Over 5000 colleges and universities in the United States are setting their opening plans for the fall. These plans range from fully online classes and activities, to in-person education with recommended protocols for social distancing and face masks. The variations between these extremes are wide and varied.
For those institutions committed to bring students back to campus for in-person education, which represents 65 percent of all schools (with another 11 percent implementing a hybrid model), plans include widespread and frequent COVID-19 testing, which is critically important to monitor and track the health of the students, faculty and staff. Using contact tracing to limit infection spread is also imperative. With more students compressed onto college campuses, social distancing quickly becomes problematic. Many large public universities were already space challenged, as they increased their enrollments in recent years to address their state financial shortfalls, with dormitory and classroom space expansions still a work in progress. Now, the conflict between space shortages and social distancing is further exacerbated.
Every institution planning for in-person education must ask the following three questions to enhance the likelihood of success.
What is risk? Defining risk as the number of infections amongst students may lead to panic amongst administrators and an accompanying reaction to move classes on-line. If this definition of risk is employed, in-person education is infeasible. Most people, let alone college-age students, find it difficult to rigorously employ the necessary public health countermeasures, like rigorous hand hygiene, social distancing and face masks for extended periods. Institutions planning for in-person education must focus on the appropriate risk, namely, the risk associated with hospitalizations and access to sufficient ICU beds. Ensuring that university communities have health care capacity is critical to manage the limited number of potential poor outcomes amongst students, faculty and staff. No student or university employee should be required to place themselves at more risk than they are comfortable.
At the same time, those willing to assume more risk should be given the latitude to do so. Changing the definition of risk on the fly will create widespread chaos, exposing even more people to unexpected risks. Once an institution defines risk, commit to it, unless overwhelming evidence suggests otherwise.
How can campuses mitigate and manage risk with in-person education? Once risk is defined, institutions that take a worst-case approach will inevitably find themselves on an endless treadmill of running from the COVID-19 risk rather than confronting it. The unintended consequences of such actions include disgruntled students, faculty and staff, and dismayed alumni, with an erosion of the solvency of an institution’s reputation. College age students are highly susceptible to infections, given their lifestyle. As a cohort, when contracting COVID-19 they are also likely to be either asymptomatic or to have mild symptoms. The greatest risk they pose is infecting higher risk groups. Data suggests that the highest risk groups on campus and in the community are those over 65 years of age and those with underlying health conditions (which includes a subset of students). These groups require special attention and consideration However, the needs of these groups should inform, rather than highjack, opening policies and plans.
How can institutions cooperate and collaborate, rather than compete, to support in-person education plans? For most institutions, if not all, spikes in infections among students are inevitable. How will universities respond and how transparent will they be in communicating such data? How will this information impact parents and future students? It is critical that universities be willing to openly share their reopening efforts, widely communicating best practices for the benefit of other schools. Given that the guide for opening campuses is being written in real-time, every institution has a vested interest in everyone’s success. An effective, albeit narrow, opening path for in-person education exists. With so many institutions, one or more are likely to stumble upon it for others to benefit. For this to occur, open communication is critical.
The sooner that we discover the lowest risk path for opening colleges and universities with in-person education, the sooner that such institutions can get back to the business of educating the next generation of citizens and making new discoveries. Higher education has historically facilitated social and economic mobility. At some point, every institution must open their doors to in-person education or place themselves at risk of losing their place at the education table.
This fall, in-person education will be an experiment in risk mitigation, with wide-reaching implications for all.
Sheldon H. Jacobson, PhD, is a founder professor of Computer Science at the University of Illinois at Urbana-Champaign. He applies his expertise in data driven risk assessment to evaluate and inform public policy and public health. His research on risk-based security provided the technical foundations that informed the design of TSA PreCheck. His opinions have appeared in the Washington Post, the New York Daily News, the Chicago Tribune and many others.
Janet A. Jokela, MD, MPH, is the acting regional dean of the University of Illinois College of Medicine at Urbana-Champaign. She has served as an infectious disease and public health consultant throughout her career.