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Posted on July 23, 2020 at 1:42 PM

by Craig Klugman, Ph.D.

Since mid-March I have been part of my university’s response to the COVID-19 pandemic. At first, I served on the “Response” task force and that transformed into our “Re-Opening” group. I’ve been working on how do we safely have students in dorms, bring people up and down the elevators in the downtown towers, enforce a mask ban, how to do contact tracing, and more. After months of working on the minutiae of having people on campus I have come to one conclusion, we should not be bringing people back to campus.

Back in March, my university gave 48 hours’ notice to move final exams online and teach the entire Spring Quarter “remotely”. That announcement on March 11, was when Chicago had 2 new cases (20 tests), no deaths, and a positivity rate of 3.4%. Given the spread happening in NYC and Seattle, we chose to go online for the rest of the year. For the prior week we had increased hand washing and were tapping feet or bumping elbows instead of shaking hands, and followed the recommendation against wearing masks (to preserve them for health care workers).

Today (July 22) as we look toward opening, Chicago reports 227 new cases (4,787 tests), 3 deaths, and a positivity rate of 4.7%. We are staying 6 feet away from people (forget about foot taps anymore). We have more cases, more deaths, and a higher positivity rate than when we closed but are now asking people to run into a building where the fire burns hotter than before. Cases are rising in 40 states and hospitalizations are rising in 39, with several having exhausted hospital ICU capacity.

Certainly, we know more now about COVID than we did then. Whereas we thought the virus could only travel on large respiratory particles, the latest recommendations say that they may travel on small particles, linger in the air, and travel through air systems. We have a better idea of what drugs do not work, that ventilators are often not the best option, and that we should all be wearing masks (or cloth face coverings) except when alone. But there is still a great deal that we do not know. There are some promising vaccines but we don’t have one yet. In some states we are better at tracking cases, but in other states (and the federal government) case counts have been removed or are hidden from the public. Lack of testing (limited supplies, broken supply chain, lack of reliability and accuracy in tests) means we are likely undercounting the spread of this disease and the deaths it has caused.

Others have argued that returning to campus is necessary for institutions’ financial well-being, for the missions of teaching and research, and that some level of spread is personal responsibility and can’t be avoided. But examples of bringing people together in closed spaces on campuses this summer have led to outbreaks including school athleticsfraternities [see also here], and so-called COVID parties

A recent essay in Inside Higher Ed, discusses an instructor’s anxiety, fear, and stark reality of teaching face-to-face. Despite our greatest hopes, it is not anywhere close to what we are used to. There’s no group work, no students working together, no wandering around the classroom as students work independently. There’s a lot more policing and being prepared for the class moving online at any time if someone in the class has a positive test (we can control, to an extent, behaviors on campus, but can’t do that when students are off campus).

OpenSmartEdu is a guide to re-opening universities drafted by several institutions. The guide offers seven trigger warnings for when campuses should be closed.

  1. Significant transmission on campus
  2. Significant transmission in local community
  3. People disregarding face coverings and physical distancing
  4. Insufficient availability of testing
  5. Insufficient healthcare capacity
  6. Insufficient space for appropriate isolation and quarantine of students living on campus
  7. Local/State/Federal mandates

How many of these trigger events already exist in your campus? Mine meets five of them (2. Our local neighborhood has seen a surge and is a hotspot in the city among 18-29-year olds); 4. People are being turned away from testing and getting results is taking up to 18 days; 5. Student health services are very limited; 6&7. With our travel ban, we may not have enough rooms to quarantine all students who need to do so before classes begin), or once athletes start practicing together. Plus, our table top exercises about having to ask people to quarantine if there is a single residential student with a positive test (themselves in isolation; roommate in separate quarantine; everyone who uses that shared bathroom; everyone in each of their classes (although technically people will be six feet apart in face-to-face classes, our summer experience in contact tracing shows that everyone in the room will be nervous and parents will make calls demanding quarantine for everyone).

The argument has been made that even if our student populations are infected, they have a low mortality rate. Low is not zero. And some aspects of a COVID infection resemble a clotting disease-causing strokes, heart disease, lung failure, plus problems with liver and kidneys and chronic fatigue in people surviving. If students do become infected (and remember that you shed virus for 2 days before having symptoms), their parents, grandparents, and immunocompromised friends could get the virus. This is not to mention infecting staff and faculty (the average age for US university faculty is 55).

A new letter organized by U.S. PIRG is signed by many leaders in public health and bioethics urging a return to a total shutdown across the country (and banning interstate travel) to reduce transmission and do things correctly this time around. Many campuses are moving away from previous decisions to open and are beginning the year online (Spelman, Morehouse, Clark Atlanta, UC Berkeley, Dickinson, Emory, Occidental, Southern California, and more) though nationally, campuses are about evenly split on whether they are online, in person, primarily online, or primarily in person.

Much of what I’ve written applies mostly to baccalaureate, academic graduate, and didactic programs. For medical, nursing, and health profession’s students in the clinic, the risk/benefit ratio may weigh differently. That’s an analysis for another blog.

Other countries are planning to re-open schools and universities. They have done so in places where mask wearing was prevalent, where adequate testing and reasonable return times existed, and where community spread (number of new cases, hospitalizations, and positivity rates) was low. The United States currently does not meet these conditions. So, yes, while theoretically safer for them to open, the reality is that an attempt in Israel, which had the disease spread under control, immediately led to a new outbreak and closing all the schools down again. The U.S. isn’t even close to being able to open and keep students, faculty and staff safe. Their lives are worth more than any benefit from meeting in person.

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