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TRISTAN SPINSKI / THE NEW YORK TIMES / REDUX
The Atlantic
The Colleges That Took the Pandemic Seriously
Many colleges and universities have figured out how to diagnose their
populations and control outbreaks—and offer a vision for more normal
life until the vaccine is available to all.
Aaron E. Carroll
January 31, 2021
Professor of pediatrics at Indiana University School of Medicine
Until vaccines against COVID-19 are available to all, the public will
need two things: a reason for hope and a vision of how to live more
safely and productively in the meantime. For both, Americans can look
to the examples set by a number of colleges and universities—a
surprising turn, perhaps, given the widespread anxieties that these
institutions’ reopening in the fall created.
Since last summer, many news stories have highlighted failures by
individual universities to manage the pandemic. Outbreaks have
occurred, and some data even suggest that college reopenings led to
more infections in the counties in which they are located. That’s only
part of the story, though. Many schools—including the one where I
work—took on the job of preventing the spread of the coronavirus among
their students, employees, and host communities and have sought to
manage the problem in a comprehensive manner. Schools that have
succeeded have done so by learning from one another, by redeploying
people and resources, and by employing the tactics that epidemiologists
all over the world have advocated but too few areas of the United
States have adopted.
I am a pediatrics professor at Indiana University. Our seven campuses,
like most of their counterparts across the country, shut down quickly
in March. Administrators soon called together a committee of experts in
medicine, public health, and public safety to create a plan for how the
school might function safely during the pandemic. I serve on that
committee, am one of four leaders of IU’s medical-response team, and
currently oversee our testing system for asymptomatic students,
faculty, and staff.
Whether our campuses should even reopen was a contentious subject, but
we committed to finding a way to safely resume classes. A large
majority of our more than 87,000 students, we reasoned, would be living
in our campuses’ host communities, regardless of whether the university
reopened its dorms. Students would be present—and would be likely to
socialize—no matter what we did. We aimed for a mix of virtual and
in-person instruction, partly on the theory that masked, widely spaced
face-to-face interactions would satisfy some of the students’ appetite
for normalcy and offer a better educational experience than fully
remote learning.
To meet these goals, we needed to prepare our health-care system to
diagnose COVID-19 cases and care for those who tested positive. At the
time, getting a coronavirus test was incredibly difficult, even for
people who were quite sick. With the help of IU’s school of medicine
and its partner health-care system, we developed a mechanism where any
of our approximately 120,000 students, faculty, and staff could get a
virtual visit with a health-care professional if they felt ill. If
symptoms warranted, this process then connected them to a diagnostic
test.
Diagnosing individual COVID-19 patients was just the first step. We
also needed procedures and infrastructure to allow them to isolate, and
intense contact tracing to identify and assist anyone else who might
have been exposed. These measures required money and significant
personnel, neither of which was widely available from the federal or
state government. But our school had an advantage: Through a
partnership with medical educators and government officials in Kenya,
many of our local faculty and staff had gained expertise in health-care
initiatives requiring substantial community outreach. With their help,
we hired and trained a corps of contact tracers. Early in the pandemic,
I had marveled at how Singapore had a goal of tracking down the source
of each identified COVID-19 infection within two hours. In the fall,
IU’s median time to close a case was half of that.
In june, while most of the country could not manage to supply enough
tests for people with COVID-19 symptoms, researchers at Cornell
released a paper outlining a scheme of frequent testing of asymptomatic
people. They believed that if their university tested a large number of
people often enough, being part of the Cornell community could become
safer than not being part of it. In other words, far from posing a risk
to its host city or town, a university could become—by supplementing
behavioral measures such as masking and social distancing with
widespread surveillance testing—a model for detecting and suppressing
the virus.
This was a vital insight. Other studies produced similar findings. At
IU, we set a goal of creating a safer environment for students,
faculty, and staff on and around campus than they would experience if
the university simply shut down. Unfortunately, by August and well into
the fall, testing capacity was still limited. No infrastructure existed
to test those without COVID-19 symptoms, and we did not want to be a
burden on our host communities by co-opting resources—including medical
capacity—that might otherwise be used for those who were ill.
Fortunately, large universities can find ways to tackle society’s
toughest problems, including the need for new ways to detect infections
en masse. Last spring, Rutgers developed a saliva-based test that
didn’t rely on medical professionals to collect nasopharyngeal swabs.
It was so successful that companies started using it to offer mail-in
coronavirus testing from anywhere in the country. It was somewhat
expensive, but it was available. IU made use of it.
Lab work is only one part of a testing system. Collecting a huge
quantity of samples was an additional logistical nightmare. But at IU,
we realized that our event staff—which has experience at moving massive
numbers of people and equipment for football and basketball games,
concerts, and commencements—could run our testing operation. Our
information-technology services, adept at collecting and processing
data as well as building websites and apps, could create dashboards,
set up tracking systems, and process test results. And when other
institutions found ways to innovate, we copied them. In our own
backyard, Purdue University announced that it would develop its own
COVID-19 testing lab. We committed to opening labs of our own and
looked around for a cheap method of testing a lot of people quickly. We
eventually chose a saliva-based testing method pioneered by the
University of Illinois.
After purchasing liquid-handling robots and PCR machines and training a
testing staff, we aimed for 25,000 tests a week in January. When
students return to campus in February, we plan to test about 50,000
people a week to detect any viral surges like the ones we and other
colleges saw in the fall. Our labs have become so efficient that we
expect many of these test results to be returned on the same day a
sample is taken. When individuals test positive on campus, our
contact-tracing team gets in touch immediately and makes arrangements
to isolate them in housing reserved for this purpose. Close contacts
are also identified and instructed to quarantine following CDC
guidelines.
All told, the testing and safety measures that we adopted will cost
about $700 a student. This was a huge investment for a state
university, but it also shows that establishing reasonable protections
for the people who depend on IU is possible on a realistic budget.
Through a combination of measures, Indiana University, and other
schools using similar approaches, kept the prevalence of infection
quite low throughout the fall semester, even as case counts rose
dramatically in the state. Now that vaccines are available, we’re
working with the government to help distribute them as quickly and
efficiently as possible—not just to our students, faculty, and staff,
but also to the communities in which we live. More than 600 students in
our health-sciences schools have trained to give vaccinations and have
been put to work all over the state distributing shots to those who are
eligible.
Not every college or university that reopened, however, has taken
enough protective steps. Unable or unwilling to invest in overcoming
the testing bottleneck, too many schools did little or no asymptomatic
surveillance. They couldn’t identify and isolate silent carriers of the
disease, and outbreaks inevitably occurred. Too many institutions were
also overconfident in their ability to persuade 20-year-olds to stop
having parties. IU was among the institutions that suspended students
for hosting large off-campus gatherings, but we relied much more on
promoting solidarity and communicating specifics than on making
threats. Everyone who studied or worked on our campuses agreed to
participate in testing and follow behavioral guidelines. Our
surveillance testing was robust enough that we did not rely on
punishment to prevent infections; when our testing revealed
disturbingly high positivity rates in most fraternity and sorority
houses, the county ordered members of those living groups to quarantine
themselves. (These measures did not prove necessary in our dorms or
anywhere else.)
Beating COVID-19 requires resources, will, and a sense of shared
sacrifice. The United States has too widely failed in the past year in
providing these. Vaccines are rolling out too slowly, and new variants
of the coronavirus are emerging. Figuring out how to live safely in
this environment is imperative.
Universities like ours have many lessons to teach. IU wasn’t the only
school to adopt a comprehensive suite of preventive measures, nor were
we the only one to have achieved a level of success with them. That we
didn’t perform miracles or depend on luck should make our example all
the more useful to other university presidents—and to mayors,
governors, and the new presidential administration.
Read this and other stories at The Atlantic
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