Infectious Disease

Universities take care of on-line and in-person studying

February 15, 2021

5 min read

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Kazemian, Kuhl and Malani do not report any relevant financial information. In the studies you will find all relevant financial information from all other authors.


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After COVID-19 was declared a pandemic almost a year ago, colleges across the country have had to switch to online learning or adjust strict infection prevention measures to prevent the novel coronavirus from spreading across their campuses.

At the beginning of the spring semester of 2021, universities are still debating whether to have in-person courses or online learning.

According to the latest results from the college crisis initiative made available to Healio Primary Care, as of mid-February, 39.62% of colleges in the US are primarily online for the spring semester of 2021, 16.28% are primarily face-to-face, 8.98% use a hybrid model and 5.06% use other strategies. The data also showed that only 1.98% of colleges are fully personal and 3.48% reported being fully online for the semester.

In addition, the initiative found that 24.61% of colleges have not yet finalized their reopening schedule for the semester.

Healio Primary Care spoke to experts about whether the campus should be back to face-to-face teaching during the COVID-19 pandemic.

College campus as a “superspreader”

A model study recently published in Computer Methods in Biomechanics and Biomedical Engineering found that universities are at risk of becoming COVID-19 superspreaders.

“Our study shows that the first two weeks of classes are the most critical phase in the reopening of the campus.” Ellen Kuhl, PhD, The Robert Bosch Chair in Mechanical Engineering at Stanford University told Healio Primary Care, “Campus outbreaks can be an order of magnitude more intense than outbreaks in the general population.”

Kuhl and colleagues collected COVID-19 case reports from 30 college dashboards in the US this fall. The facilities that ran in-person, online, or hybrid courses reported case numbers on a daily basis and had a cumulative total of more than 100 COVID-19 cases.

Of the 30 facilities, 14 saw an increase in COVID-19 infections in the first two weeks of class.

The researchers found that many institutions had a peak 7-day incidence of more than 1,000 cases per 100,000 people, and that all but one college had 7-day peaks that were higher than the nationwide peak of 70 cases per 100,000 people during the first wave and 150 cases per 100,000 people during the second wave of the pandemic.

While most locations were able to quickly reduce the number of new infections, many were unable to control the spread of the coronavirus off campus.

“For more than half of the colleges in our study, they got into the campus neighborhoods and caused outbreaks in the community,” Kuhl said.

Based on their findings, however, Kuhl said that the universities “can and should now reopen as the number of cases has fallen across the country.”

“While we haven’t explicitly explored the impact of in-person and online teaching, we believe it is extremely important to open up campus to students and then gradually and selectively open up to in-person teaching, ideally with smaller class sizes,” said Kuhl.

She added that the campus “should be alerted to isolate test lanes and flexibly switch to online classes if necessary”.

Infection prevention measures

Another study published in the Annals of Internal Medicine showed that rigorous COVID-19 prevention measures can allow safe return to campus at a reasonable cost, according to researchers.

“It is clear that two common non-medical strategies are very effective and inexpensive – and enable personal instruction.” Pooyan Kazemian, PhD, A press release states an assistant professor of operations at the Weatherhead School of Management at Case Western Reserve University. “While it is true that routine asymptomatic tests help detect some infections early and reduce transmission, they are also the greatest financial and operational burden, even when done every 14 days.”

Kazemian and colleagues used the clinical and economic analysis model of COVID-19 interventions to evaluate combinations of four prevention strategies: masking, physical distancing, testing, and isolation. The model tracked infections among college students and faculties while taking into account transmissions in the community.

The researchers found that mitigation strategies reduced cases among college students from 3,746 when there were no mitigation strategies to 493 cases with strict guidelines on social distancing and masking. The cases fell even further – to 151 – when laboratory tests were performed on asymptomatic students every 3 days.

In the faculty, they found that there were 164 cases with no preventive measures; That number dropped to 28 with social distancing and masking strategies and to 25 cases with the addition of an asymptomatic testing ability.

Kazemian and colleagues estimated that the cost of these strategies ranged from $ 400,000 for minimal social distancing to $ 900,000 to $ 2.1 million for strategies with laboratory testing. The cost was based on the frequency of the tests, with an estimated cost of $ 10 per test.

The researchers estimated that extensive social distancing and masking strategies would cost $ 170 per infection prevented compared to masks alone, and that the addition of routine laboratory tests would increase the cost per infection prevented to between $ 2,010 and $ 17,210.

“While states have started offering COVID-19 vaccines to health care workers, first responders and long-term care facilities, it is unlikely that most students, university departments and staff will be offered a vaccine by the end of the spring semester,” Kazemian said. “Therefore, a commitment to mask wearing and extensive social distancing, including canceling large gatherings and reducing class size with a hybrid education system, remains the primary strategy for minimizing infection and keeping campus open during the spring semester.”

Should the lessons be personal?

Preeti Malani, MD, The chief health officer and professor of medicine in the Department of Infectious Diseases at the University of Michigan told Healio Primary Care that the spring semester of 2021 will be different for every college across the country.

“Realistically, I would see a time when most courses can go back to a personal format,” she said.

At the University of Michigan, Malani said courses that must be taken in person – like courses in health sciences, laboratories, studios, and performances – are done with careful infection prevention measures, but other courses are held online.

She added that while campus may apply measures such as masking and social distancing mandates in classrooms, shared study areas, dining areas, recreation areas, campus transportation services and other areas, people who stay on campus often live in shared apartments with roommates, making the budget a concern.

Malani also noted that there are many strategies that can prevent the risk of outbreaks, but these risks cannot be eliminated.

“We often say that campus cannot be any safer than the general community, where COVID-19 risk is also an issue,” she said.

According to Malani, a “layered approach” to public health interventions included masking, physical distancing, avoiding large gatherings and hand washing in conjunction with monitoring symptoms, testing – even in asymptomatic individuals – contact tracing, and isolation and quarantine houses , effective.

“All of this comes at a cost – economically, academically and emotionally,” she said. “It’s imperfect, but many students have found ways to continue their education in ways that feel meaningful.”



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