What It's Gonna Take

With all the focus on when colleges reopen, how they will do so has gotten less attention.

As college administrators across the country continue announcing plans to reopen their institutions this fall, two important questions have been largely lost in the debates over those decisions. What will it take for colleges to reopen responsibly as long as there is no vaccine or treatment for COVID-19 -- and how realistic is it that colleges can put measures in place by fall?

Testing, contact tracing and isolation and quarantining of ill individuals are among the steps public health experts say will have to be taken. But myriad other measures will also have to adopted. A 20-page document from the American College Health Association outlines considerations for colleges to take into account, from local public health challenges to containment and surveillance capabilities of campuses to the need to space out students in residence and dining halls. The ideal, the guidance states, would be to have one resident per room and per bathroom, which is not how most college dormitories are currently set up.

The guidance also recommends developing a physical distancing plan for each individual course and implementing a hybrid instruction mode “for the foreseeable future” with remote options available if a resurgence of infections occurs. The remote options would support vulnerable students and others who cannot return to campus, as well as those in quarantine.

The guidance outlines various measures for college to take into account in relation to their employees, their facilities, their athletics programs and recreation facilities, their student health centers. Mental health services, already stretched at many campuses, will need to be stretched further. Health promotion activities will be paramount.

“Meticulous adherence to public health practices including hand hygiene, physical distancing, proper cough/sneeze etiquette, frequent disinfection of common and high traffic areas, symptom assessment, temperature checks, and face covering in public is the campus’ new normal,” the ACHA guidance states.

If it sounds daunting, that’s because it is.

“Our colleges and universities are in many ways like small cities,” said Sarah Van Orman, the associate vice provost for student health at the University of Southern California and a member of ACHA’s COVID-19 task force. “Only in many ways, they are much more compacted with much higher density of people, and we have this great influx and efflux of people at the beginning and end of each semester. When you think about a public health threat, or in this case the COVID-19 virus, it really is very complex.”

Preparing for that threat can be very expensive. Many of the steps colleges may need to consider in reopening -- from testing students in large numbers and reducing the numbers of students in residence halls to accommodate social distancing to monitoring quarantined students, disinfecting common spaces and classrooms more frequently, and installing signage promoting social distancing and Plexiglas at reception desks and other high-contact areas -- come with price tags, some of them hefty.

“I think that for institutions of higher education, it’s a balance of how do we have our business operate, which we need to do, versus the cost of doing business,” Van Orman said. “We know that there are some institutions that are deciding that remaining remote for another semester makes the most financial and safety sense for their students, and I think that’s a decision that may make sense for many institutions. One of the things we’re trying to stress is if colleges have extensive operations on campus in the fall, it’s not going to look like last fall.”

A handful of universities, most notably the California State University system, have announced plans to be mostly remote for the fall semester. But many more have said they will reopen for fall. Van Orman said it is too early to definitively announce a fall reopening because it will depend on local public health conditions where the colleges are located.

“The community that your university fits in has to be ready, and your university has to be ready,” she said. “You can’t have one without the other.”

Public health officials have stressed the importance of testing. Admiral Brett Giroir, assistant secretary for health at the U.S. Department of Health and Human Services, said at a Senate hearing last week that institutional testing strategies will vary depending on the rate of community spread.

Asked whether it would be possible for the chancellor of the University of Tennessee at Knoxville to implement a strategy for testing all students upon arrival in August or September, Giroir responded, “Technically, we will have the ability, and your chancellor will have the ability. We expect there to be 25 to 30 million point-of-care tests per month available. It is certainly possible to test all of the students, or it is much more likely that there would be a surveillance strategy done where you may test some of the students at different times to give an assurance that there’s no circulation, and that would be done in conjunction with the CDC and the local health department.”

“There’s also strategies that are still needing to be validated,” such as a pooling sample, Giroir added. “We know in some experimental labs as many as 10 or 20 samples can be pooled, so essentially one test could test 20 students.” Giroir said. He also noted another experimental approach of testing wastewater from a specific dorm or an entire segment of the campus to determine the presence of coronavirus.

The University of California, San Diego, is embarking on an ambitious testing program, starting with the students who remained on campus this spring. Participating students stop by designated sites on campus to pick up test kits, swab the inside of their noses and return the swabs to specimen collection bags linked to a personalized number for the student. The UCSD hospital lab runs the tests, and students who test positive would be notified by student health services and, if they live on campus, moved to isolation housing. A trained UCSD contact tracing team would follow up with the people with whom the students had contact.

“Our hope is that this initial phase will provide us with the knowledge and insight to eventually scale up to where we could potentially test monthly the vast majority of the roughly 65,000 students, faculty and staff members on campus,” UCSD’s chancellor, Pradeep Khosla, wrote in a recent op-ed for Inside Higher Ed.

Robert Schooley, a professor of medicine at UCSD and one of the principal investigators for the Return to Learn project, said the tests cost $20 each, but he is hopeful emerging technologies may soon bring the cost down significantly.

“We are going to see how this goes and obviously see what the epidemic is doing,” Schooley said of reopening. “But if the epidemic is slow enough, we see this as a way people can get back safely. We see this approach as letting us have the opportunity to pick up virus before it gets too highly prevalent on campus.”

In addition to the testing of students, faculty and staff, Schooley said UCSD plans to monitor viral content in wastewater and on high-touch surface areas.

UCSD is a major research university with schools of medicine and public health. For smaller colleges that don’t have that kind of capacity, medical experts suggest they seek partnerships with nearby research universities or hospital systems to build testing capacity.

“Testing on a really large scale is starting to become available in this country,” said William Schaffner, a professor of medicine at Vanderbilt University. “This does not mean that the institution has to do its own tests or even if an institution has an associated medical center that the medical center does the tests, but there are going to be increasingly large commercial enterprises that can run tests on a very large scale.”

Schaffner, an expert on infectious diseases, sits on a task force at Vanderbilt charged with making recommendations to the university on COVID-19 protocols. The task force will help the university determine how to approach occupancy and personal spacing in student housing and whether instruction should be virtual, in person or a mix of both. Among other issues, the group will address whether lecture halls should be avoided or used with certain seats blocked off, and the number of bathroom stalls and sinks needed to promote social distancing. Such questions will have "to be addressed not only college by college, but almost course by course," Schaffner said.

He noted that student behavior would also have to be factored into any protocol plan.

"Some of the things that we are talking about is first of all asking students who intend to arrive on campus to be on their honor for the two weeks before they arrive on campus, to adhere to a whole series of social distancing strictures," he said. "They would have to do with wearing masks and hygiene and six-foot distancing -- not going to parties and large-group celebrations. There would be a whole series of instructions, and we would ask students to do those on their honor."

But what happens if students don’t follow social distancing strictures once they come back? The Boulder Daily Camera reported this month that some University of Colorado at Boulder seniors were participating in large graduation parties despite a stay-at-home order that was in effect.

“Should there be such an instruction that there are no group events larger than X number of people?” Schaffner asked. “It’s difficult to enforce, maybe futile. We don’t know. We’re just talking about these things, and the more you talk about them, the more difficult the issues become.”