After more than a year of restrictions due to Covid-19, people across the country are increasingly growing tired of wearing masks and isolating themselves. So it’s no surprise that as vaccination efforts accelerate, more and more states — against the general advice of public-health experts — are lifting restrictions. The consequence is also no surprise: Covid positivity rates are once again surging.
Higher education is not immune to Covid fatigue. Most colleges are planning to resume in-person instruction this fall, a move supported by most students, who are largely unhappy with an all-virtual learning environment and eager to have a traditional college experience surrounded by their peers.
Many colleges are counting on mandatory vaccination of students — and perhaps faculty and staff members — to reduce the Covid risk on campus. But even though widespread vaccination is, without question, our most effective means of protecting campus safety, few colleges have actually committed to such a requirement. And vaccination hesitancy is real: Thirty-seven percent of adults under 45 say they won’t get vaccinated. While mandates or incentives may accelerate vaccine uptake, we must prepare for the possibility that a significant number of our students and employees will remain unvaccinated in the near term.
Complicating matters is the fact that American colleges are magnets for international students and scholars, and worldwide access to vaccination is predicted to lag behind the U.S. About 1 billion vaccine doses have been delivered, and more than 80 percent of those doses have been distributed to high- or upper-middle-income countries, meaning Covid-19 variants could continue circulating and creating unknown complications even in countries that achieve high vaccination coverage.
So while there’s reason for optimism that the U.S. will achieve herd immunity in the next several months, it’s unlikely that immunity will come in time for the fall semester.
Fortunately, higher education has a bigger collection of evidence-based tools to guide us through a successful return to in-person instruction than we did a year ago. And the most valuable tool among them — vaccination — doesn’t supplant the others that many colleges have thus far deployed with great success in preventing and containing Covid infection while campus density is reduced.
Here’s what we will continue doing this fall at the University System of Maryland, even while resuming “normal” operations. We think other institutions should consider a similar strategy.
Tap in-house experts. As the pandemic spread last spring and our campuses shifted to remote learning and telework, we assembled expert groups to inform critical decisions. Workgroups were focused on key infection-control aspects of our “return to campus” last fall: Covid-testing and symptom-monitoring regimens, physical-distancing guidelines, masking and hand-washing protocols, and deep-cleaning practices. Having epidemiologists, public-health experts, and emergency managers on the workgroups ensured that decisions were evidence based.
In addition, meetings were scheduled several times a week between system leaders and campus presidents and cabinet members. This improved collaborative decision making and sped up systemwide dissemination of information and best practices. Now is the time for institutions across the country to start assembling similar groups for fall-2021 decision making.
Re-densify. Carefully. In the initial months of the pandemic, reducing density on campuses was one of few strategies available to limit Covid spread. Like many colleges across the country, our campuses offered most classes online or in a hybrid format. Dorm rooms were converted to single occupancy. Staff and faculty members were required to work remotely when possible.
Of course, reduced population isn’t a sustainable — or desirable — long-term solution. Students miss the dynamic exchange of ideas that in-person learning provides. They miss the social engagement and sense of belonging that enhances their college experience and improves retention. It’s why many colleges plan to return to full capacity this fall.
But it’s critical that this re-densifying be guided by lessons learned. Colleges should consider their overall vaccination coverage when deciding capacity guidelines. Keeping some courses in a hybrid format or adding course sections can reduce classroom density. Offering grab-and-go meals can depopulate dining halls. And requiring vaccination for residential students can make dorms much safer, even with full occupancy.
As institutions re-densify, tried-and-true prevention protocols — masking, hand washing, limits on gatherings — will be even more important in controlling viral spread.
Make it easy to monitor and report symptoms. In the earliest days of the pandemic — before testing was widely available — our campuses required daily symptom monitoring for early Covid detection. They developed simple, web-based tools that on-campus students and employees used to report CDC-defined symptoms. Positive symptom reports triggered further assessment and referral to testing for confirmation. Quick contact tracing in collaboration with local health departments and implementation of quarantine and isolation protocols contained spread.
Ideally, vaccinations among students and employees will make daily symptom reporting unnecessary, but they won’t fully eliminate the need to monitor for infections, especially as more-communicable Covid variants emerge. At the least, institutions should maintain a passive, easy-to-use surveillance system — one that allows students, faculty, and staff to report Covid symptoms, and that automatically triggers assessment and testing.
Conduct surveillance testing. As last fall approached and molecular tests became more widely available, our campuses incorporated Covid testing into comprehensive plans for a return to in-person instruction. This included testing all students, both residential and commuter, before they arrived. That allowed us to establish a baseline positivity rate against which success in infection containment could be measured.
After arrival, our campuses conducted ongoing surveillance testing of students and employees to identify and respond to outbreaks. This surveillance testing allowed our campuses to remain operational throughout the fall semester, even as Covid positivity rates spiked across the state.
We then adapted our testing strategy in response to the prolonged Covid surge that stretched from the end of the fall semester into the start of spring. Using a combination of molecular and rapid antigen tests, we increased testing frequency — up to twice weekly — capturing at least 50 percent of on-campus populations with each round. Frequent testing with the rapid return of results enabled us to begin this spring semester with known and low campus positivity rates, at the same time that Maryland’s statewide rate had surged above 10 percent. Well into spring, our campus positivity rates remain below 1 percent.
While twice-weekly testing might not be required come fall, colleges should continue surveillance testing of people on campus until herd immunity is achieved, with a priority on those not fully vaccinated.
College students can return to campus safely this fall — if we have sufficient vaccination among students, faculty, and staff, and if we sustain those practices that have gotten us through the worst of the pandemic: routine testing, symptom monitoring, density limits, rigorous disease-prevention protocols, and a commitment to learn from our own public-health and crisis-management experts.
Is it a return to normal? For the universities like ours that have followed these practices for a year, it’s starting to feel that way. But if continued vigilance allows more students back on campus this fall, then that’s a normal we are happy to live with.
