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One thing is clear as students return to some college and university campuses amid the coronavirus pandemic: It will be very tricky to get this right.
Public health experts are concerned that attempts to start in-person classes too soon and an overreliance on imperfect testing practices could lead students to underestimate the risks of getting infected on campus, potentially seeding new outbreaks and spreading COVID-19. That’s especially true with ongoing community spread of the virus in much of the country and difficulty controlling what precautions students take when they’re not in class.
Some universities opened in-person classes only to suddenly go remote after clusters of coronavirus infections emerged or the number of students testing positive ticked up quickly. Other schools are delaying in-person returns until September or October, and then will limit in-person attendance or require negative test results from everyone returning. Still others are planning only remote classes.
Many of the schools with students on campus are trying to head off an outbreak by requiring that everyone wear masks and practice social distancing.
But even with such precautions in place, experts think safely holding in-person classes at most schools right now will be complicated and expensive. One team of researchers, using a mathematical model, calculated that if schools tested everyone for the coronavirus every two days—and if students faithfully adhered to mask, sanitization, and social distancing guidelines—it would be theoretically possible to have an abbreviated, in-person fall semester without any uncontrolled outbreaks.
Yet the fact that it’s theoretically possible doesn’t necessarily make it achievable, according to A. David Paltiel, PhD, a professor of health policy and management in the public health modeling unit at the Yale School of Public Health in New Haven, Conn., and lead author of that study, which was published in the journal JAMA.
“We’re setting an extremely high bar—a high bar financially, a high bar logistically,” Paltiel says. “I suspect that most of the universities and colleges in the country aren’t going to be able to meet the standard that we said would be required.” He says that he and colleagues have received pushback from university representatives who have described such a regimen as not practical or feasible, or even as just “science fiction.”
That may be true, Paltiel says. But “if you really don’t think it’s feasible for your college, you really need to be asking yourself if you have any business reopening.”
For those considering heading back to school, here’s what experts think students and parents need to keep in mind.
Know the Plan
First and foremost, parents and students should be absolutely clear on what the school’s plan is for avoiding outbreaks, says Sharon Nachman, MD, chief of the division of pediatric infectious diseases at Stony Brook Children’s Hospital in New York. That plan should have details on how schools will deal with “hot-button topics,” Nachman says, including what happens if someone gets sick and how many classes will be taking place in person.
If students are living on a campus, there needs to be a place for sick students to isolate, and students that have potentially been exposed to the virus need to be able to quarantine, Nachman says.
Schools should explain how they plan to track cases and how they’ll notify potentially exposed students. Understanding what happens if the school has to close because of an outbreak is also particularly important, Paltiel says. Schools “can’t make that decision on the fly,” he says; the administrators need to determine in advance the point at which in-person classes are no longer workable.
If the school does have to close because of COVID-19, students may need space to quarantine, especially if they won’t be able to travel home without exposing others or without putting vulnerable family members at risk.
Control the Spread
Each school’s plan should also include standard infection control precautions. Social distancing should be required. According to Centers for Disease Control and Prevention guidelines for institutes of higher education, the highest risk for coronavirus outbreaks is if schools are holding full-sized classes, activities, and events in person. Holding just certain classes and activities in person while ensuring that everyone can remain at least 6 feet apart is lower-risk, though it’s still significantly riskier than all-virtual learning.
“Most colleges have already appreciated that the large lectures are going to be online,” Nachman says.
But there are still questions about how to limit class sizes and campus populations—some schools are bringing back only certain students, either staggering groups or holding distanced in-person classes only for classes that require physical participation, such as lab work.
Masks also need to be worn by everyone in a campus community both indoors and anytime it’s not possible to stay 6 feet apart, according to the CDC guidelines. And while outdoor classes and activities sound like good ways to reduce risk overall, Nachman says, masks should still be worn in those settings if people are going to be close enough to reach out and touch each other.
Roommates need to be on the same page about how they’re interacting with people outside the room, Nachman says. Check to see whether your school has a plan for changing rooms or otherwise resolving conflict that arises regarding different attitudes toward social distancing and infection prevention.
Think Beyond the Bubble
While some campuses are trying to create a sort of “bubble,” keeping students contained on campus once they arrive, that’s not possible for the majority of college students around the country. Only 16 percent of college students live on campus, according to Department of Education data compiled by Robert Kelchen, PhD, an associate professor of higher education at Seton Hall University in South Orange, N.J. Just over 27 percent of students live with their parents, according to his analysis, a percentage that climbs to about 40 percent for community college students.
“It’s way more complicated” for these students, Paltiel says, because they risk being exposed in the community, especially if spread is high, and because they could expose parents who may be at a higher risk of serious complications from COVID-19.
Commuter students should consider wearing a mask at home, Nachman says, if they decide to attend in-person classes at all. And any student living off campus needs to be encouraged to follow the same social distancing guidelines away from school that they do at school, Paltiel says.
Understand the Limits of Testing
Regular testing of an entire student body could be enough to control COVID-19 outbreaks, if done every two days, according to Paltiel’s model, as long as students and staff are taking all other precautions to prevent the spread of disease.
But such a program is expensive and logistically complex, especially with widespread testing delays across the country. Some schools are testing only symptomatic students, which will allow too much asymptomatic spread before clusters are identified, Paltiel says. That’s like having “fire departments that respond only to calls when a house is known to have burned to the ground,” he says.
Some schools have required students to have a negative coronavirus test in the weeks before they arrive on campus, but that isn’t sufficient to ensure that a student didn’t get infected between taking the test and arriving on campus.
Another concern about testing is that it could provide a false sense of security, says Nathanial Beers, MD, a fellow of the American Academy of Pediatrics and a pediatrician at Children’s National Hospital in Washington, D.C. If students who test negative don’t wear face coverings or don’t follow social distancing guidelines, outbreaks are likely.
The Legal and Financial Questions
Think twice about signing away any rights if you’re asked to sign a COVID-19 waiver, absolving the institution of liability in case of infection. Experts say it’s worth signing only if the institution is being conscientious and careful about disease prevention, if the risk of infection is worth being there in person, and if you have no choice. (For more information, see CR’s article on COVID-19 waivers.)
Some schools have slashed tuition for their online classes; others have not. Some students have even opted to purchase tuition insurance, according to CNBC. What makes sense for each family will vary depending on the school and the student.
Students who are considering a return to in-person classes should talk to the finance or financial aid office to find out whether there will be any sort of housing or tuition refund if the semester pivots to online only.
Keep in mind, experts say, that even with a long list of infection control procedures in place, it’s still possible that the situation will go awry. “This is completely new ground for all of us, and we will learn from it each week and each month,” Nachman says.
Perhaps most important is that schools should be prepared for when things don’t go according to plan, Paltiel says.
“On too many campuses everything that could go wrong needs to go right, and that’s no way to build a safety net,” he says. “If you get it right, the students have a great year. If you get it wrong, a lot of people get hurt.”
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