It is now clear that welcoming college students back to campuses for the fall semester can lead to Covid-19 outbreaks. Several institutions have reported more than 1,000 cases each. What lessons can colleges and their surrounding communities take from the past month?
To better understand the dynamics of coronavirus transmission at colleges, The Chronicle has tracked case numbers in more than 50 counties that contain four-year colleges with student bodies that make up a significant proportion of the county population. A preliminary analysis reveals the same trend in several places: Anywhere from four to 12 days after students move into dorms, coronavirus cases shoot up in the county. Interviews with officials in local public-health departments suggest the spikes were driven by positive diagnoses among students.
Four to 12 days after students move into dorms, coronavirus cases shoot up in the county.
Where colleges have seen a large number of coronavirus cases among students, leaders should plan as though infection will move into the surrounding town. “A university is such a part of its community,” said Jon Zelner, an assistant professor of epidemiology at the University of Michigan at Ann Arbor who studies how social behavior spreads infectious diseases. “I don’t know that we can draw a clear distinction.”
The Chronicle crunched numbers from USAFacts, a nonprofit group that collates data from the Centers for Disease Control and Prevention and local health agencies. Not all counties tracked by The Chronicle saw a sharp upswing in cases following the return of students. In some counties, colleges’ return dates weren’t closely associated with changes in the direction of cases in the county. But the counties that did see spikes may yield lessons for other campuses that are seeking to contain outbreaks — or for local officials who want to keep the spread from becoming a regional case surge.
Three of those counties — those that house the University of North Carolina at Chapel Hill, Iowa State University, and Washington State University — were particularly instructive.
The Early Returners: UNC and Iowa State
For weeks this summer, the average number of new positive coronavirus cases in Orange County, N.C., hung below 20. In fact, newly reported cases were gently declining in the region, even after the July 4 holiday, which had worried public-health officials. UNC-Chapel Hill, whose students make up nearly a fifth of Orange County’s overall population, began its dorm move-in process on August 3, and average daily cases continued to fall. Until they didn’t anymore.
After August 13, new coronavirus cases began rising in Orange County. Between August 13 and August 27, the county saw 754 new positives, compared with just 139 during the previous two-week period. Many of those additional new cases were most likely students: During that time, the university reported 814 new student cases and 12 new cases among faculty and staff, for a total of 826. The university’s numbers are larger than the county’s because the county doesn’t include students and staff who were tested outside of Orange .
There is “no way to know” how many of the county’s reported coronavirus positives are from UNC, and how many from the surrounding community, wrote Todd McGee, a county spokesman, in an email. But the county does have data suggesting a lot of new cases were among 18- to 24-year-olds, he said.
The fact that UNC’s numbers are so high compared with the county total does point to one silver lining. It suggests that so far, the virus has been mostly contained on the campus. Still, Orange County isn’t out of the woods. “Given that many of the clusters occurred off campus,” McGee wrote, “the concern for possible community spread remains.”
Asked about community spread, UNC’s media-relations office pointed to an open letter “to our Carolina neighbors” that the university posted, outlining how it’s dealing with reports of off-campus student parties, a major route of viral spread.
As long as some students are around, living and socializing in close proximity, they could always be the source of an outbreak, said George Diepenbrock, a communications officer for Lawrence-Douglas County Public Health, whose jurisdiction includes the University of Kansas. The longer it’s been since a university’s students returned, without sparking a town outbreak, “the more hopeful we would be,” Diepenbrock said.
But even several weeks in the clear doesn’t buy local health authorities the peace of mind to relax their attention to spotting and containing infections. For UNC-Chapel Hill, it’s been a month, but “even then,” Diepenbrock said, “it’s likely going to be an ongoing piece of work” to prevent transmission into the community.
By coincidence, Iowa State University also began moving students back into dorms on August 3. Story County experienced a spike in cases around the same time Orange County did.
Les White, Story County’s public-health director, couldn’t say for sure whether a large majority of the recent new cases were Iowa State students, but as in Orange County, Story has data suggesting the new positives are traditionally college-age adults. In addition the county’s case-number tallies have closely tracked the university’s, suggesting that university cases may be a large portion of the county’s overall caseload.
A month after dorm move-in, there’s little evidence to suggest Iowa State’s infections are seeding outbreaks far beyond its students. Still, White said: “There is always that fear that that will happen.” Iowa State students frequently go into the city of Ames. “All individuals are able to go to Target or Walmart or wherever they want to,” she said. The county has set up one major roadblock for the virus: “Our bars are closed, so that is one area where there’ll be less opportunity for spread.”
She said she was hopeful Iowa State’s “very good” program for quarantining positive students will keep the virus contained. “I really feel confident in the measures that they have put into place,” she said.
There’s another major difference between UNC and Iowa State. After seeing coronavirus outbreaks among students in residence halls and Greek houses, UNC announced on August 17 that it was abandoning its plans for in-person classes for undergraduates, and encouraged students to leave the dorms. Students who had tested positive and were already isolating and quarantining on campus were to finish their quarantines. Ten days later, Orange County’s new daily case rate began dropping.
On Wednesday, Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, urged colleges not to send coronavirus-positive students home, lest they spark outbreaks around the country. “It’s the worst thing you could do,” he said during an interview on NBC.
On Monday, Wendy Wintersteen, Iowa State’s president, said she had no intention of going online, Iowa State Daily reported. “While campuswide action is possible, and the university is prepared to change course if necessary, our first steps are to pinpoint areas of concern, and intervene appropriately to mitigate spread of the disease,” Angie Hunt, a university spokeswoman, wrote in an email to The Chronicle.
Meanwhile, Story County’s per-capita daily new coronavirus cases has far outstripped Orange County’s.
Coming on Campus Now: Washington State University
Going all-online may not always be enough to prevent spikes in college towns. Washington State University decided in late July to hold nearly all undergraduate classes remotely, and open dorms only to students who demonstrated need. “At that time we asked students not to return to Pullman,” said Phil Weiler, a university spokesman. “That’s really not what we’re seeing happening.”
Some students returned to off-campus apartments, for which they had already signed leases, just before classes began on August 24. On August 22, Whitman County began seeing a steep rise in coronavirus cases. “It’s safe to deduce these are by and large WSU college students,” Weiler said. He didn’t have up-to-date numbers, but the university has an agreement with the county to do contact tracing for any WSU-related coronavirus positives, so it’s aware of those cases.
For now, the new positives appear confined to young adults, but WSU is sensitive to the risk of wider spread. “Our biggest fear is that it gets beyond the student-age group,” Weiler said. The university is creating mobile testing sites on campus and in two areas where many students live off campus, to try to identify as many student cases as possible. Like other institutions, however, it can’t provide isolation housing for off-campus students. They’ll be told to shelter at home, just like any resident would.
The lesson from Washington State University’s experience, Weiler said, is to be ready for unanticipated cases: “We need to be nimble and respond very quickly.”
“The thing about Washington State,” said Zelner, the Michigan epidemiologist, “is we see increase in transmission, but we don’t necessarily know what that would have looked like under a different set of circumstances. The outbreak could have been that much larger if the students were all in the dorms and more of them had come back to off-campus housing.”
He supported WSU’s choice to go all-online and thus reduce the pressure that students might feel to return to town. It’s clear many wanted or needed to anyway. “I think some of it is inevitable,” he said.
Clear lines of blame can be difficult to draw. About the other examples The Chronicle shared with him, Zelner pointed to counterfactuals that, like WSU’s, are nearly impossible to answer. Would some college counties have eventually sustained similar numbers of coronavirus cases anyway, even if their students hadn’t returned? The cases that have disappeared from UNC’s Orange County — have they been scattered, to seed infections elsewhere?
Not that Zelner doesn’t believe that in-person college operations can contribute to the spread of the coronavirus. “It’s hard to see how you construct a situation where you bring lots of students in close contact with each other and not see increases in transmission, even if everybody is doing ‘the right thing,’” he said.
And the price the community pays may not always be in infections. The county that the University of Michigan at Ann Arbor is in, Washtenaw, hasn’t yet seen a rise in average daily new cases since the university welcomed students back into the dorms on August 24. But Ann Arbor public schools are starting fall entirely online. Zelner’s son will be doing first grade over Zoom.
“That connectivity goes much further than just the uptick in cases. It relates to the choices the community has to make, knowing that these universities are going to open. What would the public-school situation be in different places, but for that? What would the precautions be that people are taking at home?” Zelner said. “The other side of it is, maybe you don’t see much of a rise in the community because people are taking more precautions that they wouldn’t have had to take, or felt that they had to take, but for this happening.”
