Swab, Spit Or Stay Home? A Wide Variety Of Plans To Keep Coronavirus Off Campus

Yousuf El-Jayyousi, a junior engineering student at the University of Missouri, wanted guidance and reassurance it would be safe to go back to school for the fall semester. He tuned into a pair of online town halls organized by the university hoping to find that.

He did not.

What he got instead from those town halls last month was encouragement to return to class at the institution affectionately known as "Mizzou." The university in Columbia would only be testing people with symptoms. In addition, university officials were saying that people who tested positive off campus were under no obligation to inform the school.

"It feels like the university doesn't really care whether we get sick or not," says El-Jayyousi, who is scheduled for two in-person classes and lives at home with his parents and 90-year-old grandmother.

He'd seen a study from researchers at Yale and Harvard that recommends a more widespread testing approach for campuses. He asked his instructors if he could join lectures remotely once classes begin on Monday. One was considering it; the other rejected the idea.

"It was kind of very dismissive, like 'so what?' " El-Jayyousi says.

But that "so what?" felt enormous, packed with fear and unknowns for El-Jayyousi — and some of the 20 million other students enrolled in some level of postsecondary education in America, if they are not already online only.

In keeping with the uncoordinated national response to the COVID-19 pandemic in other sectors, institutions of higher education have received little guidance, such as a set of suggested standards, from the federal government or anywhere else. They've essentially been left to make their own decisions, so the policies for reopening campuses that abruptly shut in March are all over the map.

Hundreds of colleges still undecided

According to the College Crisis Initiative, a project of Davidson College, a common approach hasn't emerged for responding to the pandemic. Among the 2,958 institutions it tracks, 151 were planning to open fully online, 729 were mostly online and 433 were taking a hybrid approach. Just 75 schools were insisting on students attending fully in person, and 614 were aiming to be primarily in-person. Some 800 others were still deciding weeks before instruction was to start.

The decisions often have little correlation with the public health situation in the region. Although the University of Missouri is in an area of the state that recently experienced a coronavirus surge, the school is holding some in-person instruction and has nearly 7,000 students signed up to live in dorms and other university-owned housing. Harvard, in a region with extremely low rates of viral spread, has decided to put all courses online and is allowing students to defer a year.

The specific circumstances colleges and universities face are as much determined by local fiscal and political dictates as by medicine and epidemiology. It is often unclear who is making the call. Many students must navigate these unknown waters on their own, even as they (or their families) have written tuition checks for tens of thousands of dollars and signed leases for campus and off-campus housing.

The potential risks — physical, educational and financial — may boomerang back on individual students: Two weeks after University of North Carolina students, as instructed, returned to the flagship campus in Chapel Hill with the promise of at least some in-person learning, all classes went online. Early outbreaks at UNC surged from a few students to more than 130 in a matter of days. Most undergrads have about a week to clear out of their dorms.

"It's really tough," neuroscience major Luke Lawless, 20, says. "Chapel Hill is an amazing place, and as a senior it's tough to know that my time's running out — and the virus only adds to that."

Local politics over local infection rates

The education professor behind Davidson's College Crisis Initiative, Chris Marsicano, points to a few big factors driving the extreme diversity of approaches: One is simply the sheer diversity of schools in the United States; another is the tendency of many colleges to follow the leads of more prestigious institutions. State and local politics also play a big role.

"Some states have very strong and stringent mask requirements. Some have stronger stay-at-home orders. Others are sort of leaving it up to localities. So the confluence of politics, institutional ... imitation and different needs that the institutions have are driving the differences," Marsicano says.

Location matters a lot, too, Marsicano adds. He points to urban schools, such as George Washington University and Boston University, where the conditions of the immediate environment are often beyond the control of the school. That's different from places such as the University of the South in remote and rural Sewanee, Tenn.

"It's a lot easier to control an outbreak if you are a fairly isolated college campus than if you are in the middle of a city," Marsicano says, noting that 90% of students will return to the small Sewanee campus.

Student behavior is another wild card since even the best containment plans will fail if college students "do something stupid, like have a massive frat party without masks," Marsicano says.

"You've got student affairs professionals across the country who are screaming at the top of their lungs, 'We can't control student behavior when they go off campus!' "

Another factor is the lack of direction at the federal level. Education Secretary Betsy DeVos has held dozens of calls with governors and state education superintendents, according to the Department of Education. But the main webpage addressing the crisis in higher education offers little national guidance beyond reminders that many paperwork filing deadlines have been extended and other regulatory requirements have been relaxed. Schools are encouraged to distribute basic coronavirus fact sheets from the Centers for Disease Control and Prevention.

Most of the pandemic-related aid dispensed by the department — $30 billion from the CARES Act — is for K-12 schools, with about $13 billion for higher education, including student aid.

A relief package passed by the U.S. House of Representatives included some $30 billion for higher education, but the Senate adjourned on Aug. 13 without taking action on it. A trio of Democratic senators, including Elizabeth Warren, is pushing for mandatory reporting of coronavirus case numbers on college campuses.

Campus communities with different levels of contagion are making opposite calls about in-person learning. The University of Missouri's Boone County has seen more than 1,400 confirmed coronavirus cases after a spike in mid-July. According to the Harvard Global Health Institute's COVID-19 risk map, Boone has accelerated spread, with 14 infections per day per 100,000 people. Two neighboring counties were in the red zone recently, with more than 25 cases per day per 100,000 people.

At such rates of infection, the institute advises stay-at-home orders or rigorous testing and tracing. But the University of Missouri, in addition to allowing students to live on campus, is also taking a hands-off approach to instruction. Officials have left the decision in the hands of deans, many of whom are letting departmental chairs or even individual faculty members decide whether to hold classes in-person or remotely.

Meanwhile, Columbia University in New York City opted for all online instruction, even though the rate of infection there is a comparatively low — 3.8 cases per day per 100,000 people.

Administrators at the University of Missouri considered, and rejected, mandatory testing. "All that does is provide one a snapshot of the situation," University of Missouri System President Mun Choi said during one of the town halls.

The university has an in-house team that will carry out case investigation and contact tracing with the local health department. On Monday, following questions from the press and pressure from the public, the university announced a reversal: Students will now be required to report any positive coronavirus test, even if obtained off campus.

Colleges must choose whom to test and how often

CDC guidance for higher education suggests there's not enough data to know whether testing everyone is effective, but some influential researchers, such as those at Harvard and Yale, disagree.

"This virus is subject to silent spreading and asymptomatic spreading, and it's very hard to play catch catch-up," says Yale professor David Paltiel, who studies public health policy. "And so thinking that you can keep your campus safe by simply waiting until students develop symptoms before acting, I think, is a very dangerous game."

Simulation models conducted by Paltiel and his colleagues show that, of all the factors university administrators can control — including the sensitivity and specificity of coronavirus tests — the frequency of testing is most important.

Paltiel says he's "painfully aware" that testing everyone on campus every few days sets a high bar — logistically, financially, behaviorally — that may be beyond what most schools can reach. But he says the consequences of reopening campuses without those measures are severe, not just for students, but for vulnerable populations among school workers and in the surrounding community.

"You really have to ask yourself whether you have any business reopening if you're not going to commit to an aggressive program of high-frequency testing," he says.

The Fighting Illini move aggressively on testing

Some institutions that desperately want students to return to campus are backing the goal with a maximal approach to safety and testing.

About a four-hour drive east along the interstates from the Missouri school is the University of Illinois at Urbana-Champaign, whose sports teams are known as the Fighting Illini.

Already, large white tents with signs reading "Walk-Up COVID-19 Testing" have popped up across campus; there students take a simple saliva test.

"This seems to be a lot easier than sticking a cotton swab up your nose," graduate student Kristen Muñoz said after collecting a bit of her saliva in a plastic tube and sealing it in a bag labeled "Biohazard."

In a few hours, she got an email telling her to check her result online: negative.

The school plans to offer free tests to the 50,000 students expected to return this month as well as some 11,000 faculty and staff members.

"The exciting thing is, because we can test up to 10,000 per day, it allows the scientist to do what's really the best for trying to protect the community as opposed to having to cut corners, because of the limitations of the testing," says University of Illinois chemist Martin Burke, who helped develop the campus's saliva test. The test received emergency use authorization this week from the federal Food and Drug Administration.

The test is similar to one designed by Yale and funded by the NBA, which cleared the FDA hurdle just before the Illinois test. Both Yale and Illinois hope aggressive testing will allow most undergraduate students to live on campus, even though most classes will be online.

University of Illinois epidemiologist Becky Smith says they are following data that suggest campuses need to test everyone every few days because the virus is not detectable in infected people for three or four days.

"But about two days after that, your infectiousness peaks," she says. "So, we have a very small window of time in which to catch people before they have done most of the infection that they're going to be doing."

Campus officials accepted Smith's recommendation that all faculty, staffers and students participating in any on-campus activities be required to get tested twice a week.

Illinois can do that because its test is convenient and not as invasive as a test using a nasal swab. That means the campus doesn't need swabs, or as much personal protective equipment as it would otherwise need to collect and process the more invasive tests, Burke says. Analyzing the samples on-site at campus labs also avoids the backlogs occurring at public health and commercial labs.

As colleges roll out plans, students mourn what would have been

Most other colleges fall somewhere between the approaches of Missouri and the University of Illinois, and many of their students are still uncertain how their fall semester will go.

At the University of Southern California, a private campus of about 48,500 students in Los Angeles, officials had hoped to have about 20% of classes in person — but the county government scaled that back, insisting on tougher rules for reopening than the statewide standards.

If and when students are eventually allowed back, they will have to show a recent coronavirus test result that they obtained on their own, says Dr. Sarah Van Orman, chief health officer of USC Student Health.

They will then be asked to do daily health assessments, such as fever checks, and those who have been exposed to the virus or show symptoms will receive a rapid test, with about a 24-hour turnaround through the university medical center's lab. "We believe it is really important to have very rapid access to those results," Van Orman says.

At California State University — the nation's largest four-year system, with 23 campuses and nearly half a million students — officials decided back in May to move nearly all its fall courses online.

"The first priority was really the health and safety of all of the campus community," says Mike Uhlenkamp, spokesperson for the CSU chancellor's office. About 10% of CSU students are expected to attend some in-person classes, such as nursing lab courses, fine art and dance classes, and some graduate classes.

Uhlenkamp says testing protocols are being left up to each campus, though all are required to follow local safety guidelines. And without a medical campus in the system, CSU campuses do not have the same capacity to take charge of their own testing, as the University of Illinois is doing.

For students who know they won't be on campus this fall, there is sadness about losing the social experiences, networking opportunities and hands-on learning so important to college.

But the certainty also brings relief.

"I don't think I would want to be indoors with a group of, you know, even just a handful of people, even if we have masks on," says Haley Gray, a 28-year-old graduate student at the University of California, Berkeley starting the second year of her journalism program.

She knows she won't have access to Berkeley's advanced media labs, or the collaborative sessions students experience there. And she says she realized the other day she won't be able to sit around the student lounge and strike up unexpected friendships.

"That's a pretty big bummer, but, you know, I think overall we're all just doing our best, and given the circumstances, I feel pretty OK about it," she says.

This story is part of a reporting partnership that includes Kaiser Health News, KBIA, Illinois Public Media and Side Effects Public Media.

Copyright 2020 Kaiser Health News. To see more, visit Kaiser Health News.