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Regular and frequent testing is the key to reopening safely. My colleagues David Paltiel at Yale and Rochelle Walensky at Massachusetts General Hospital have written about how often this testing needs to happen: two to three times a week. It is the frequency and turnaround time in screening that matter most, not necessarily the sensitivity of test. But even Paltiel and Walensky caution that the best testing strategy will work only if everything else goes according to plan with masks and social distancing. And unfortunately most universities and colleges aren’t doing frequent testing, and close to half of them are not really doing testing at all, even if they are in areas of high prevalence of the virus.
Despite the critical nature of this kind of active disease surveillance on campus (and in fact in managing epidemics in any setting), some have argued that any sort of frequent testing is not only impractical but unwarranted, even counterproductive. The University of Michigan at Ann Arbor’s president, Mark Schlissel, shocked many this month when he suggested that students might use a negative test result to act out and behave badly, thinking they weren’t a risk to anyone. Schlissel then made an unfortunate statement claiming that HIV testing created a wave of infections in the 1980s and ‘90s as gay men decided to abandon safer sex after getting negative test results. It’s one thing to say, look, we cannot test as much as we want, but we feel as if all the other control measures in place will be sufficient to protect our students, staff, faculty, and the surrounding community. But to go down the road of making other kinds of rationalizations, as Schlissel did, is irresponsible.
As we see more and more outbreaks on campuses, university presidents and trustees will run for cover, and these kinds of rationalizations for what they did and did not do are going to come in a torrent. They’ll blame students first and foremost for breaking campus codes of conduct, and bring the hammer down on them. For example, here’s what Donde Plowman, chancellor of the University of Tennessee at Knoxville, said in mid-August: “We will hold you responsible, and it’s possible that you could be expelled from school, and I will not hesitate to do that if our students are irresponsible.”
But who is being irresponsible here? Many are going to blame the Centers for Disease Control and Prevention, as it hasn’t provided anything like real guidance to universities and colleges, let alone elementary and secondary schools, to manage risk. We’ve been abandoned by our political leaders as we head into a dangerous period of the pandemic with Covid-19 potentially colliding with seasonal influenza this fall. If we had a real national commitment to testing, many more colleges and universities would be able to test their students, staff, and faculty members with cheaper, faster antigen-based screening tests, and rely on federal support to help them tackle all the rest of what is needed now to keep us all safe.
Even so, if a college’s plan to manage the coronavirus hangs on the behavior of 18- to 22-year-olds, it isn’t much of a plan at all; it’s a house of cards ready to collapse at a moment’s notice. This isn’t to infantilize our students, but to say that a comprehensive response is more than a signature on a campus compact. In states with still-substantial epidemics, there is not much universities can do to prevent outbreaks. There is too much virus, too many people, and too many opportunities for transmission. Furthermore, without testing frequently, outbreaks in this setting will quickly grow out of control — epidemics follow a pattern of exponential growth, and containing them early is key. It’s hard to make the case that reopening for face-to-face instruction can be done in this situation.
But even in states with low Covid-19 prevalence, the situation can change quickly, particularly as students with parents in tow descend in the millions from across the country onto campuses in the coming days and weeks, reshuffling the local and regional epidemiological realities. As the summer ends and many of us in colder climates move indoors, risk is going to change as well. Thus, making plans for reopening that are based on the nature of the epidemic in July may be outdated in their optimism in October. In the context of a deadly pandemic you hope for the best but plan for the worst, not the other way around. Many colleges and universities have already moved completely online for at least the fall, even in states with relatively low prevalence. Others are taking a gamble that they can do some of the semester in person with some of their students. It’s a wager I hope they win.
I understand what the pandemic has done to education in the United States, to my students, to my colleagues, to the city in which I work and live. I am not carping from the sidelines, just asking for college leaders to put health and safety first, and realize that even doing their best right now might not be good enough to protect us. They’ll need to move quickly when things go wrong, not keep looking around to see what others are doing or delaying a response for weeks to consider their options. But the Pollyannas who want to confidently march us into the new semester should be held responsible for their negligence and accountable for their actions — not the young people who were told they would be safe under their care. Whether it’s a college president, a university’s board of trustees, or a governor presiding over a state system, the buck stops at the desks of those who make the decisions.