Where We Stand with Covid-19 — June 5

I would like to take a moment at the beginning of this week’s report to express my deepest sympathies to the family of George Floyd and my solidarity with those fighting for social justice and racial equality. There’s no mask to protect us against police brutality. There’s no vaccine for racism. The culture of white supremacy has existed in overt and covert forms for over 400 years, and it is time for greater systemic societal change. This change can be accomplished in many ways, including by listening to voices of color, standing in solidarity with our Black brothers and sisters, learning about our history, donating to causes fighting racism, peacefully protesting and voting for one’s beliefs on the national, state and local levels. We must all come together, in unity, to acknowledge the privilege some of us have simply by the color of our skin. The pursuit of an anti-racist society lies in all of us.

This photo shows a contemporary view of where 250,000 people once stood to listen to one man say that “I have a dream that my four little children will one day live in a nation where they will not be judged by the color of their skin, but by the content of their character.” We must give voice to the values that unite us and work to create a hopeful vision for America, where we can actively promote the ideologies and people who best suit our future.

This is the 8th update in my weekly reports analyzing the Covid-19 pandemic and its effects on the country, higher education and study abroad. Previous versions are available on this blog, Off the Silk Road. Last week, I presented new insights and data with regards to how colleges are planning for the fall. This week, I’ll build on what we know and share more information about plans and considerations.

In the words of Chris Cuomo, let’s get after it.

A national look

I first wanted to address recent police attacks to journalists, many of whom you can see in this spreadsheet, including my student journalist colleagues at Ohio State University. Additionally, medical professionals fighting the coronavirus have been the targets of police violence. This is unacceptable. These people are just trying to do their vital jobs. They are essential workers. Treat them as such.

As much of the current news has focused on the recent protests, it seems that the nation’s conscience has shifted away from the coronavirus. We must not be cavalier — the virus is still here and will continue to spread rapidly, especially with increased mobility with the summer months. 21 states see rises in cases (many of which are in the South and opened early), and we are now beginning to potentially see the results of Memorial Day movements.

I am concerned about how the protests and gatherings will affect viral transmission. This is not to say that I disagree with the concept or cause of protesting. Not at all — these are systemic issues in society where we need change. However, from an analytical public health standpoint, protesting and gathering in large groups is an epidemiologically risky move. Socially distant protesting is an oxymoron. In my opinion, coronavirus transmission from protests could go one of two ways: either the virus will spread among protesters, many of whom are young and thus could spread quickly asymptomatically, or it could spread widely among protesters and their contacts (including older relatives). The next few weeks will be critical to see how the protests affect viral transmission, especially in these cities.

Now I know what you’re thinking. The protests are outside, so viral transmission is lower. This could be true, but we do not know. I’m especially concerned as many people are huddled close together, do not wear masks, scream (which accelerates viral particles) and share equipment (water bottles, bullhorns, etc.). Additionally, the use of tear gas has been reported on widely as extremely dangerous for the spread of the virus, for three main reasons. Tear gas could: 

• Expose more people to the virus (through coughing)
• Compromise the body’s ability to fight off the infection
• Cause mild infections to become more severe illnesses

“We can’t stop thinking about COVID,” St. Louis, MO mayor Lyda Krewson said to my colleague Sarah Teague in the St. Louis Post-Distpatch. “We know that black and brown communities have been more devastated by COVID than white communities. We don’t want these protests to contribute more to that tragedy.”

Governor of New York Andrew Cuomo is urging those who have attended the protests to get tested for Covid-19, and I urge other states and localities to do the same.

It’s been six months that the world has been living with Covid-19. There is much that we know and much that we do not. As usual, I’ll briefly summarize what we’ve learned this week.

Superspreading remains a huge concern. We are reasonably confident that the virus will not mutate much, according to the WHO. The virus may greatly affect the blood vessels. Infection waves are still very possible. The virus has caused a 42% decline in visits to the emergency room for the first few months of the year, many which could result in serious complications. As New Zealand begins a return to normal life, the virus continues to spread rapidly all over the world, particularly in Latin America.

Those who have symptoms from the virus could be living with its longterm effects for months. A CDC study in China seems to suggest that with higher severity levels of symptoms, close contacts are more likely to be infected. These findings provide population-based evidence for transmission from persons with presymptomatic COVID-19 infections. One Arizona hospital’s ICU beds are nearly at full capacity. Hospital burden is a significant problem, as seen from this UC Berkeley study. As Wuhan declares itself virus-free after blanket testing 10 million, nearly all of its 11 million residents, environmental samples in high-touch places (subway stations, doors in public areas, etc.) also confirm that the virus is not present. A study from a Seattle nursing facility shows that a large fraction of COVID-19 cases (27/48=56%) were asymptomatic at the time of testing. 24/27=89% later developed symptoms. This suggests a vast majority of asymptomatic cases were presymptomatic. A study from the University of Vermont argues that school-aged children are far less important drivers than adults. (It’s worth noting that many of these studies are not yet peer reviewed and are in the pre-print stage). A new paper by French researchers shows that dogs may be able to detect the presence of the virus through people’s sweat. We are still trying to make sense of the coronavirus’ death rate.

Dr. Michael Osterholm and his team at the Center for Infectious Disease Research and Policy at the University of Minnesota published their fourth report in their “Viewpoint” series, this time on contact tracing. The authors argue that adapting a “one-size-fits-all” approach to contact tracing is not optimal but a national plan is. Additionally, guidance on using technology would be helpful.

For those planning summer activities, I found that this video does a good job at analyzing the risk factors that could lead to viral transmission: distance, duration and ventilation.

A new Gallup poll shows that around one-third of Americans always wear a mask outside the home, with the most common mask-wearing groups being women, Democrats and city dwellers. It is worth noting that the latter two groups also seem to be hit hard by the virus.

The most comprehensive study to date on the topic in the Lancet shows the effects of mask wearing and physical distancing on viral transmission. The risk of infection or transmission when wearing a mask was 3% versus 17% when not wearing a mask. Transmission was lower with physical distancing. These may seem obvious, but it is always good to put numbers to our theories.

If you’re looking for a good read on how the coronavirus hampered the CDC response, this New York Times investigation has you covered.

I wanted to use this example from Winooski, Vermont on why we must not be too cavalier in thinking the virus has disappeared. 34 new cases have emerged in one town after testing, many connected to one family. This could readily happen anywhere.

Having laid down the groundwork on the national scene, let’s take a look at the latest developments in higher ed.

Higher education

I wanted to start this week’s discussion with a striking study from the CDC. The study shows the spread of infection at an Air Force Basic Military Training. This study is interesting since military barracks are a similar setting to a college campus — dorms close together, communal eating spaces, etc. Additionally, the age demographic is very similar to college students. All new recruits arriving to the base were put in a two-week quarantine (similar to my College Bubble model). In a population of 10,579 trainees, Covid-19 incidence was limited to five cases (47 per 100,000 persons — lower than most of the country), three of which were in persons who were contacts of the first patient. What does this show? Nonpharmaceutical interventions (NPI) work!

• Arrival quarantine
• Social distancing
• Rapid isolation
• Masks

It is worth noting that the interventions were implemented in a highly structured and sufficiently resourced military base: members of the Air Force, which are most certainly more disciplined than the regular college student. Social distancing in Air Force terms means disperse and separate immediately. Nevertheless, it is an intriguing study.

My colleagues Arielle Gordon and Miriam Brown at Colorado College outline arguments for colleges reopening and colleges against reopening in their CC Covid-19 Reporting Project newsletter.

Arguments for reopening:

1. Accessibility
2. Revenue
3. Student feedback
4. Economic impact
5. Slow vaccine development

Arguments against reopening:

1. No vaccine
2. Difficulties with social distancing
3. Potential for lawsuits
4. Peer pressure

I highly recommend that you check out their report for more details on each of these factors.

In an interview with my former Middlebury colleague and CNN reporter Annie Grayer, Dr. Anthony Fauci said that the decision to reopen schools needs to be predicated on the level of infection in each community. “I hesitate to make any broad statements about whether it is or is not quote ‘safe’ for kids to come back to school,” Dr. Fauci told CNN.

“I’ve kind of come to believe that this is our version of the Manhattan Project,” Boston University president Robert Brown told my colleague Grace Ferguson with regards to opening his institution. Yes, it is. Colleges rely a lot on auxiliary revenues, many of which count on students being on campus. College budgets remain in flux and endowments cannot always be used to save schools. From an economic angle, it is obvious: open schools for on-campus instruction in the fall. However, with regards to public health, some people may say otherwise.

I’m particularly concerned that we have not fully grasped the viral spread potential on a college campus, based on data and reports we have from student-athletes returning to campus. In the past week, student-athletes at Iowa State, Oklahoma State and the University of Alabama have tested positive for the virus, as well as cadets at West Point (where Trump is due to make a commencement address).

I worry that the decisions schools make for the fall will come before we fully understand the effects the protests and summer have on viral spread. With a large wave possibly emerging this summer, viral prevalence in the community could come to the point that opening for the fall would be an imprudent decision.

With that in mind, let’s take a look at the college models we have seen this week.

The University of Florida has released a draft of their opening plans, where students would be screened to determine the level of risk they bring to campus based on from what area of the country (or world) they travel. The University of Texas at Austin expects to hold as many as 19% of its classes online this fall, with masks required inside. Professors will be able to end class if a student refuses to wear a mask, and those who refuse to comply will be subject to a disciplinary hearing. Stanford University plans to rotate undergraduates on and off campus next year, with the equivalent of two class years (50% capacity) on campus each quarter in a four-quarter year including summer. Which students will be on campus when is still uncertain. The University of Georgia has released a detailed plan for their return to campus, which I expect more schools will do. Both Boston University and Northeastern University have released their own versions of a hybrid teaching and learning model, which essentially means students can choose to return to campus with a combination of digital and in-person classes or continue remote learning from their place of choice. One faculty member at Boston University has argued that teaching in person should be optional as well, as 66% of faculty in this Chronicle of Higher Education survey said they are uncomfortable returning to campus this fall. Incoming first-year students at the University of Pennsylvania remain unsure of their intentions to enroll for the fall, as reported by my colleague Isabella Simonetti. Ensuring first-years adapt to college life will be critical, whatever form college will be in the fall. As six Harvard graduate schools go online for the fall, the decision for undergraduate students will be made in consultation with 11 working groups, as reported by my colleagues Juliet Isselbacher and Amanda Su. “Wherever students end up living, whatever kind of residential arrangements were able to make, learning is going to have to be to a large extent — if not entirely — remote,” Dean of Undergraduate Education Amanda Claybaugh said.

The University of Hawaii has been planning to socially distance classrooms, which is the first school I’ve seen that has put out concrete adaptations for social distancing in classrooms. For example, a lecture hall that normally seats 384 can seat only 61 with 6-foot social distancing. Here’s a great photo of university architects and engineers setting up classrooms.

Meanwhile, at Northwestern University, the school’s registrar is struggling to determine how social distancing will affect course registration. “Of 128 Registrar-controlled classrooms, 44 are deemed usable for a typical classroom setting,” the school’s associate provost for operations and facilities said. Ventilation will be critical to limit viral spread. Purdue University’s president told the Senate Committee on Health, Education, Labor and Pensions that the school has ordered over one mile of plexiglass to install in their classrooms behind professors’ desks (wow). Stanford University has launched a symptom tracker to test among their summer staff. This is similar to Yale’s Hunala tool. Bowdoin College has toughened its leave of absence policies, expecting a potential influx of students taking the semester off if classes are online in the fall. The community of Chapel Hill, where the University of North Carolina is located, is concerned for the students’ return. Students have expressed concern with Temple University’s plan to hold classes in person. “I need someplace to go in between classes,” one student said, pointing to the plan to limit dining service to online orders and takeout and close many communal areas on campus. “How are they going to enforce somebody throwing a party in an off-campus apartment,” another asked. These are all important questions schools should be asking.

For more information on various teaching models on campus, including fully in-person, blended synchronous, the flipped classroom and fully online, I would suggest you check out these graphics from Clemson University. As more schools announce plans, we may use these models in future reports.

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Faculty are also concerned about their new normal teaching life. Logistical and pedagogical issues will affect teaching on college campuses in the fall. Stress is likely to influence learning as well.

Small colleges are considering deals with local hospitals to provide testing. This will be an interesting new development to watch, and I will hopefully have some data on this point (small colleges using local hospitals, larger universities using their own facilities for testing) soon.

What is key to plans for reopening? Communication. Specifically, communication must take place between five key stakeholder groups:

• Students
• Faculty
• Staff
• Families
• Local community members

Student input is particularly critical, and I would encourage colleges to survey their students on their thoughts on the fall. My colleague at The Middlebury Campus, James Finn, and I conducted and reported on an all-student survey which received 583 responses, around one-fifth of the student body. Here are some of our findings:

• 58% of students responded that they would seek to take a leave of absence if Middlebury remains remote in the fall.
• 62% said they had a job or internship cancelled due to the pandemic.
• 71% would be “very unwilling” to pay full tuition for a remote fall semester.

We also had an open free-response question and we were intrigued at what students said. “Everyone I know would try to take a semester off if it were to be remote,” one student wrote. “I am extremely concerned about the potential of party/social culture instigating an outbreak…I do not know that every student may follow social distancing/quarantining rules. In fact, I expect many to break them…I am worried that places of massive, close social gatherings (social houses, Atwater, etc. [these are places on campus]) will create a possible breeding ground for the virus,” another responded. I’d encourage you to check out the full report here.

Study abroad and international travel

I still don’t think study abroad programs will be running for the fall. I’ve decided to turn this section into a place where I list some of the schools who have cancelled programs for the fall. This week, Pomona College, Duke University and Boston University all announced international program suspensions.

As the world decides on when it is deemed safe to travel, the Trump administration placed a ban on flights operated by Chinese airlines, then quickly scrapped the ban. This was an extremely odd and misguided policy.

The Good Stuff

Let’s roll the clips of the good stuff. In my weekly tradition, I feature my favorite pieces from the week, including my favorite examples of student journalism. 

• Peaceful protesters in Washington, DC sing “Lean on Me” in unison.
• People really miss dancing.
• Students at Brown University have joined protests all around the world.
• The Washington Post’s oral history of 48 strange strange minutes of Trump violently dispersing protesters and taking an outing to St. John’s Episcopal Church for a photo op.
• The pandemic has caused a new uptick in demand for aboveground pools.
• A chance encounter with American Airlines CEO Doug Parker and a Southwest flight attendant turned into an emotional discussion on race.

Conclusion

I monitor national metrics on a daily basis and will continue to see the effects of summer and the protests on viral spread. We still cannot quantify that effect. We must remain prudent that our actions can make a difference and transmission now could significantly impact colleges returning in the fall. I anticipate we’ll see more decisions in the coming weeks, and I’ll do my best to bring those reports to you. The virus is still out there, even if it is no longer in the news every minute of the day.

I’d like to thank all the student journalists with whom I have the pleasure of working. In the next weeks and months, these student journalists will become ever more important in chronicling their colleges’ decisions for the fall and beyond. Support their work by reading it.

Let’s all keep doing what we’re doing and we’ll get through this together. My best to all for good health.

Like what you see? Don’t like what you see? Want to see more of something? Want to see less of something? Let me know in the comments.

For more instant updates, follow me on Twitter @bhrenton.