WILL UNIVERSITIES BE THE NEXT COVID-19 TINDERBOXES?
Editor's Note: My thanks to colleagues in the National HMO Lobby for sending the link to this article. Although it refers to university campuses in the United States, what it says is very relevant indeed to university campuses here in Nottingham and elsewhere.
It speaks to the need for government (national and local) and the universities to address the 'fair degree of unease amongst residents of university towns and cities ... regarding the fairly rapid addition of [large numbers of students from places all over this country as well as from all over the world to our neighbourhoods]. We know that plans are being made to ensure the safety of students and staff, but there seems to be a paucity of information when it comes to guarding those residents living in neighbourhoods where student-occupied HMOs are dominant and where, as the behaviour earlier this summer has provided ample evidence, too many students will ignore guidance in pursuit of what they see as the 'student experience'. ...
After Cruise Ships and Nursing Homes, Will Universities Be the Next COVID-19 Tinderboxes?
JULY 16, 2020 7:00 AM EDT
Since the start of July there have been at least two outbreaks among student athletes, coaches, and staff—with 37 infected at the University of North Carolina (UNC) Chapel Hill and 22 at Boise State. Clusters of infection have been traced to college town bars popular with students.
A common misconception is that young people with COVID-19 don’t die and therefore college re-openings pose little risk. Sadly, this isn’t the case. COVID-19 deaths in the young are rare, but they happen. Universities across the U.S. are mourning the loss of students in the lead-up to the school year, including Joshua Bush, a 30-year old nursing student at the University of South Carolina, Trevor Syphus Lee, a 27-year old senior at Utah Valley University, and Juan Garcia, a 21-year old Penn State undergraduate.
One might imagine that the rapid, uncontained spread of a serious and poorly understood disease which is already killing students would cause universities all across America to put their re-opening plans on hold. Unfortunately, that’s not the case.
The Chronicle of Higher Education compiled a database of the fall reopening plans of over 1,000 colleges and universities and found that 60% are “going to open for business and bring all of their students back.” Given how much is still unknown about the virus and especially its long-term effects on those infected, this could be the largest-scale uncontrolled public health experiment America has ever undertaken, with students, staff, faculty, parents, and communities as the unwitting test subjects. No other nation has reopened schools and universities with the level of rampant community transmission we see in the U.S. today, or with so little coordination or guidance as to protective measures.
The rush to re-open is driven by the very reasonable conviction that universities and colleges ought to provide their students face-to-face classroom teaching and a residential “campus experience.” There is more to college than the transmission of knowledge, and online learning has significant disadvantages. But during a pandemic, both classrooms and presumably campus residential settings present risks universities are not equipped to handle.
Safety measures proposed so far revolve around sanitation, masks, and physical distancing. These might be sufficient for a trip to the supermarket; for several reasons, they are likely to fail in the context of daily life at a university.
First, some colleges are only “encouraging” (not mandating) mask wearing this fall, drastically reducing effectiveness. When a strict rule is in place, classroom enforcement will likely be up to individual instructors, and proper mask use (e.g., a snug fit that keeps all noses covered) cannot be guaranteed.
Second, physical distancing is a moving target. Some states have argued that 4 feet of distancing is enough in the classroom, on the assumption that everyone will only cough (or breathe) straight ahead. UNC Chapel Hill even suggested that 3 feet would do, until an outcry caused them to reverse course.
Third, evidence suggests that when students and instructors spend extended time together in the classroom, even universal mask use and six feet of distancing may not be enough.
There is a growing consensus that in places with an uncontrolled COVID-19 epidemic, being inside a building where people are talking—such as in a bar, restaurant, office, or classroom—puts you at risk of infection. We now know that SARS-Cov-2, the virus that causes COVID-19, can linger in the air in the form of tiny droplets (aerosols) and can infect people as they breathe in.
Research has shown that air flow can transmit aerosolized SARS-Cov-2 much further than 6 feet. In the absence of constant and efficient ventilation, viral particles can remain airborne for at least 3 hours. In most universities, opening all the windows and doors would be impractical or impossible, and air conditioning systems can waft recycled air over occupants for hours. Masks help, but they’re not perfect protection.
Not surprisingly, many professors, particularly those who are older or have pre-existing medical conditions, say they will refuse to teach inside classrooms. But to be able to refuse, you need some degree of power. There’s a real risk that so-called contingent faculty, those in “insecure, unsupported positions with little job security and few protections for academic freedom” will have no choice—they will feel pressured to teach in person or be replaced.
Beyond the classroom, colleges and universities are “congregate settings” that are known to create high risk for viral transmission, akin to nursing homes or cruise ships. The campus experience includes bringing students together in dormitories, dining halls, athletic training, parties, bars and clubs—gatherings that would risk becoming “superspreading events.”
Some universities are hoping that a pre-semester quarantine period, an honor code that encourages students to self-report symptoms and adopt masks and distancing, and campus-wide contact tracing will help avert catastrophe. But a recent study led by Dr Sherry Pagoto at the University of Connecticut—a survey of 2,698 students who will be returning to campus in a few weeks, and in-depth interviews with a further 35 students—suggests that many obstacles lie ahead, especially if students are not meaningfully engaged in the reopening planning process. (Dr Pagoto has shared the initial findings of the 35 in-depth interviews on social media.)
Every student said quarantine is not realistic and will fail. They also said that if they develop mild COVID-19 symptoms, they may not report them. If they become infected, they’d be reluctant to tell the university about their contacts, especially those at bars. They were pessimistic about the safety of social events, suggesting mask use would not be universal. The fact that 117 studentsat University of Washington fraternities have tested positive since late June suggests that such fears are well founded. The overarching message seems to be that just telling students not to do things and leaving it at that is not a reliable policy.
While the risk of death from COVID-19 is lower among the young than the old, we’ve seen that young adults can die of the disease and the risk is five to nine times higher among those who are Black, Latinx or Indigenous. Even if they recover from the initial acute illness, infection with the novel coronavirus can have debilitating long-term consequences, including lung disease, heart problems, brain damage, and mental health problems. And we don’t yet know what other lingering effects the disease might have.
Infections among students will also put the lives of others around them at risk. The highest risk of death will be among service and maintenance staff on campus—cleaners, bus drivers, food service employees, janitors, facilities managers and support staff—who wield little institutional power. A recent outbreak of COVID-19 among housekeepers at UNC Chapel Hill, tasked with cleaning the rooms of student athletes, is just the tip of the iceberg. Over 40% of service and maintenance staff on U.S. university campuses are people of color, who are at elevated risk of dying if they become infected with SARS-Cov-2.
For the city where a campus is based, reopening will be like dropping a cruise ship into the center of town—and giving passengers free rein. Campus outbreaks cannot be hermetically sealed—they will inevitably cause a spike in community spread, affecting the city, state, and beyond. Universities that fully re-open in the midst of an uncontrolled epidemic will bear responsibility for the damage they cause to their wider communities.
What would it take to re-open safely? We can look to Taiwan as an example. Rather than leaving individual universities to piece together their own plans, Taiwan’s Ministry of Education produced a national strategy for college campuses. The strategy included an initial quarantine, frequent testing of all students, sanitation, masks, distancing, reduction of student density, cleaning of dorms twice daily with bleach, and allowing only one student per dining table. It also included mandatory quarantine for anyone exposed, and infection-number thresholds at which an entire university would shut down. With this huge array of protective measures on campus, Taiwanese universities were able to reopen successfully and see a total of just seven confirmed university-based cases by June 18, and only four new cases nationwide since then.
Aside from the safety protocols more rigorous than any we’ve seen proposed in the U.S., Taiwan’s universities had another advantage America’s don’t: a well-controlled epidemic with virtually no community transmission. To date, Taiwan has had only 451 cases and seven deaths. Not a single state in the U.S. has had anything like that level of success.
In that context, it’s hard to see how any U.S. university could have a safe on-campus reopening plan comprehensive enough to succeed.
We understand the financial pressures that colleges and universities are facing. Some could risk bankruptcy without the revenue that reopening will generate. We also recognize the enormous benefits of campus life and in-person teaching and the wishes of some students and parents to experience these. But at what price?
These institutions need to be honest about the trade-offs. They should publish their estimates of the number of infections, hospitalizations, and deaths that re-opening will cause. That will allow students, instructors, parents, and the wider community to better understand how much suffering must be endured, and by whom, as the price for the benefits of reopening. These institutions should also state clearly what level of illness will trigger another shutdown.
The Trump administration is applying increasing pressure on the education system to reopen, hoping that Americans will grow numb to COVID-19 deaths. Colleges and universities should not become complicit in fostering numbness, even if suspending in-person tuition would threaten their financial viability. They should put the health and safety of their students, instructors, service and maintenance staff, and communities first. Who else do they exist to serve?
Clarification, July 20: The original version of this article didn’t specify the extent of Dr. Pagoto’s findings she has shared online.
Student ‘Covid-19’ Parties: This Is Why Cornell’s Logic Is So Sketchy
CNN is reporting that college students in Tuscaloosa, Alabama have been hosting “Covid-19 parties.” Living in off-campus housing near the University of Alabama, these young adults are gathering in groups that include individuals who are known to be infected with coronavirus. The goal, according to at least one Tuscaloosa city council member, is to become the first to be diagnosed with Covid-19 and win a cash prize.
While this sort of activity represents an extreme form of antisocial behavior among college students, it is an example of what university officials are going to be grappling with this coming semester as they reopen their residential campuses. College students are going to party, plain and simple. And many of these young adults are going to be flouting rules about social distancing along the way.
Ironically, Cornell University recently decided to reopen their campus at least in part because of a modeling study conducted by some of its researchers that focused specifically on student misbehavior. The findings included the assertion that in-person classes would result in less infections and hospitalizations than offering classes online. Such a counter-intuitive conclusion rested on several assumptions, including the idea that bringing students to Ithaca, New York would allow university officials to do more testing and to better monitor and control student misbehavior.
Experts on the behavior of adolescents and young adults already have spoken out regarding the naivete of such thinking. For example, Temple University’s Lawrence Steinberg recently wrote an op-ed in the New York Times calling such attempts to control the behavior of college students as fantasies that “border on the delusional.” He provided a strikingly pessimistic prediction “that the college and university reopening strategies under consideration will work for a few weeks before their effectiveness fizzles out.”
Dr. Steinberg based his dismal forecast on the expectation that students will slowly ignore social distancing guidelines as they meet up with old friends, begin partying in their dorms and at off-campus residences and, at least for some, become intoxicated and have sex with other students that have just met. Not a “Covid-19 party” by any means. Just typical college student behavior.
Martha Pollack, the president of Cornell University, claims that she and her institution are following the best empirical evidence that is available to them. "Even with all the limitations and uncertainties in any sort of modeling, we still think it makes sense to rely on the science," she said. The work she is relying on, however, seems to run counter to almost everything we know about college students. Whether or not Cornell students host an actual “Covid-19 party” is beside the point. They are going to gather. They are going to party. They are going to take risks. And when they become infected with the coronavirus, they are going to transmit the disease to others who come into contact with them.
Some of the infections will happen from student to student, most of whom are less susceptible to the ravages of Covid-19. Other transmissions, however, will occur with those adult professors who teach their courses, clean their buildings and cook their meals, and provide them with goods and services through purchases from local shops and businesses. Many of these older individuals are more vulnerable, of course, and inevitably some of them will die. Then what? University leaders must begin to take normal college student behavior into account when planning for their campuses to reopen. Otherwise, their statements quickly become just so much smoke and mirrors, with the attendant risk of quickly being forced to close down again.
[Stephen M. Gavazzi, Forbes, Thursday 2 July 2020]
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