An Alternate View of High Case Counts

At Georgia College and State University, more than 10 percent of the on-campus student population has been infected with COVID-19 this semester. Roughly 700 students have tested positive at an institution with fewer than 7,000 students. The college only last month started offering testing for students, so many of those cases were self-reported from students who were tested elsewhere.

But now, after an intense and alarming spike in late August, cases have declined sharply at the college. Though at its height the administration was reporting over 60 student cases per day, now the average of student cases over the past seven days yields a result of less than one.

Damian Francis, an epidemiologist and professor of public health at Georgia College, says that cumulative case count doesn’t matter much at this point.

“This is an example of a university that got it right,” he said.

Francis said that in his interpretation of the data, students arrived at the university from areas with high community spread. An outbreak occurred, but those infections mostly ran their courses and petered out within 14 days.

“I give half the credit to the students,” he said, explaining that students have held back from socializing in large groups and other risky activities.

Other colleges have expected students to arrive with cases and have tried to put in place measures to prevent an outbreak, such as testing all students or asking all students to quarantine for two weeks upon arrival, allowing infections to resolve without causing an outbreak the size of the one at Georgia College.

Francis says those measures would have likely been impossible or unadvisable at the public institution. Mass testing, he said, would strain the state’s capacity to procure and pay for diagnostic tests. Mass quarantines would likely not prevent students from socializing, though he emphasized he is an epidemiologist and not a behavioral psychologist. (At many private colleges, those measures and procedures are in place.)

While some in higher education have maintained that all college reopenings are irresponsible, some health experts, especially those that work for or with colleges, have argued against that pessimism. Reopening colleges is part of reopening society, they’ve said, and case numbers aren’t as important as how colleges are able to manage them.

While some colleges have sent or kept students at home for the semester, Francis joined others in saying that that plan is not necessarily more responsible.

“Students are safer on campus than at home,” he said, explaining that the college has requirements on masking and other measures that students wouldn’t necessarily have at home.

The college has not been offering quarantine housing to most students, only those with nowhere else to go. Many have traveled home to quarantine once they’ve gotten a positive test result. Francis said quarantine housing would likely increase student welfare and make students feel more comfortable but wouldn’t help prevent cases on its own. Bodies such as the American College Health Association have recommended offering quarantine housing for all students.

Georgia College has also continued to hold in-person classes throughout and after the outbreak. Some instructors have complained that they are putting their safety at risk teaching students face-to-face. Francis said he understands the anxiety of his fellow faculty members, especially during the height of the outbreak, and he thinks allowing more instructors to choose online classes would likely put their minds at ease.

The outbreak, he said, was concerning because it was unclear if case numbers would decline or simply continue to rise. But now that cases are once again low, it’s clear that the measures the college has been taking, such as social distancing in classrooms and requiring masks, are working. In comparison to some large, well-resourced institutions, the college has not made huge changes to campus life. But, Francis said, the changes they've made have been enough.

Avery James, an M.F.A. student, undergraduate teaching assistant and member of the employee union on campus, said that she’s grateful for the declining cases, but she is still concerned about the aftereffects of reopening.

“We should still take into consideration that this is a novel virus and that we still don’t necessarily know the long-term effects of this,” she said. “There have been reports of lung scarring and blood clots and cardiac arrest for people that have been perfectly healthy and gotten through it.”

James said she’s also concerned about how the college reopening affected the broader community, including whether students gave the virus to their families when they were sent home or may have infected others in Midgeville, Ga., where the college is located.

Reviews of county-level data have revealed that a college starting in-person classes has been correlated with rising COVID-19 case counts in those counties. Between 1,000 and 5,000 additional cases per day nationwide are likely attributable to colleges reopening for face-to-face instruction, a working paper released on a preprint server from multiple researchers at different universities has suggested.

COVID-19 case data from Baldwin County, where Georgia College is located, does not conclusively suggest that infections on campus drove a larger community outbreak in other demographics. 

Steven Dorman, president of Georgia College, said he agrees with Francis’s interpretations of the data.

“I believe what this is telling us is that our preparations, our continued mitigation strategy and the constant reminders that we are sending out -- all of this appears to be working,” he said via email. “I greatly appreciate the work that the entire university has done to keep themselves and each other safe.”

Dorman added that he believes large off-campus student gatherings also contributed to the August outbreak, but that students have responded well to reminders to keep distant.

On whether mitigation methods that other colleges have used, such as quarantining or testing students upon arrival, would have helped prevent a high cumulative case count, Dorman said the college followed the best advice of public health experts.

“At the time we reopened, the [Centers for Disease Control and Prevention] did not recommend quarantining or testing the entire campus prior to opening. And, it appears that some campuses who were able to have mass testing or require testing prior to coming to campus have not fared much better,” he said via email. “We will leave it to the epidemiologists and to those who study this at CDC to do a thorough analysis of whether quarantining or mass testing could have or would have prevented an outbreak or would in the future.”

Some in higher education and public health have questioned the advice of the CDC, due to revelations about political influence in its public guidance, but the United States at this time has no other federal body offering alternative guidance.

Dorman said he is “not aware” of spread into the community.