings.
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To test, all five schools used polymerase chain reaction or PCR tests, which are the gold standard for diagnosing COVID-19. However, the results may take days when the demand for evidence is high (SN Online: 31/08/20). One school also used a test called loop-mediated isothermal amplification or LAMP, which, like PCR, measures viral DNA to identify infections. LAMP is less sensitive than PCR, but the results arrive much faster as it is not necessary to send samples to a laboratory.
Antigen testing, which detects virus proteins and also gives fast results, has helped a school move students quickly into quarantine, although those tests have a higher rate of false negative results. One school also organized wastewater sampling in dormitories to detect the first signs of outbreaks.
“Colleges are high-risk, but also exactly where innovation can occur,” says Pardis Sabeti, a computer geneticist at Harvard’s Broad Institute and MIT, who has worked with more than 100 colleges and universities on their COVID-19 mitigation strategies. .
An example of such an innovation, she says, is the universal use by students of phone-based applications for symptom tracking and contact tracking. Sabeti stated that student engagement and leadership were also key to successful outbreak control. Several universities have recruited students as health ambassadors to promote safe behavior; in one school, a panel of students imposed punishments on their peers who broke the rules.
Four of the five schools outlined here faced at least one outbreak during the fall, but none sent students home before the Thanksgiving break. As the spring semester begins and universities bring even more students to campus, the experiment continues.
“Most schools had very failed semesters (in the fall),” Sabeti says. To do a better job in the spring, he suggests that schools double public health measures and civic engagement with both students and wider communities. In the schools outlined here, student participation appeared to be an important part of control efforts. Several of the schools are adding new strategies as case totals have been rising around the country.
Choose a different handful of universities and you’ll probably find a different mix of approaches and outcomes. Perhaps by the end of the spring semester a best practice book can be written to keep schools safe during a pandemic.
University of Wisconsin – Madison
In September, Wisconsin had one of the highest per capita COVID-19 rates in the country. The University of Wisconsin-Madison was at the center of concern: Hundreds of students tested positive when the campus opened in late August. Some students on campus gathered in large groups without masks despite college restrictions, according to the student newspaper Badger Herald. At the peak of the outbreak in early September, 911 students and staff tested positive in a single week.
The university has partnered with a local biotechnology company that had developed a COVID-19 PCR test. As a research university, UW-Madison had the infrastructure to quickly analyze test samples on campus.
The initial plan was to test all students living in residences every two weeks, says Jake Baggott, associate vice chancellor and executive director of the University’s Health Services. But when cases escalated in September, the school moved on to weekly tests.
“We try every residence and every floor of every residence every day,” Baggott says. A staggered schedule was set based on life arrangements: if a student was tested on a Monday, the roommate was tested on Tuesday, the door neighbor tested on Wednesday, and so on. This amazing helped administrators identify outbreak sites more quickly, as they had new data available every day at the hyperlocal level.
Students who tested positive were isolated for two weeks and anyone who was known to be exposed to an infected person or who showed symptoms went into quarantine. All non-essential staff activity has been suspended for undergraduate students for two weeks, starting September 7th. As of Sept. 20, a record 432 students were isolated and 100 were in quarantine.
By the end of September, new daily cases had dropped below 20 and test positivity (apart from tests that tested positive) remained below 5 percent, a threshold recommended by the World Health Organization before a community should think about reopening. The university used similar tactics to crack down on a smaller outbreak that began in late October.
North Carolina State University of Agriculture and Technology, Greensboro
When the campus reopened, North Carolina State University of Agriculture and Technology, NC A&T soon, had the ability to test only symptomatic students. And the change was slow: the results took five to six days, sometimes longer.
The COVID-19 strategy changed in late September, when the school received antigen testing through a grant from the U.S. Department of Health and Human Services for testing at black colleges and universities. Compensation for rapid antigen test results is a higher probability of false negatives (up to 1 in 5 in asymptomatic people). But for the administrators the speed paid off.
“We decided to try it everywhere we could,” says Robert Doolittle, medical director of the Student Health Center, at the health center and on campus’s emerging sites.
When an outbreak began after a Halloween party, which violated campus rules, the university restricted socialization in person and tested approximately 1,000 students in a week with both antigen and PCR testing. Health center staff educated students on how to interpret the results of each type of test: antigen test results are preliminary and can give false negatives, while PCR test results are more definitive. PCR tests identified 61 cases in students who had negative antigen results, but rapid tests still allowed the school to send 160 students to immediate isolation.
The young people who worked at the Student Health Center were instrumental in the testing effort, says Yolanda Nicholson, director of health and wellness education. Students campaigned on social media, created educational videos and stayed out of the center to announce test hours. Nicholson and student staff encouraged those who came to try to tell their friends about the experience. Some students went live on Instagram while rehearsing, showing their peers what the experience was like.
While upper-class students criticized some freshmen for meeting without masks in August, as noted in the student newspaper, the A&T record, students, for the most part, says Nicholson, "took it seriously."
In an infomercial shared by Nicholson with Science News, students expressed their reasons for taking the test: "for my family, for my loved ones, for us." NC A&T students understand that black residents of the United States have been hit hard by the pandemic, Nicholson says. Demand for evidence increased toward the end of the semester, as students were anxious to avoid bringing the virus to their families.
University of Washington, Seattle
Brotherhood and fraternity homes – where students live and gather for parties – have become sources of COVID-19 outbreaks in many schools. The University of Washington experienced an outbreak of fraternity in the summer and applied the lessons learned.
“It was in late June, I was in the car and I got a call from a chapter president (fraternity) that he has three members living on his premises and that they are symptomatic,” says Erik Johnson, then president of the Interfraternity Council. "We entered emergency lock mode".
The 25 brotherhood houses were quarantined that same day. Within 48 hours, a testing site was created to test all residents.
Johnson describes a major team effort: the university created tests; the county public health department, which responded to the first known outbreak of COVID-19 in the United States, handled contact tracking; and the leadership of the fraternity communicated the importance of quarantine and other security guidelines. The summer outbreak was revealed in about two weeks, with the latest case of the outbreak being identified on 8 August.
Both college leaders and students used that summer experience to prepare for fall. Genevieve Pritchard, president of the 2020 Panhellenic UW Association, which oversees the associations, joined weekly meetings with teams from the local public health department and the university’s environmental health and safety office before brotherhood homes were opened. Students could attend webinars to ask questions.
When an outbreak hit the fraternities in the early fall quarter, infected students were quickly identified and isolated. The university reported 200 new cases the week ending Oct. 4, 76 new cases the following week, and 42 new cases the following week. Only about one-fifth of the regular student population had attended campus.
Colorado Mesa University, Grand Junction
As a school located away from large testing labs, the University of Colorado Mesa did not have access to the results of the 24-hour PCR tests. Thus, the school relied on other methods of selection and deliberate community building to bring its undergraduate students – many of whom are first-generation, low-income students – to campus.
The school used a “kitchen sink approach” for COVID-19 surveillance, says Eric Parrie, CEO of COVIDCheck Colorado. Students had to give negative before returning to campus and, upon arrival, participated in randomized tests with LAMP rapid tests, PCR tests for anyone known to have been exposed to the virus, and residual wastewater sampling.
John Marshall, vice president of Student Services, and Amy Bronson, program director of the university’s Physician Assistant Program, held COVID-19 virtual councils starting in the spring. Student leaders have fostered safety among their peers through campaigns on social media such as the school’s “CMU is back” music video.
With a nod to Maverick, the university's mascot, the students grouped in small pods called "evil." Set up based on housing and activities, the pods could be four students in an apartment or 20 students on a sports team. They were allowed to eat lunch together, congregate more than six feet in public spaces, and remove masks in their community living areas. The approach allowed sports teams to continue practicing, according to the student document, the criterion.
The university faced an outbreak in November, which Marshall and Bronson attributed to community outreach in Grand Junction, where many college students work. Campus testing and contact tracking increased during this time. Students were sent home by Thanksgiving and the school ended its semester with two weeks of classes and remote exams, fulfilling the school’s original plan for the fall.
Rice University, Houston
One of the foundations of Rice University’s reopening plan was to conduct weekly COVID-19 testing for college students, says Yousif Shamoo, deputy research provost. After seeing Texas residents wait days for test results in the summer, the school lined up two Houston-based testing partners, Baylor Genetics and Houston Methodist Hospital, to give it a 24-hour return to test results.
Starting in the summer, student leaders helped the university prepare educational materials in COVID-19 and set up a system to discipline those who broke the rules and reward those who followed the rules, says Emily Garza, director of Student Judicial Programs.
Inspired by the Rice Student-led Board of Honor, the COVID-19 Community Court includes representatives from all 11 residential colleges selected by the student leadership and trained by the Student Judicial Programs. Students in court judge their peers for violating COVID-19 protocols on campus; students, staff, and community members can report misconduct through an online portal.
The court was criticized as a way out for students to police each other. But I see Shamoo as a means to education, reminding students that their actions have consequences.
As punishment for being caught without a mask, for example, “We’ll have you write a three-page essay on whether you think masks are good ideas or not,” he says. Students wrote their essays after watching videos and reading articles on public health and safety issues around COVID-19. Another common penalty was community service hours, in which students created and published pamphlets in campus buildings about COVID-19 precautions.
During the fall semester, about 130 student rapes were reported, half on campus and half off campus. The judicial office of the university staff investigated the off-campus infractions.
Rice has also trained more than 100 student health ambassadors to serve as resources for her peers who have questions about COVID-19 but do not want to ask administrators. The number of cases remained low in Rice, with no day seeing more than six reported cases. During the fall semester more than 75,000 tests were performed and only 135 cases were confirmed.