How 5 universities tried to handle COVID-19 on campus

One year into the COVID-19 pandemic, we know the SARS-CoV-2 virus spreads easily through large indoor gatherings and communal living spaces. A person can become infected, spread the virus to friends, family, teachers or coworkers, and then start exhibiting symptoms several days later — or never show any signs of infection.

With these kinds of risks, a college campus seems like one of the more dangerous places to spend time. In fact, U.S. counties with large colleges or universities that offered in-person instruction last fall saw a 56 percent rise in COVID-19 cases in the three weeks after classes began compared with the three weeks before. Counties with large schools that offered only remote learning saw a drop in cases of almost 18 percent, researchers from the U.S. Centers for Disease Control and Prevention reported on January 8 in Morbidity and Mortality Weekly Report.

Universities that opened their campuses in August and September faced an uncharted, months-long experiment in infection control. They had no manual, no surefire way to keep students and staff from getting sick.

Science News took a look at five universities that opened in the fall. Each school cobbled together some type of testing at various frequencies coupled with uneven rules about wearing masks and public gatherings.

For testing, all five schools used polymerase chain reaction, or PCR, tests, which are the gold standard for diagnosing COVID-19. Results can take days, however, when demand for tests is high (SN Online: 8/31/20). One school also used a test called loop-mediated isothermal amplification, or LAMP, which, like PCR, measures viral DNA to identify infections. LAMP is less sensitive than PCR, but results come in much more quickly since there’s no need to send samples to a laboratory.

Antigen tests, which detect proteins from the virus and also give rapid results, helped one school move students quickly into quarantine, even though those tests have a higher rate of false-negative results. One school additionally set up wastewater sampling at dorms to pick up early signs of outbreaks.

“Colleges are high risk, but also exactly where innovation can happen,” says Pardis Sabeti, a computational geneticist at the Broad Institute of Harvard and MIT, which worked with more than 100 colleges and universities on their COVID-19 mitigation strategies.

One example of such innovation, she says, is universal student use of phone-based apps for symptom monitoring and contact tracing. Student engagement and leadership was also key to successful outbreak control, Sabeti says. Several universities recruited students as health ambassadors to promote safe behavior; at one school, a student panel meted out punishments to their peers who broke the rules.

Four of the five schools profiled here faced at least one outbreak during the fall, but none sent students home before Thanksgiving break. As spring semester gets under way, and universities bring even more students back to campus, the experiment continues.

“Most schools have had very unsuccessful [fall] semesters,” Sabeti says. To do a better job in the spring, she suggests that schools double down on public health measures and civic engagement with both students and broader communities. At the schools profiled here, student involvement seemed to be an important part of control efforts. Several of the schools are adding new strategies as case totals have been climbing around the country.

Pick a different handful of universities and you’ll probably find a different mix of approaches and outcomes. Maybe by the end of spring semester, a book of best practices for keeping colleges safe during a pandemic can be written.

University of Wisconsin–Madison

In September, Wisconsin had one of the highest per capita rates of COVID-19 in the country. The University of Wisconsin–Madison was at the center of concern: Hundreds of students tested positive when campus opened in late August. Some students on campus gathered in large groups without masks despite university restrictions, according to the Badger Herald, a student newspaper. At the peak of the outbreak in early September, 911 students and staff tested positive in a single week.

The university partnered with a local biotechnology company that had developed a PCR COVID-19 test. As a research university, UW–Madison had the infrastructure to quickly analyze test samples on campus.

The initial plan had been to test all students living in residence halls every other week, says Jake Baggott, associate vice chancellor and executive director of University Health Services. But when cases spiked in September, the school moved to weekly testing.

“We sampled each residence hall, and each floor of each residence hall, every day,” Baggott says. A staggered schedule was set based on living arrangements: If one student was tested on a Monday, the roommate was tested Tuesday, the next-door neighbor tested Wednesday and so on. This staggering helped administrators identify outbreak sites more quickly, as new data were available each day at a hyperlocal level.

Students who tested positive were put into two-week isolation and anyone known to be exposed to an infected person or exhibiting symptoms went into quarantine. All nonessential in­person activity was suspended for undergraduates for two weeks, starting on September 7. On September 20, a record 432 students were in isolation and 100 were in quarantine.

By late September, new daily cases had dropped below 20, and test positivity — the share of tests returning positive results — remained below 5 percent, a threshold recommended by the World Health Organization before a community should think about reopening. The university used similar tactics to crack down on a smaller outbreak that began in late October.

North Carolina Agricultural and Technical State University, Greensboro

When campus first reopened, North Carolina Agricultural and Technical State University, NC A&T for short, had the capacity to test only symptomatic students. And turnaround was slow: Results took five to six days, sometimes longer.

The COVID-19 strategy shifted in late September, when the school received antigen tests through a U.S. Department of Health and Human Services grant for testing at historically Black colleges and universities. The trade-off for the antigen test’s quick results is a higher likelihood of false negatives (as many as 1 in 5 in asymptomatic people). But for administrators, the speed was worth it.

“We decided to test everywhere we could,” says Robert Doolittle, medical director of the Student Health Center — at the health center and pop-up sites around campus.

When an outbreak started after a Halloween party, which violated campus rules, the university restricted in-person socializing and tested about 1,000 students in a week with both antigen and PCR tests. Health center staff educated students about how to interpret the results of each test type: antigen test results are preliminary and may give false negatives, while PCR test results are more definitive. The PCR testing identified 61 cases in students who had negative antigen results, but the rapid tests still allowed the school to send 160 students into immediate isolation.

Young people who worked at the Student Health Center were instrumental to the testing effort, says Yolanda Nicholson, director of health education and wellness. The students ran social media campaigns, created educational videos and stood outside the center to advertise testing hours. Nicholson and student staff encouraged those who came in for testing to tell their friends about the experience. Some students went live on Instagram while they got tested, showing their peers what the experience looked like.

While upperclassmen criticized some freshmen for gathering without masks in August, as noted in the student paper, the A&T Register, students, for the most part, Nicholson says, “took it seriously.”

In an infomercial Nicholson shared with Science News, students expressed their reasons for getting tested: “for my family, for my loved ones, for us.” NC A&T students understand that U.S. Black residents have been hit hard by the pandemic, Nicholson says. Demand for testing rose toward the end of the semester, as students were keen to avoid bringing the virus home to their families.

University of Washington, Seattle

Fraternity and sorority houses — where students live and gather for parties — became sources of COVID-19 outbreaks at many schools. The University of Washington experienced a summer fraternity outbreak and applied lessons learned.

“It was late June, I was in the car, and I get a call from a [fraternity] chapter president that he has three members living in his facility that are symptomatic,” says Erik Johnson, Interfraternity Council president at the time. “We went into emergency lockdown mode.”

All 25 fraternity houses went into quarantine that same day. Within 48 hours, a testing site was set up to test every resident.

Johnson describes a major team effort: The university set up testing; the county public health department, which had responded to the first known U.S. COVID-19 outbreak, handled contact tracing; and fraternity leadership communicated the importance of quarantines and other safety guidelines. The summer outbreak was brought to heel in about two weeks, with the last case of the outbreak identified on August 8.

Both the university and student leaders used that summer experience to prepare for the fall. Genevieve Pritchard, 2020 president of the UW Panhellenic Association, which oversees sororities, joined weekly meetings with teams from the local public health department and the university’s environmental health and safety office before sorority houses opened. Students could attend webinars to ask questions.

When an outbreak hit sororities at the start of fall quarter, infected students were quickly identified and isolated. The university reported 200 new cases the week ending October 4, 76 new cases the next week and 42 new cases the week after that. Only about a fifth of the usual student population had come to campus.

Colorado Mesa University, Grand Junction

As a school located far from large testing laboratories, Colorado Mesa University did not have access to 24-hour results for PCR tests. So the school relied on other screening methods and deliberate community building to bring its undergraduates — many of whom are first-generation, low-income students — back to campus.

The school used a “kitchen-sink approach” to COVID-19 surveillance, says Eric Parrie, CEO of COVIDCheck Colorado. Students had to test negative before returning to campus, and once they arrived, they participated in random testing with LAMP rapid tests, PCR tests for anyone known to have been exposed to the virus and wastewater sampling of residence halls.

John Marshall, vice president for Student Services, and Amy Bronson, program director of the university’s Physician Assistant Program, held weekly COVID-19 virtual town halls starting in the spring. Student leaders encouraged safety among their peers through social media campaigns such as the school’s “CMU is back” music video.

With a nod to the Maverick, the university mascot, students were grouped into small pods called “mavilies.” Set up based on housing and activities, pods could be four students in an apartment or 20 students on a sports team. Mavilies were allowed to eat together, congregate closer than six feet in public spaces and remove masks in their communal living areas. The approach allowed sports teams to continue practicing, according to the student paper, the Criterion.

The university faced a November outbreak, which Marshall and Bronson attribute to community spread in Grand Junction, where many university students work. Campus testing and contact tracing ramped up during this time. Students were sent home for Thanksgiving, and the school finished its semester with two weeks of remote classes and exams — adhering to the school’s original plan for the fall.

Rice University, Houston

A foundation of Rice University’s reopening plan was weekly COVID-19 testing for undergraduates, says Yousif Shamoo, vice provost for research. After seeing Texas residents wait days for test results in the summer, the school lined up two Houston-based testing partners, Baylor Genetics and Houston Methodist Hospital, for 24-hour turnaround on test results.

Starting in the summer, student leaders helped the university prepare educational materials on COVID-19 and set up a system to discipline those who broke the rules and reward those who followed the rules, says Emily Garza, director of Student Judicial Programs.

Inspired by Rice’s student-run Honor Council, the COVID-19 Community Court includes representatives from all 11 residential colleges who are selected by student leadership and trained by student Judicial Programs. Students on the court try their peers who break COVID-19 protocols on campus; students, staff and community members can report misconduct through an online portal.

The court has been criticized as an outlet for students to police each other. But Shamoo sees it as a means for education, reminding students that their actions have consequences.

As punishment for being caught without a mask, for example: “We’re gonna make you write a three-page essay on whether you think masks are good ideas or not,” he says. Students wrote their essays after watching videos and reading articles about public health and safety concerns around COVID-19. Another common penalty was community service hours, in which students created and posted flyers on campus buildings about COVID-19 precautions.

During the fall semester, about 130 student violations were reported, half on campus and half off campus. The university’s staff judicial office investigated the off-campus violations.

Rice also trained over 100 student health ambassadors to serve as resources for their peers who have questions about COVID-19 but don’t want to ask administrators. Case numbers remained low at Rice, with no single day seeing more than six reported cases. Over 75,000 tests were conducted during the fall semester and only 135 cases were confirmed.