President Joe Biden last week declared the COVID-19 pandemic to be over, a historic moment for a nation that has seen nearly 100 million reported cases since 2020 and one million deaths. Vaccinations, boosters and simple herd immunity have for now tempered fears and allowed for much more normal interactions and operations than even a year ago.
For higher education, the pivot back from fully remote to fully reopen has been welcoming this fall. Campus leaders have expressed confidence that even with reductions in protocols and mandates that they will be able to handle potential outbreaks, hardened by 30 straight months of planning, team-building, reacting and finding solutions.
Still, where there’s coronavirus and flu and monkeypox–and a winter ahead–disruption likely will occur. New subvariants continue to emerge, though none yet have stormed in to unseat the prevalent BA.5 and BA.4.6. There is one more on the way, BA.7, though it is unclear whether it will be any more severe than its omicron predecessors. Colleges should continue to keep a watchful eye on developments and heed the guidance of public health officials, especially if a new variant does break through to oust omicron.
Over the past few years, the American College Health Association’s COVID Task Force has been meeting with college health leaders across the country and providing advice to institutions. They’ve leaned largely on the Centers for Disease Control and Prevention guidance in creating their own roadmap for safe reopenings.
With so much change happening in the past few months and with populations seemingly reluctant to get new bivalent boosters, University Business asked Task Force co-chair Dr. Anita Barkin, a nurse practitioner and former head of health services at Carnegie Mellon University, to discuss the latest on COVID and the flu and how colleges should be navigating this very unusual and surprisingly quiet period this fall.
What are you hearing from college health leaders about uptake of vaccines and boosters on campuses with COVID numbers waning?
There is a lack of real enthusiasm for embracing mitigation strategies like masking, vaccine requirements and booster requirements. Most schools we’ve talked to have said we’re going to encourage it and educate people about the availability of the booster, but we’re not going to require it. They are turning it back to individuals to be responsible. One of the drivers I used to hear most consistently is that students are motivated to get vaccines if they feel that they’re going to lose footing academically and if they’re going to miss classes. That may be a hook for them to get the booster and flu shot.
If I were still in my role as executive director of health services, I would be including the opportunity to get the bivalent booster with flu shots. Some schools are doing that. Some other schools are outsourcing their flu clinics and asking if the company can include boosters. One school said if we can’t get it, we’re going to talk with a local Walgreens [to get students appointments] or are asking Walgreens if they’ll do on-campus clinics.
Short of mandates, why should colleges be encouraging students to get boosters now?
If I’ve already gotten the initial series and gotten boosted and haven’t been ill, why wouldn’t I take advantage of a vaccine that now has the two variants that are circulating included? [A new study from the University of Minnesota shows both the efficacy and safety of the new boosters]. But it’s hard to make a case with college students who, by and large, are not having any significant illness. Certainly, there are some reports of long COVID, and you don’t know how it’s going to affect you. COVID has been tricky. I’ve been a nurse practitioner for over 40 years, and I have never seen anything like this, where there’s one unpredictable scenario after another.
One the strongest protections implemented by colleges was robust testing. So why have colleges opted to reduce it?
It’s really about resources. It has been very expensive to do heavy-duty testing and surveillance. Colleges are saying, why should we have robust surveillance if we have people who can test at home? The level of concern, given the severity of illness or lack thereof, is disincentivizing schools from spending a lot of money. And there are ways to do surveillance that are pretty typical of the way that we’ve done it in the past: How many people are showing up in the health service with COVID? How many people showing up are testing positive? Are we seeing a lot of absenteeism? Are local health officials seeing an increase in the severity of disease? What the CDC said, is look at what’s happening in your local hospital. Talk to your local public health people. I have talked to enough schools to know that they are not inclined to start up surveillance testing again.
Another great development were COVID dashboards. Some have remained, but many disappeared. Without them and testing, what should college leaders do if outbreaks occur?
If the school doesn’t have a dashboard or took it down, campus leaders should be communicating to the campus that we are seeing an uptick in cases, and this is how we know that is happening: there have been positive tests, health services are overwhelmed, there is class absenteeism. It’s important that they say, here are our recommendations to decrease your risk–mask wearing, getting the vaccine or booster, remembering to wash your hands and avoiding large gatherings. And they should say, we’ll communicate with you again and give you an update in a week, or five days.
Positive cases have gone down dramatically since the beginning of the year, and the U.S. did well in stretches during the pandemic, but delta and omicron surfaced to change that. How attuned should campus leaders be to emerging variants?
As the chief medical person on campus, I had to understand what public health threats look like. I needed to understand how to develop a response plan, and how to roll out a response to a public health threat. This is not the last novel virus we’re going to see. And this is not the last pandemic. We need to learn from the past so we don’t make the same mistakes going forward. We weren’t prepared for this pandemic. And I wonder if we’ll be prepared for the next one. Should college health professionals be aware of emerging public health threats? Absolutely.
Most colleges developed thorough plans over the past few years, led by COVID teams, some of which have been disbanded. We’ve heard some leaders tout their ability to pivot during crises, with the knowledge that their campus can react because they’ve done it before. However, many institutions have seen sea change in leadership over the past two years. What is the key to responding to new health developments?
You need continuity. Emergency response structures have to be reviewed periodically. They have to be tweaked accordingly, and there have to be tabletop exercises going forward. Because it could happen at any point in time, like meningitis, or H1N1 or COVID. We learned from each one of those experiences, and you need to go back and ask what really went well and what didn’t.