Campus outbreaks of COVID-19 were almost guaranteed

Scientists have learned a few things over the past six months as the COVID-19 pandemic has continued. We’ve learned that the virus that causes COVID-19 transmits particularly well when a group of people are together in a small, poorly ventilated area. We’ve learned that young people are just as susceptible as older people to infection. We’ve learned that if there is widespread community transmission, the virus will find its way to the very places we don’t want it go.

So, it’s not surprising to us, researchers who study diseases that can be prevented by vaccines, that with schools and colleges reopening, the virus is spreading.

These are places designed around the idea of bringing lots of people to one place. Many of them bring people together from all over the world. They are perfect places for disease to spread.

How we got here

Back in March, colleges and universities closed down like everything else except essential businesses. They sent students home. There was a rough transition to online instruction. Students weren’t happy, faculty weren’t happy. And so, they started to come up with plans on how to reopen for in-person instruction for the fall semester.

Many places installed plexiglass barriers in classrooms, considered mask mandates and worked out physical distancing in lecture halls. Most people realized that professors who taught large classes should plan for remote learning.

University administrators and public health experts started making these plans in the spring. Back then, we scientists and public health researchers all operated under the assumption that community spread would be under some sort of control by fall. We all thought that the country would increase testing capacity, and we have. Then, once new cases dropped to a low level, we could institute contact tracing, the way other countries had.

But that part hasn’t happened. And so now these same colleges and universities are facing huge increases in cases, including at the University of North Carolina, Notre Dame and the University of Alabama. Many universities that have opted to return to in-person classes are also having a surge in cases. These outbreaks will inevitably spread to the wider communities in which the campuses are located.

It seems that for many of these institutions, the priority was on financial concerns, which involved a return to a normal fall semester to the greatest extent possible. They then developed plans that they thought would make this possible. Faculty at many institutions and at least one ethics committee have argued that the priority should have been the safety of students, faculty and the surrounding communities.

While schools across the country have different priorities, enrollments, campus size and student demographics, many schools share one thing in common: making no real contingency plans around reopening amid COVID-19, other than going remote if governors mandated it.

The schools that did spend the summer figuring out how to deliver high quality education remotely, or how to safely provide housing and access to services for the most vulnerable students, are less likely to have their fall semester disrupted. However, the College Crisis Initiative’s data dashboard found that only 7% of 1,442 four-year schools surveyed were planning on a fully online fall semester.

The challenge ahead

And so, the inevitable has come to pass. Now, many college campuses will struggle to control their outbreaks, because there are a lot of unique challenges inherent to COVID-19 in this population.

Colleges are not nursing homes or prisons. Some are trying to limit contact with the broader community.

But in general, students are not kept under lock and key. They have visitors from other schools. They go back and forth to their parents’ homes. And, yes, they go to parties. To us, blaming students for wanting a normal-ish college experience when the schools themselves have set the tone for trying hard to return to normal isn’t fair.

It’s also true that not all of the contact students have is as irresponsible as some have suggested. Many students hold jobs in the communities that surround the school. And most of these jobs aren’t typically the work-from-home type of job. In our undergraduate careers we both worked at jobs that had high contact rates with the community. And often, when your job is waiting tables at a local pizza place or manning a library desk, most of your colleagues are students as well. All of these factors will make contact tracing very hard.

Public health experts also expect a relatively high proportion of college-aged students to be either completely asymptomatic or to only have very mild symptoms.

Without universal testing, these students won’t know they’re sick. They may not isolate if they have mild symptoms. But they will still be able to spread the virus to others. Symptom and temperature screenings may not recognize these individuals as those who need to stay away from campus buildings.

A different kind of test

Which brings us to testing. Some places are doing universal testing of students, multiple times per week. But, given the state of testing in the U.S., that is not a realistic possibility for most schools.

The unique epidemiology of COVID-19 in young adults, along with the contact patterns on college campuses and the inability to effectively screen through symptom reports or diagnostic testing, have left college campuses with few options for safely operating with in-person classes.

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