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COVID-19 — Lessons learned from UNC can benefit hundreds of other colleges

COVID-19 — Lessons learned from UNC can benefit hundreds of other colleges
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What the University of North Carolina at Chapel Hill (UNC) discovered is that COVID-19 infections occur when universities bring students back to campus. An initial surge of infections is no surprise. What is more surprising, however, is that UNC abandoned what they believed were carefully constructed plans at the first sign of trouble. Will other schools make the same mistake?  

Believing that a few hundred infections among thousands of students is trouble is naïve. The trouble is not when students arrive on campus infected, or when some community transmission occurs among students; it is when the spread of these infections accelerates and community transmission reaches the local residents, particularly those who are older and more vulnerable to bad outcomes.   

The preponderance of student infections are asymptomatic or mild, posing minimal personal health risk. With proven public health practices in place to slow (not stop) the spread of the virus, including face coverings, physical distancing recommendations and frequent hand washing, the goal is to suppress the spread of the disease such that the basic reproduction number, the average number of people that an infected person infects, falls and stays below one. With that outcome, the growth of new infections will moderate and eventually fall, hopefully to at or near zero. The more adherent the students are to these practices, the more quickly this phenomenon will occur. Testing allows campuses to map the infection landscape, identifying the numerous asymptomatic students who can foment community transmission on campus and into the local community. Frequent testing with rapid response is critical to limit infected people from spreading the virus, since the value of tests falls precipitously within 24 hours. Unfortunately, the UNC plan quickly unraveled, pulling the plug on in-person education and sending their students back home to spawn new infections from where they came.  

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With numerous other large colleges and universities around the nation planning to bring students back to their campus this week, will the UNC debacle be played out again and again, akin to watching a COVID-19 horror movie version of “GroundHog Day”? University of Notre Dame and Michigan State University have both already pulled the plug on in-person education. All eyes now turn to hundreds of large schools (listed by the Chronicle of Higher Education) with plans to hold “primarily in-person” or “hybrid” education. These include: Purdue University; University of Nebraska — Lincoln; Oklahoma State University — Stillwater; University of Oklahoma — Norman; University of Georgia — Athens;  Texas A&M — College Station; University of Iowa; Iowa State; Texas Tech University; and Virginia Tech. 

In an ideal world, no community transmission would occur. In the real world, 18 to 24 year olds will behave in a manner that will lead to new infections. The challenge is to get a sufficient percentage of them to buy into and comply with the proven public health practices so that the community transmission rate stays low enough to keep the basic reproduction number below one. A compliance rate of 80 percent or more will be necessary. 

When a well thought through investment plan turns south, sage advice is to stay the course. UNC did not heed such advice. Will other schools learn from this public health debacle and stick with their plans, in spite of the initial surge of infections? 

A silver lining with this event is that students around the country now see that if they violate the proven public health practices asked of them, they will create the same environment as seen at UNC and face the same risk of being forced to abandon any plans for in-person classes and asked to leave campus. What students could have viewed as a hypothetical possibility is now a COVID-19 reality show. 

Managing risk means that there is no turning back from opening universities once students show up on campus. Students must be embraced as partners to mitigate risk and protect the most vulnerable people in the local community. Closing campuses and sending infected students away will lead to more infections nationwide. 

The initial period when students arrive on campus is critical. Students now see that they are in control of their fate on campus. They are the best group to self-enforce compliance. UNC is the first school to demonstrate what does not work. Hopefully they will be the last. 

Sheldon H. Jacobson, PhD, is a founder professor of Computer Science at the University of Illinois at Urbana-Champaign. He applies his expertise in risk-based assessment to evaluate and inform public policy.