The positive headlines and numbers are enticing. A recent downward trajectory of COVID-19 cases across most of the United States has college leaders asking a tough question: is it time to start easing restrictions on campus?
“I’m definitely aware of colleges in my area that are all discussing this right now, even planning for that eventuality,” says Gerri Taylor, the co-chair of the American College Health Association’s COVID-19 Task Force, which assists college health centers. “Even if they’ve not lessened any of those mandates, they’re considering the what-ifs and are making those plans.”
Several universities have gotten a headstart in lifting some restrictions because of declining case counts and lower numbers in their surrounding communities. The University of Texas opted to bring all of its faculty back from distance learning with numbers improving in Travis County. Ivy League schools Brown, Harvard and Columbia have announced the softening of some protocols.
For Harvard, a reduction in testing announced this week was quite an about-face from its stance two weeks ago, when Executive Director of Health Services Dr. Giang Nguyen warned that “the pandemic is not over” after a surge in cases hit its business school.
But he and Katherine O’Dair, the Dean of Students, wrote in a letter to the community published by the Harvard Crimson that “thanks to your commitment to behaviors that help us lower the risk of transmission, the rate of positive COVID-19 cases in our undergraduate population declined and has remained low.”
Most institutions – from the University of Michigan to Arizona State University to Stanford University – are experiencing drops in COVID cases and almost no hospitalizations, a stunning accomplishment given the much fuller campuses this fall, the packed college stadiums on Saturdays and the lurking delta variant. Even in consistent COVID hotspots, positive cases and hospitalizations are down sharply. Louisiana, Mississippi, Florida and Alabama are all reporting around 50% decreases in cases over the past 14 days. Projections from several models all agree that the likelihood of COVID continuing to wane through March is pretty good.
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So is the continued concoction of tests, masks, vaccines and social distancing still necessary? That still depends on a number of factors that leaders know all too well – cases on campus, cases in the community and other factors such as the number of ICU beds available in area hospitals, which is at less than 15% in some southern states.
“I think it’s very important to take into consideration where your state is, where your college is in terms of vaccination percentages, and number of cases, number of hospitalizations, and certainly number of deaths,” says Taylor, a nurse practitioner and the former Health and Wellness Director at Bentley University in Waltham, Mass. “That data has to be sifted and evaluated carefully. Colleges that are doing this hopefully are doing it based on their particular data in their area of the country. I don’t think we’re ready to change any of our guidelines at this point in time. This is a novel disease, and we just don’t know where it’s going. Are there other variants that are going to take hold? I think it’s taking baby steps.”
Not a one-size-fits-all solution
Despite the overall success of the Northeast in combatting the virus (the bulk of institutions in the region have vaccine mandates in place) upticks in New Hampshire and Maine have forced some like Keene State College to keep restrictions in place. In the Upper Midwest, Minnesota, Michigan and North Dakota all have seen big spikes in the past two weeks. More than a dozen states still have not reached the 50% vaccine threshold, let alone nearing 70-80%. And yet, institutions in some states are seeing no cases or single-digit numbers.
“It depends on the school,” Taylor says. “You can’t just say every school should test X number of times. We have small schools, we have large schools, we have ones that are really well-resourced, ones that are not, ones that have very high vaccination rates that are in states where there are high vaccination rates. Are they safer than areas of the country that have lower vaccination rates? We have to look thoughtfully and not make any precipitous decisions just because another school made a decision. That may be right for them, but it may not be right for every school.”
As institutions experienced from last fall through the summer – with spikes and downturns and the emergence of the delta variant – the one thing they need to be is flexible, especially as they head into a different time of the year.
“Colleges need to be ready to pivot on a moment’s notice,” Taylor says. “It is a concern that we will soon be moving indoors. We’ve been outside all summer and in the fall. The weather has not become cold enough to be having primary activities all indoors. I think we have to watch that and see what happens. None of us has a crystal ball that can tell us whether COVID will increase significantly or continue to wane a bit.”
Taylor notes that one concern is that holidays are coming up fast. Harvard, in fact, made it clear in its new guidance that it would weigh protocols around Thanksgiving.
“I think colleges that have anybody on their campus, whether it’s a small percentage or a large percentage that are unimmunized, their travel home could potentially infect others,” Taylor says. “I think the need for vaccination is critical. And it’s critical right now, because you have to have lead time on this. If students are getting Pfizer, for instance, they get the first injection, they need three weeks for the second one and then two weeks until that’s fully effective. So we’re talking five weeks. We’re almost [to Thanksgiving]. Colleges need to think about that right now. You can’t wait until the week before they go home for Thanksgiving.”
“We’re almost [to Thanksgiving]. Colleges need to think about that right now. You can’t wait until the week before they go home for Thanksgiving.”
Experience matters
Higher education has led the charge nationally during the pandemic by providing robust learning options for students, gathering safely and being able to test and isolate cases quickly. That’s come from the experience of dealing with other major incidents, Taylor says.
“There’s really been no other institutions that have put into place the kind of testing program, the vaccine mandates, the mask mandates that colleges have,” says Taylor, who notes that AHCA’s COVID guidance was borne out of work by Carnegie Mellon University’s Anita Barkin, the other Task Force co-chair, on H1N1 and swine flu in the 2000s. “Why is that? Because we in college health have dealt with outbreaks of illness for many, many years, and critical situations, crises on campus, meningitis, car accidents. We’ve needed to be able to respond quickly and efficiently to those situations. We’ve never been through this before with COVID, but we’ve certainly had a lot of experience in our history of having to deal with stuff like this.”
But COVID has been a tricky game of cat-and-mouse, with recommendations changing and decisions being forced rapidly. Taylor and Barkin have tried to provide a steady hand in crafting guidance that helps institutions make sound judgments. But the difference in demographics, the timing of outbreaks and the sizes of institutions has made one-size-fits-all recommendations a challenge. They’ve changed guidelines three times since they began and likely will continue to tweak them as the pandemic progresses.
“We had a writing team of about 11 experts from all over the country. And then we had people vet those from disparate colleges – small, large, southern, northern, western, Historically Black Colleges, faith-based institutions,” Taylor says. “It has taken an enormous amount of work and attention to detail to do that. But we did give a little bit of leeway: If things are improving, if your data is showing that you’ve had no cases, maybe you want to consider discussing meeting with your public health department, either at the local level, regional level or state level.”
Only then can they make those fateful decisions. Whatever tack institutions take, they should be promoting heavily the one element that may get higher education to that new normal.
“We still believe the more people that are vaccinated on campus, the less risk we’re going to have for COVID, the delta variant, and hopefully, for any future variants that are coming our way,” Taylor says. “This will make the campus a safer place for everyone.”
