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Six lessons colleges are teaching us about COVID-19

Colleges around the country who brought students back to campus are detecting thousands of COVID-19 infections. Every school is simultaneously serving as a chemistry, behavioral and data science lab during the campus reopening experiment. What are these experiments teaching us?      

Here are six key lessons learned so far from the fall semester that colleges can use to get it right in the spring.      

First, tell the truth using data. Although most 18 to 24 year olds are asymptomatic or have mild symptoms, if a large enough pool of such young people become infected, some will suffer prolonged adverse health consequences and a small number will die. Based on data from the Centers for Disease Control and Prevention (CDC), less than one out of every 1,500 COVID-19 confirmed cases in this age group results in a death. However, this is on the same order of magnitude as deaths from other causes. COVID-19 deaths represent just 2 percent of all such deaths, a critical acknowledgement. Transparent communication of risk, even in a rapidly developing pandemic, is necessary to inspire trust.          

Second, explain why containing the spread of the virus makes sense and is in everyone’s best interest. The risk of widespread student infections is that it increases the likelihood of spread to at-risk populations. Few students would intentionally spread the virus to their grandparents. However, when they spread the virus to an older person, they are spreading the virus to someone’s grandparent. Once again, the data does not lie. Just 15 percent of the COVID-19 confirmed cases have been people over 65 years of age, yet this age group represents 80 percent of the deaths.         

Third, address misinformation quickly and with facts. For example, a CDC statistic that has circulated on social media and elsewhere is that 94 percent of COVID-19 deaths have been associated with other health conditions, including obesity, diabetes and heart conditions. Many health conditions have the potential to be fatal and it is unusual that the cause of death is a single factor. The more accurate depiction is that COVID-19 has caused many people to die earlier, and some much earlier, than they would have. With an effective vaccine and treatments, these premature COVID-19 related deaths will cease, reducing fatality rates in the future. Until then, COVID-19 will continue to result in premature deaths.        

Fourth, containing the spread of the virus requires a multilayered strategy. Two such layers are physical distancing and face coverings, which suppress the spread of the disease. Surveillance testing represents a third layer, meaning testing everyone. By only testing symptomatic infections, as many campuses are doing, asymptomatic infections spread undetected. Such infections can seep into the local community and can inadvertently infect at-risk persons. Without widespread surveillance testing, everyone is in a state of uncertainty about his or her infection status and risk to others.      

Fifth, acknowledge that national conflicting messages and misinformation have seriously undermined public health officials at the local, state and federal levels. The lack of testing capacity has fueled the myth “not everyone needs to be tested” and has the potential to kill people. Communicate the correct message. The COVID-19 impact on young healthy people on college campuses has little to do about their own personal health risk, but rather about their likelihood of infecting others at higher risk. The solution is exactly what the CDC website once recommended not to do. Create the necessary capacity to test everyone — symptomatic and asymptomatic —using a widely available, inexpensive test with a rapid turn-around time, such as the saliva test developed at Yale or the University of Illinois. Test people often, commensurate with their risk of exposure. If individuals take great precautions to avoid risky environments, weekly or biweekly testing may suffice. For those with risky or unknown risk exposure, multiple tests per week are appropriate.     

Six, communicate that testing students on college campuses is less about individual health risk and more about gaining knowledge of the population’s overall risk. Frequent and widespread testing empowers people with knowledge about their infection status, enabling every infected person to take the necessary precautions to protect others from becoming infected. Likewise, leaders are empowered with critically important data about how best to keep their people and their community safe. Colleges following the ill-conceived CDC guidelines (now corrected) by testing only those with symptoms are certain to miss asymptomatic contagious people who will keep the virus transmission chain alive. Such an approach ensures the virus will eventually reach at-risk people, who are more likely to have adverse outcomes. Giving everyone the knowledge of their infection status is a critical step forward to keep campuses open this fall, and into the future.    

Accurately and transparently communicating the degree of risk is critical; and such risk varies between average healthy college students and older grandparents. Using data to explain the situation and provide rationale for safe behaviors provides sound reasons for taking appropriate precautions that are in everyone’s best interest. 

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

Janet A. Jokela, MD, MPH, is the Acting Regional dean of the University of Illinois College of Medicine at Urbana-Champaign. She has served as an infectious disease and public health consultant throughout her career.         

Tags college reopening Coronavirus coronavirus infection rate Coronavirus testing COVID-19 COVID-19 testing schools reopening Social distancing testing capacity

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