College campuses are coronavirus breeding grounds. They don’t have to be.
In the last weekend of August, officials in the city of Columbia — home to the University of South Carolina — broke up a pool party where more than 200 college students were packed into a courtyard. “It was like Mardi Gras,” the fire chief told a local paper. “Nobody was practicing social distancing. Nobody was wearing a mask,” despite a local ordinance requiring so. “That was just the perfect storm to spread the virus,” he later said.
Over the next few days, the university registered more than 435 new Covid-19 cases. Other illegal parties near the campus, including many held by fraternity and sorority houses, likely also contributed to the spike in cases at the school, which has approximately 35,000 students enrolled this fall (in a mix of in-person, online, and hybrid classes).
Since the start of August, the University of South Carolina has reported more than 2,300 student Covid-19 cases. And it is not alone. There were more than 178,000 estimated coronavirus cases on more than 1,400 college campuses across the US as of October 8, according to a New York Times tracker.
Most universities are employing familiar, evidence-based measures to fight the coronavirus: distancing, testing, tracing, and isolating. But the rollout of these policies — and their success in fighting outbreaks — varies widely from school to school.
At some schools, all students must get tested at least once a week if they want to remain on campus. At others, even students with Covid-19 symptoms have difficulty getting tested at all. Some schools are providing single-occupancy rooms for students who should quarantine after being exposed to the virus, while others send students back to their dorms to wait to see if they get sick.
University officials acknowledged to Vox that they cannot prevent every risky party. But whether a party sparks a large outbreak or a small one comes down not just to students’ behavior, but also the school’s Covid-19 systems that are already in place.
The task of controlling infections doesn’t just affect students either. Cases can move through staff and the community at large, especially with many students living off-campus, where rules are difficult to enforce.
“Universities and colleges are not islands unto themselves, and they exist in their communities,” says Crystal Watson a public health risk expert at the Johns Hopkins Center for Health Security. She says that infections among students are “essentially feeding cases in the community.” Indeed, many towns with the highest rates of Covid-19 as the fall semester got underway were those that house large universities.
So how can universities do their best to support students wanting to do the right thing, and also help nudge others into line? Let’s take a look at how various schools are handling the key pillars of limiting Covid-19 spread, what seems to be working — and what doesn’t.
Sizes of in-person classes vary widely, as does the density of students allowed in on-campus housing
We’ve known since early in the year that keeping people physically distanced is one of the best ways to limit spread of the coronavirus, which is why universities sent nearly all of their students home midway through the spring semester.
Over the past two months, however, millions of students have returned to the majority of campuses across the US — campuses where, for the most part, in-person social gatherings are limited and masks are required.
But the similarities often end there. Although most schools have increased their offerings of online coursework, the number and sizes of in-person classes vary widely, as does the density of students in on-campus housing.
Simply having fewer students on campus naturally reduces the number of contacts students could have. It’s a sort of passive control strategy — and an important one.
“That’s where we’re seeing the biggest outbreaks, where administrations brought all of the students back — or many of the students back,” Watson says.
At the University of Alabama, for example, only about 15 percent of their 38,000 students enrolled in distance learning for the semester. And residence halls are mostly full. “We are about 90 percent capacity for our on-campus beds, a percentage on par with recent years,” Deidre Stalnaker, director of the university’s communications, wrote to Vox in an email.
Between August 1 and October 1, the school listed more than 2,500 Covid-19 cases on their main campus, which has been among the top 10 universities with the most reported cases, according to data collected by the New York Times. (Keep in mind that comparing numbers of positive tests across universities can be problematic because some are testing more widely than others. And a smaller school might have higher rates of the virus but among fewer students overall.)
When on-campus housing is close to normal capacity, students often have roommates, shared bathrooms, and other opportunities to unwittingly spread the virus. Large numbers of students also mean more people frequenting other common areas on campus and off, adding to each student’s potential contacts. So these schools will need more testing, tracing, and isolation and quarantine resources if and when outbreaks start.
Early outbreaks at some schools prompted administrators to abort their on-campus learning plans altogether. At the beginning of the semester, for example, the University of North Carolina Chapel Hill, which usually has about 30,000 students, brought many back to campus and had dorms at about 63 percent capacity, with a mix of single and double rooms, the Washington Post reported. But classes were only in session for nine days before a spike in the test positivity rate to 13.6 percent prompted the school to abruptly end all in-person undergraduate instruction.
Johns Hopkins University, where Watson works, is keeping almost all of its students remote for now. “There are obviously massive tradeoffs here,” she says. But “leaning toward more conservative has been better.”
Other schools have brought back only a fraction of undergraduates, restricting on-campus presence to students who truly need to be there for housing or academic reasons. Watson suggests universities “focus on having the students on campus who really need to be there because classes they need have hands-on activities,” for example, she says.
This is an approach the University of Washington is following, which started its fall quarter on September 30. About 90 percent of their classes are virtual, saving in-person learning for things such as health care training, biological research labs, and the like that aren’t possible to do virtually, notes Geoffrey Gottlieb, an infectious disease specialist at the University of Washington’s School of Public Health who is also chair of the school’s advisory committee on communicable diseases. And the university is keeping its residence halls to about one-third of normal capacity, ensuring students have single rooms and single bathrooms. (Although this has not prevented the spread of the virus off campus, where there have been recent outbreaks at fraternity and sorority houses.)
This on-campus de-densifying is important for reducing opportunities for transmission overall, Watson says. “This virus spreads really readily, so even one mistake can cause an epidemic,” she says. Especially if other measures aren’t in place to detect and stop it.
Some schools have made testing mandatory, while others have left it voluntary
Testing for the coronavirus is essential for tracking its spread and knowing when additional containment measures should be put into place. Undetected cases of Covid-19 on campus mean that there is no way to give these infected students and their contacts instructions about quarantine and isolation, allowing the virus to spread further, especially among those with mild or asymptomatic cases.
But on some university campuses, it hasn’t always been easy for students to get tested.
For example, the University of South Carolina stopped its saliva-based testing program for more than four days (including Labor Day weekend) due to an ill staff member. At the time, the school had already confirmed more than 1,000 Covid-19 cases.
Breaking: @UofSC now has 1,017 active student cases of COVID-19 and 9 employee cases. The total of 1,026 is double last week’s 557 cases. Article to come.
— The Daily Gamecock (@thegamecock) September 1, 2020
When testing resumed, instead of the previous 1,200 saliva tests they had been able to process each day, the university could only run about 200 tests (although the school notes that they have also been able to offer nasal swab tests for people with symptoms). That number has slowly climbed back up to 1,000 tests per day in the past month. But getting one of those scarce tests was not always easy for students.
A sophomore there, Kailey Cota, told Vox that in mid-September on-campus testing had only been available in a two-hour window, Monday through Friday. “For me, personally, it’s a problem — a lot of students have class during that time,” says Cota, who is also assistant news editor at the student-run newspaper. (Testing availability has now been expanded to up to 10 hours a day, depending on the day, rotating through different locations.)
Cota has also heard rumors that some students who develop symptoms intentionally choose to get tested for the virus off campus — “that way the numbers for USC don’t go up, and they don’t close campus,” she says.
Testing at the University of South Carolina is also entirely voluntary, as it is on many campuses. Cota says that if a student is contacted by contact tracing and “told to get tested, that’s all on the honor system. They cannot force us to get tested.” (Many schools are hemmed into voluntary testing because of state guidelines, notes Gottlieb.)
A spokesperson for the school notes that it now has more tests available than it can find students to take them. “Next week we are launching new incentives for students to get tested on a randomized basis — [with] free T-shirts [and] the chance to win prizes — in order to combat testing fatigue and help us better understand the spread of the virus,” Jeff Stensland, the University of South Carolina’s director of public relations, wrote to Vox in an email over the weekend. “We have seen that our capacity is outpacing demand for testing, which is part of the reason we’re offering the incentives.”
The University of South Carolina has now reported more than 2,300 student cases — of about 19,700 student tests — between August 1 and October 1 (a more than 10.5 percent test positivity rate over two months). In the last week of September, however, the university was averaging only about 265 daily student tests, about four of which were positive each day.
Based in part on this low number of detected cases, the school marks the current campus status as below a low-risk level: a green “new normal.” (Which is difficult to determine based on how few students had been getting tested on campus.) On September 10, Deborah Birx, the leader of the White House coronavirus task force, visited the university and recommended additional surveillance testing on campus (which is part of the school’s new efforts to expand test availability and entice students to use it), as well as sending a government team to provide additional testing for the city of Columbia.
Experts note that a broad testing approach is crucial. “Schools that have done the best so far have had a layered testing strategy,” Watson says. Specifically, they have tested everyone when they arrived on campus for the semester (or required proof of recent negative test), they test anyone with symptoms or known positive contacts, and they have broad ongoing surveillance testing for people without symptoms.
But testing is not a full Covid-19 strategy in itself, as the White House outbreak also shows. Testing is just a window to look through to observe the virus’s spread — and see if mitigation efforts need to be stepped up, Watson says. Which is what some schools, such as the University of Illinois, have done.
The University of Illinois created an ambitious campus testing program, requiring every on-campus student to get tested at least twice a week with the school’s rapid saliva test. (The school has conducted more than 466,000 Covid-19 tests since early July.)
However, just several days into the semester, it detected 320 new cases in a single day, bringing its campus-wide test positivity to almost 3 percent (because of universal regular testing, this was close to the true campus infection level). The next week, administrators put the campus on lockdown for two weeks.
The lockdown drastically slowed case spread; the test positivity rate has stayed below 1 percent since early September (and is currently at approximately 0.2 percent). And the university continues to conduct more than 10,000 tests on a typical day to monitor for new outbreaks.
5. “But they had to take more drastic steps, and reduce on-campus activity!”
Indeed they did. And a week ago they started relaxing again, without ill effect yet. Surveillance and rapid response are part of any reasonable plan. That they did this and it worked was a huge success.
— Carl T. Bergstrom (@CT_Bergstrom) September 22, 2020
“The University of Illinois has been a model program,” Gottlieb says. Widespread surveillance testing can catch these outbreaks “before they get completely out of hand,” he says, prompting effective scaled-up containment strategies.
The delicate task of contact tracing on campus
Manual contact tracing, the type the US has been using to track potential Covid-19 cases, has been a challenge even among non-college adults, many of whom have been reluctant to give the names of friends or the businesses they have frequented. Translating this approach to college students has been particularly difficult.
Which makes sense. If you’re a college student who has been casual with the school’s Covid-19 rules around in-person gatherings, would you admit it — and name your close friends who have as well? Especially if this means you all might end up isolated in quarantine for two weeks?
#UNC sent a warning to Greek orgs after learning some members were intentionally not reporting positive COVID results, and were refusing to comply with contact tracing. Now there’s added concern from other students and community members because frat parties continue. Story at 5. pic.twitter.com/TuupHObzVq
— Sarah Krueger (@WRALSarah) September 14, 2020
Universities have some leverage because they can require students to at least agree on paper to comply with tracing as a condition of their return to campus, Watson points out. (Many schools, including Ohio State University, have included this in their student Covid-19 pledge, for example.)
However, it doesn’t make the calculus of compliance much easier. “There are lots of disincentives [for students] in reporting exposures or cases,” Watson says. “I think schools have to be creative and help students manage their way through this and try not to be punitive because that does not engender trust.”
But many schools are taking the punitive route. The University of Alabama, which had more than 2,000 student Covid-19 cases three weeks into its semester, announced that it was issuing more than 600 Covid-19-related sanctions to students, including 33 suspensions. Many other schools have been meting out disciplinary measures to students who break Covid-19 rules, including, more recently, Iowa State University and the University of Colorado.
“That’s a delicate balance,” Gottlieb says, in “trying to dissuade that behavior, but also we don’t want folks to not report and not get tested. I don’t know if anyone has the perfect answer.” The University of Washington, where he works, has told students that it will not use tracing information to discipline students, in an effort to encourage them to participate.
At the University of Illinois, one of the reasons cases started to spike at the end of August, university experts determined, was that modelers failed to take into account students’ reluctance to comply with contact tracing.
Physics professor and university Covid-19 response modeler Nigel Goldenfeld noted in an online discussion, “What’s not in the model is that students would fail to isolate, that they would not respond to efforts to reach them by [contact tracers], that they would go to a party even if they knew they were Covid-positive,” the Daily Illini student newspaper reported.
— XKCD Comic (@xkcdComic) September 4, 2020
Additionally, some Illinois students were not entering correct data into their symptom-tracker app (these are being used widely on campuses but also have mixed incentives for students to fully comply).
Even for those with the best of intentions, it can just be difficult to remember who you have been within 6 feet of for at least 15 minutes, especially on a busy college campus where many people are strangers.
This was true even when most college students were at home. Back in April, “we found that participants could not always precisely recall who they had been within six feet of,” Alison Cohen, an epidemiologist at Stanford University’s School of Medicine, who has conducted nationwide surveys of undergraduate behavior during the Covid-19 pandemic, wrote to Vox in an email. “This will likely be even more difficult as students are more mobile this fall.”
Not all universities have been able to provide comfortable housing promptly for isolating and quarantining students
Isolating people with Covid-19 from others is an essential step for stopping the spread of the virus. Quarantining people who might have the virus — because they had close contact with someone confirmed to have it — is also crucial. But not all universities have been able to quickly provide comfortable housing for isolating students.
Alex Bransteter, a sophomore living on campus at Ohio State University, posted on Twitter about his disappointment in the conditions of his quarantine room at the school, where there had already been more than 2,600 positive student Covid-19 tests in mid-September.
“My A/C has black speckles on it, the room was very dusty, weird stains on the walls, and the window couldn’t open,” he wrote to Vox in an email from his room. (Administrators at the university said that they can move students in quarantine or isolation to new rooms if they alert staff of any issues, and that the windows in that particular high-rise building were designed to not open.)
At the University of South Carolina, some students have been isolated in a dorm that was slated for demolition soon, Bates West. “I’m sure students wanted to avoid going there,” Cota says. “Bates West was one of the grossest dorms on campus.” As one student who was sent there told Vice, “the building was musty and dusty, and the AC didn’t work.” Other students in quarantine or isolation at the school complained of poor wifi that led to disruptions in their virtual classes.
These sorts of unappealing accommodations at some schools (which get shared readily on social media) are not adding any incentives for students to comply with voluntary testing or contact tracing.
“Institutions of higher education should make the isolation experience easy and affordable and an acceptable alternative to how students would otherwise spend their time,” Cohen says. Additionally, she notes, students in isolation or quarantine should be offered benefits such as paid sick leave from work if they don’t already have it.
Schools can also help students prevent further spread of the virus by using the different strategies of isolation and quarantine most effectively. Students who have tested positive for the virus can isolate together, potentially opening up additional on-campus housing space. However, the same is not the case for people told to quarantine. “Students should not be quarantined together if they’ve been exposed,” Watson explains. “Then you run the additional risk of passing the virus along.”
Some universities are offering up individual quarantine options for students who live on campus. For example, the University of Texas, with assistance from the City of Austin, has made free hotel rooms (with wifi and food) available to these students so they can safely quarantine away from others.
But individual quarantine is a big hurdle for many schools. “This makes it really hard for colleges and universities because that requires a lot of single-occupancy rooms,” Watson says, especially schools that have brought back a large portion of their students.
Students could also conceivably be put into single-person quarantine, for two weeks at a stretch, multiple times throughout the semester as they come into contact with different people who test positive, perhaps even adding another disincentive for contact compliance.
“For college students, 14 days is a long time to be without close physical contact with your social group,” Leah Brunner, a graduate student at the Colorado School of Public Health who studies mental health and has been working with undergraduates this semester, wrote to Vox in an email. This sort of isolation also carries additional social stigma on some campuses, she says. “Many students feel shamed.”
For students who live off campus, which is frequently the majority of the student body at large universities, there is also often little schools can do to encourage proper quarantining or isolation practices, other than supply information and recommendations, and possible threats of discipline.
— CBS News (@CBSNews) September 11, 2020
On campus, the New York Times has reported that some schools have deployed nurses, security guards, or police to help students adhere to the rules while they are in isolation or quarantine.
“The key is sharing the responsibility”
Plenty of students see what their institutions could be doing better to help them help their school’s efforts. There are some very basic improvements that Cota sees her school, for example, could make to help decrease the spread of Covid-19 around campus. She lists: expanding the hours for testing, improving the communications from campus health officials, and trying to make quarantine and isolation stays better.
“Students were the one to put the blame on in the opening weeks,” Bransteter, the Ohio State sophomore, said. “But it was the plans put in place that were completely not ready for 30,000+ students to come on campus. … The university put forward a lackluster plan for the school year and had to adapt simultaneously with us students. Personally, every week contributed to the anxiety of contracting Covid-19.” Ohio State has now reported more than 2,900 cases (but has an overall test positivity rate of less than 3 percent from more than 109,000 student tests since mid-August).
To be sure, everyone has a role to play in managing Covid-19 on university campuses. “The key is sharing the responsibility,” Watson says. “It shouldn’t be all students’ responsibility to follow all these rules and stop outbreaks — these are college kids, and it’s not totally realistic. I think leadership has the responsibility to manage risk, to have fewer students on campus, to manage outbreaks before they occur,” she says.
Despite widespread media coverage of parties, the majority of undergraduates are doing their part to follow their school’s rules — and sometimes even doing more than they are asked.
Cohen and her colleagues found that undergrads have often gone above and beyond local health recommendations, for example having restricted their contact with others even before stay-at-home orders were issued in the spring. And universities should be sure to support the students who choose to be extra cautious, she says. “All colleges should make it possible for students who make more conservative risk calculations than the institution to nevertheless be able to participate actively in coursework and other activities throughout the Covid-19 pandemic,” Cohen says.
But as universities strive to keep Covid-19 from spiraling on their campus, “any ideal Covid-19 containment strategy would likely require a lot of resources,” Cohen says, whether that comes in the form of low-density housing, widespread surveillance testing, robust contact tracing, additional accommodations for quarantining students, or other offerings.
“This [question of campus resources] could become another axis upon which inequalities widen during the Covid-19 pandemic,” she notes.
Katherine Harmon Courage is a freelance science journalist and author of Cultured and Octopus! Find her on Twitter at @KHCourage.
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Author: Katherine Harmon Courage