Infectious Diseases Professor’s Thoughts on Colleges Reopening

| Evan Thompson

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As colleges prepare for a year unlike any other, administrators are working to make their schools as safe as possible. The challenge is extraordinary: COVID-19 continues to run rampant through the United States, and cases are again surging across the nation. Students will soon be returning from all corners of the country to congregate indoors in close proximity, making college campuses potential transmission hotspots.

David Hamer, an infectious disease specialist and medical epidemiologist at Boston University (BU), is part of the medical advisory group working to prevent an outbreak at his school. BU's safety protocols are extensive: Masks must be worn in public places. Undergraduates will be tested for COVID-19 twice per week. A web app will grant or deny permission to enter buildings based on the results of personal health check-ins. Some students will be under quarantine from the moment they step on campus.

But all the preparation in the world can't prevent the spread of the coronavirus without uniform compliance from students, faculty, and campus workers. TBS sat down with Hamer to discuss BU's plan for limiting the spread of the virus, his worries about the upcoming year, and the inherent risks and challenges of operating amidst a pandemic. Our conversation has been edited slightly for length and clarity.

TheBestSchools (TBS): How do you feel about colleges reopening?

David Hamer (DH): I'll be honest: I'm concerned. I'm going to be co-teaching two four-credit courses in the fall at BU. Usually, that would mean a lot of student interactions. I also teach at the medical school and within the infectious disease fellowship. So I have both clinical teaching and then in-class responsibilities at the School of Public Health.

What will it be like in class?

It's going to be a different world. Classes are going to be de-densified. Some of the students are going to be online. Our ability to have close interactions with students is going to be reduced. There's a negative side to that because I think it's really good to be able to work closely with students.

How often will the school test students for COVID-19?

We have a protocol. Undergrads will have to be tested twice per week. And then others are going to be more on a weekly cadence, unless it's somebody like a faculty member who is only coming in periodically to campus. Then they may end up being tested every two weeks. If somebody stays entirely at home, they wouldn't be tested at all.

Are there any other major safety precautions?

Regular testing is going to be part of a strategy tied in with contact tracing and isolation of infected students. There will also be mask use, improved airflow in buildings, more attention to cleaning surfaces, and lots of alcohol-based hand wash available. I think all of those measures are going to reduce the risk of infection significantly. My greater concern is being able to deliver quality teaching when it's a mixture of in-person and Zoom.

Does the hybrid format have limitations?

One is just the physical limitation. If you're standing in a classroom, you have to be able to look at the handful of students who are physically there. You also have to keep checking the monitors to make sure that those on Zoom are engaged. If they want to ask questions, you have to check to make sure that they get a chance to participate.

My worry is students doing other stuff at the same time and not being very focused on the class. We're going to need to adjust some of what we do so that there are more interactive activities and maybe less didactic teaching.

Are you better prepared for remote teaching now than you were in spring?

Definitely. We've learned how to both use the technology, but also to take advantage of it to interact with the students. I guess it depends to some extent on the size of the group. If everybody's got their camera on, you can see what they're doing and get a feel whether they're paying attention. We've gotten better at using the technology and taking advantage of it to deliver education better.

But I still feel like it's just not the same as having a bunch of students in a classroom where you can break into separate groups. Certain types of activities are going to be more difficult to do.

What are your thoughts on the coronavirus and the challenges ahead?

We have a big challenge. The United States is in pretty bad shape right now in terms of the number of cases. And unfortunately, it has to do — to some extent — with central leadership.

It's been a problem with the White House, with the way they've managed things, and then by suppressing the CDC. It's really fallen on the states to do their management. We're going to continue to have a large volume of cases going into the fall. Places like Massachusetts and New York that have had pretty good control over the last couple of months are going to be facing a challenge.

In particular, the state of Massachusetts has at least 100,000 students returning. Many of them will be coming from parts of the country where there's an ongoing transmission, so the potential for a second wave is substantial.

Will a vaccine make a difference?

There is a rapid movement on the vaccine front. A lot of the vaccines are going into phase three trials. Usually, those take months at a time. We may have results by late fall. And then, potentially a vaccine or two by the winter. If we do end up with a fairly effective vaccine, and they're able to scale up production, then by the spring, hopefully, we could be in a different place.

How effective are vaccines?

Well, it depends on how good the vaccine is. The FDA has said the minimum protective efficacy that they'll allow is 50% protective, but that's not very good for a vaccine. A good vaccine, like a measles vaccine, is 90%, 95% protective. And then, after you get two doses, it's close to 100%. That's what we want.

But if you look at the flu vaccine, that varies depending on the fit with what's circulating. And that helps, but if it's only 50%, 60%, 70% protective, that means we still have to continue various social distancing, mask use, and other measures. The efficacy of the vaccine is going to be key.

How has the coronavirus affected higher education across the country?

It's had a negative impact. Many universities have lost income and have had to either furlough or just completely lay off employees, put in freezing hires, or cut costs in different ways. At BU, everybody's retirement funds were cut. They just stopped donating to retirements. That saved them $85 million.

The effect in terms of employment and benefits is pretty substantial, but universities lost a lot of income, and that's why they're struggling to make a push to be open — because of the lost income. This is going to be a short-term thing. It's going to be a year or two, and then there's going to be a rebound, but it's going to have a negative impact on the short-term.

Could there be any ripple effects because of this disruption?

One is that we're going to learn a lot more about distance teaching, and that will

become probably more integrated in the future into standard teaching. The mixed approach may be more common in the future. There are probably other effects. I'm worried about all the people losing their income and livelihood from this and what will happen to them.

Will we have a vaccine in 2020?

Researchers around the world are rapidly trying to produce a safe and effective vaccine against SARAS-CoV-2, the virus that causes COVID-19. But experts say it's not realistic to expect a vaccine until 2021.

Vaccines go through several stages before being approved for large-scale use. Scientists are developing more than 165 vaccines against the coronavirus, and 27 vaccines are in human trials.

Phase 3 trials — the final step for determining whether a vaccine is safe — recently began for mRNA-1273, the vaccine developed by Moderna and the National Institutes of Health (NIH). This phase will test 15,000-30,000 adults who do not have COVID-19. However, it will take some time to measure the vaccine's effectiveness and how long it protects people from the virus.

Tell me about BU's testing capabilities.

BU has built — and now has operational — a robotics-based laboratory that will be able to do 42,000 tests per week. We've been stratifying employees and students to figure out who has to have more frequent testing.

How will a quarantine work?

It's a detailed plan that keeps being updated. The state of Massachusetts has announced that anybody coming from anywhere except New York, New Jersey, New England, or Hawaii has to quarantine for 14 days. Well, we've got thousands of students coming from all those places in the middle-to-late August, and we're trying to figure out how we quarantine them when we don't have any quarantine beds.

What else worries you?

There's just a lot of different parts. How do you manage food service? If you have cafeterias, how do you make it so that you don't have a crowd there?

Then you have to think about the food service employees. They're not BU employees. They're employees of a contracting organization. So who tests them? Who's responsible for monitoring them?

This week, I've reviewed protocols for the medical school. How are they going to do anatomy lab? I reviewed protocols for the athletic facilities. How are they going to open the gym? There are just so many different pieces.

Will students self-report symptoms?

You have to complete a daily attestation, with questions like: Have you had contact with somebody confirmed with COVID-19? Do you have a fever? Do you have a cough? Shortness of breath? Loss of sense of smell?

If any of those are positive, then you are contacted by student health services — or occupational health, if you're an employee — and told where to go to get a test, and you can't report to campus that day. In fact, some places are tying it to your ID. Your ID will be blocked from going into the building.

How does that work?

It's a web-based app. You're going to have to get clearance to be able to get into certain buildings. We're going to have a three-part system. You have to have done your medical attestation, you have to have had your test in the last week or last three days, and you have to have your next test scheduled, and then you get a green light. And so security at certain buildings can ask you to show your green light on your phone.

What else will students do?

Students are going to be asked to sign a — almost like an MOU [memorandum of understanding], to say: When I return to campus, I will do the following: I agree to be tested; I agree to wear a mask in public places. I agree to do this, this, this, and that.

I'm not sure it includes acknowledgment of the risk of getting COVID-19, but it's more, "I will adhere to the safety precautions and testing according to the schedule that's appropriate for me," and so forth.

How much faith do you have in students to carry out these protocols?

I think that some students will be very adherent because they're concerned about their health, or they're altruistic. Others will be like, "Well, why worry? I'm young. I'm not going to get very sick from this." So I think we need to educate them.

We also need student ambassadors to get out there and say, "Hey, you have to do this. You have to protect your professors. You have to protect your family, if you're going to see your family. There are some students that are vulnerable. We have to protect them. We need to be thinking of others, not just ourselves."

It's going to be a challenge. And the question is: How much can you enforce some of these things? Having the green light system will help. That's something that if you don't do your scheduling, your testing, and your attestation, then you may be blocked from going into certain buildings.

Are there any additional safety measures that would make you feel more comfortable teaching on campus?

One thing that's a little harder to control is trying to optimize ventilation systems and air filtrations in buildings. Because many buildings are closed, and you can't open windows. But improved airflow and ventilation are critical.

Do you have any predictions for how things will play out in the fall at BU?

I don't know. I'm worried. What I think is going to happen is we're going to have an immediate surge of cases because of people coming from Florida, California, Texas, et cetera. We'll be able to test our systems because those students will need to be isolated. We have 400 isolation rooms set up.

The quarantine is going to be a little bit more challenging, because we're going to have to technically quarantine three, four dozen students. But if we can get them to arrive and get things under control, then I think we'll be good with a frequent testing cadence [and] scaled-up contact tracing.

What else may be challenging?

The wild card is what happens off campus. If there's a big party at one of the universities, or in some of the off-campus housing, you've got a superspreader event, you get a bunch of people exposed, then that could lead to major problems. But I think it's going to work out okay.

What would your reaction be if the campus closed again because of COVID-19?

That would be a disaster. It would require either sending students home, or it just would lead to a lot of extra expenses. We shifted all classes online in the spring. We made it work, but it's just a lot more challenging. I think because we've done it once before, we could do it again, but it would be a major shift from the current plans.

Is it safe for students to convene on campus when so many schools across the country have become the source of outbreaks?

We anticipate a good number of students are going to be positive. We expect maybe 40 percent of students to come from states with high levels of transmission. There's a plan for them. They're being advised to quarantine for 14 days before they come to campus. When they arrive, they'll check in and immediately schedule a test for themselves that day. Then they'll be quarantined for the next week. They'll only be able to leave quarantine for testing and for food. Once they have three negative tests, they'll be out of quarantine. Since we anticipate so many students to come from states with high transmission, MIT has created a calculator to anticipate the level of transmission on campus. That model suggests we're going to have a range of anywhere between 80 and 200 positives. It'll be interesting to see it play out.

Isn't it inherently unsafe to bring students to campus when you know some will already be infected?

Because the people that we expect to be positive will be policed, the risk of spread is going to be greatly reduced. But we can't eliminate it.

Are you worried students could face fatal risks being on campus?

There's definitely concern for that. It's a very limited likelihood. But students that have a higher risk will have the option of doing all-remote education. The higher risk students will not be on campus, which is only a small subset. They include students with inflammatory bowel disease or autoimmune disorder that requires autoimmune suppressive treatments or other illnesses that require powerful, anti-inflammatory treatment. Boston also has really excellent healthcare available.

How will you track students under quarantine?

There are different ways it's going to be monitored. If they're in dorms, there are resident advisors on the floor. There's going to be a restriction of movement based on individual status. Theoretically, they could sneak out and end up going to a restaurant or go to a party in another part of town. There are going to be attempts to monitor that. They'll all be signing an agreement that they will abide by the new rules. There are various, gentle ways of enforcing that. There's no crime. The degree of enforcement is still being discussed.

How do you feel moving forward?

It's hard to predict. If students are reasonably adherent to the rules, we'll be able to contain things well on campus and also prevent spread outside to the community. But there's always going to be students who are going to be non-compliant and we'll have to figure out how to deal with those. One really important component of this is that we'll be monitoring disease transmission on and off campus. We're working on a dashboard that will have the number of tests done, the number of positives, and people under quarantine. We're also going to be looking at the three counties that surround the campus. We've arranged with the state department of health to have data on new cases that will be posted daily.

Evan Thompson is a Washington-based writer for TBS covering higher education. He has bylines in the Seattle Times, Tacoma News Tribune, Everett Herald, and others from his past life as a newspaper reporter.

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