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California State University, Chico

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In interviews and in a call with several governors last week, three of the nation’s top medical leaders dealing with the coronavirus outbreak urged colleges not to close residence halls and send potentially infected students back home.

“That’s the worst thing you can do,” Dr. Anthony Fauci said on the Today show, echoing Dr. Deborah Birx, the White House’s coronavirus response coordinator, and Dr. Robert Redfield, director of the Centers for Disease Control and Prevention.

But on the ground, university officials who have decided to do just what the health leaders are urging them not to do say that continuing to house students amid a rapid outbreak is easier said than done.

While some, like the University of Alabama system, have decided to continue housing students even as they’ve seen large spikes in students testing positive for the disease, others like California State University, Chico, have opted to stop housing nearly all students, saying that so many resident assistants got sick that keeping residence halls open poses its own dangers.

North Carolina State University said it took a similar step before the warnings because its outbreak was so rapid, it feared running out of room to quarantine all who needed to be.

To some critics, that colleges are responding to outbreaks in different ways reflects the absence of a clear national strategy.

Despite the concerns raised by Fauci and others, the federal government hasn’t formally told colleges not to send students home. Guidance for colleges issued by the CDC remains silent on the issue, though it also does not say it’s OK for colleges to close residence halls, either.

In addition, the CDC has urged colleges when they reopen campuses to work closely with local health officials. But colleges are hearing different levels of concern over sending students home.

Last week, Terry Hartle, senior vice president of government relations at the American Council on Education, said colleges are receiving mixed messages. At the same time as Fauci and Birx were making their remarks, President Trump was pushing the Big Ten athletic conference to shift gears and play football this fall.

“There’s a failure to have unified national leadership,” said Dr. Georges Benjamin, executive director of the American Public Health Association.

Meanwhile, on the ground, college leaders who have decided to close their residence halls described following CDC and other guidelines in reopening their campuses, including quarantining students who become sick. But they have seen their plans overwhelmed by the sheer numbers of people infected and the speed of the disease’s spread.

At Chico State, President Gayle Hutchinson said in an interview last week the college had hoped to prevent an outbreak in part by limiting the number of students it houses to 2,200 instead of the usual 16,000.

It had students pledge to act responsibly, required them all to take COVID-19 safety training and ran public service announcements to drill home the point.

“But at the end of the day, it just takes a few people, and it's an exponential spread, not just multiples,” Hutchinson said.

It’s certainly possible to get the virus from passing someone in the supermarket, she said. But she has heard about large off-campus parties involving her students, as there have been in other parts of the country.

She saw the number of positive cases among 18- to 24-year-olds in surrounding Butte County, a rural area north of Sacramento, explode by more than 500 in the first week after classes started on Aug. 24.

Each residence hall on campus had at least one student who had tested positive for the disease. While the university had reduced the number of students it houses, some students still shared bathrooms.

Critically, so many of Chico State's 24 residential advisers had also gotten sick, she didn’t feel the university could provide enough supervision for the students. The university couldn’t find replacements.

“It was a difficult decision,” she said of deciding to close housing except for about 100 students being quarantined or those who were granted exemptions because they had no place else to go.

“We said at the very beginning our first priority was the safety of our students and faculty, and to continue to provide a high-quality education,” she said. “We’re trying to make the best of a difficult situation.”

North Carolina State University on Aug. 26 decided to close its residence halls, except for those serving students who had received an exemption, when it identified three clusters, defined as five or more cases in close proximity or at the same location. The university had 126 new cases that same day, bringing to 907 the number of students testing positive for the virus since Aug. 11, according to the university’s dashboard tracking the number of cases.

“Over the past few days, our campus community has experienced a quickly rising number of positive cases of COVID-19 in both on- and off-campus housing,” the university’s chancellor, Randy Woodson, said in a message to the campus. “We hoped and strived to keep residence halls open and safe to best serve our students. However, the rapid spread and increasing rate of positive cases have made our current situation untenable.”

Pressed further about the decision, university spokesman Mick Kulikowski said a concern was that at the rate the virus was spreading, the 166 units N.C. State had set aside to quarantine infected students wouldn’t be enough.

“These units were trending toward being completely full,” Kulikowski said.

Local and state health officials were consulted before the university made the decision, on the same day as Fauci’s Today show appearance. And although the discussions happened before the warnings by top federal officials, the local health agencies “advised that we consider reducing the on-campus population density and allow for single rooms and private bathrooms for residents, where possible,” Kulikowski said.

“It’s a complicated question with multiple factors,” Kulikowski said of the concerns about students spreading the disease in their home communities. But like Hutchinson he said, “the safety and health of the campus community, though, was prioritized first.”

Similarly, UNC Chapel Hill students, other than those granted waivers or in quarantine, were told Aug. 17, before the comments by Birx and Fauci, to move out by Aug. 30.

The university had seen its percentage of positive tests jump from 2.8 percent to 13.6 percent. “As much as we believe we have worked diligently to help create a healthy and safe campus living and learning environment, we believe the current data presents an untenable situation,” Chancellor Kevin M. Guskiewicz said in a message to the campus.

At the State University of New York at Oneonta as well, the system's chancellor, Jim Malatras, and campus president Barbara Jean Morris closed the campus last Thursday after being alarmed by a sudden jump in cases -- 100 in a single day, to bring the number of infected students to 389.

New York governor Andrew Cuomo had on Aug. 27 ordered campuses in the state to pause in-person operations for two weeks if there were 100 cases or if 5 percent of the campus population tested positive for the virus.

But Malatras said he didn’t want to just pause for fear the virus would spread even further. “I was not comfortable with that. Our president was not comfortable with that,” he said at a press conference announcing the closure of dorms and referring to Morris.

“It’s a rapidly moving beast,” Malatras said. “A party of just a few dozen students resulted in nearly 389 cases that we know today. There could be more.”

No Simple Strategy for Stopping the Spread

The steps those universities are taking to make sure they are not sending asymptomatic but infected students around their states and the country are as varied as the advice they’re getting from local health officials.

Hutchinson acknowledged the university doesn’t have access to enough tests to see if everyone being sent home is free of the virus.

“It’s important for the students going home, like other younger people, to act responsibly to not spread the virus. I’m confident a majority will,” she said.

Lisa Almaguer, spokeswoman for the Butte County public health department, said in an email the county hadn’t given the OK to close the residence halls, but she didn’t reply when asked if it had raised concerns with Chico State about how to respond to the outbreak.

Asked about the concerns that sending students home could spread the disease, she noted that college-aged students are free to travel the state regardless of what Chico State does.

She did say the department advised the university to quarantine infected students for 14 days if it was going to otherwise close residence halls.

At North Carolina State, Kulikowski said the university tested more than 3,000 students at residence halls and Greek housing that were identified as clusters for the virus. It also provided testing to students who wanted it.

Those living on campus who tested positive for the virus or were in close contact with someone who was were told to remain in isolation in their residence halls until cleared by the campus’s health services. But they were also allowed to return home to quarantine with their parents or families, if they wanted.

In all, Kulikowski said, most students were tested before going home. However, not all were. The university, a public institution, can’t force everyone to be tested, he said.

Instead, North Carolina State gave students instructions as they headed home, urging them to get tested and to self-quarantine for 14 days, “as a critical step to help slow the spread of COVID-19 and protect your family, friends, and community.”

But Amy Silver, a freshman at N.C. State, told The News & Observer, a newspaper in North Carolina, she was concerned about inadvertently spreading the disease to her parents and brothers back home. “I am worried that I have contracted it and don’t have symptoms yet,” she said.

“I don’t want it to affect them in any way,” Silver said. “They’re such hard workers and so I’d hate potentially for it to affect their health and their jobs.”

At SUNY, the concern over spreading the virus was mitigated somewhat by a new test the college had access to in which pools of students are tested.

Rather than having to test everyone in a group again if there were a positive test, the new test allows them to identify which ones are sick, and they can let the others go home.

Benjamin, of the American Public Health Association, though, is concerned about colleges sending students home, particularly if they have not been tested. “The problem is who are they going to infect on the way,” he said, though he acknowledged the risk is less if students’ families live nearby and they can drive a short distance home.

Pooled tests are a proven strategy, he said. But even they aren’t perfect. Some who are infected by the virus might test negative, particularly if they are tested in the first few days after they are infected because of the time it takes for the virus to appear.

“You could miss someone,” he said of letting students go home if they test negative. “But nothing in life is 100 percent perfect. All we can do is reduce the risk.”

Benjamin criticized the lack of detailed guidance from the CDC. “Normally what would have happened is the CDC would have given detailed guidance to the colleges, Benjamin said. “It’s not taking away [the colleges’] authority but having people in the scientific space give a consensus recommendation.”

Devin Jopp, chief executive officer at American College Health Association, which hasn’t issued guidance on how to close, also said CDC recommendations would help colleges, even if they are working with local health officials to decide whether to close residence halls.

Some county health departments are overwhelmed and some do not have the same expertise as others on infectious diseases, he said. “Colleges absolutely should try to coordinate with their health officials, but you have to recognize it’s sometimes going to fall on the shoulders of the institutions,” he said.

To Jopp, the closure of colleges points to the need for Congress and the Trump administration, as they remain in a stalemate over another coronavirus relief package, to provide more money for colleges.

Some colleges, particularly those without health centers, may be overwhelmed by an outbreak and feel like they have no choice but to close residence halls, Jopp said. Others, like Chico State's Hutchinson, may feel like their schools are unequipped to handle an outbreak because of a shortage of staff, facilities or equipment, to keep their students and faculty safe if they keep residence halls open.

Some colleges also do not have the ability to quarantine all students who are infected or could be infected, to keep the disease from spreading through residence halls, especially if there’s a major outbreak.

“People think all the colleges have all this space laying around, but that’s not always the case,” Jopp said.

Not all colleges are able to do contact tracing to keep the virus from spreading. “It’s expensive. I don’t know how many can afford to do that. We’re talking about millions of dollars,” he said.

Indeed, the amount of testing being done on campuses varies greatly.

The CDC's interim guidance to colleges on testing recommends testing of symptomatic students and employees and those who have known or suspected contact with an infected individual. But it makes no recommendation with regard to broad surveillance testing of asymptomatic students and staff over the course of a term, or if colleges are considering sending students home.

It does note that institutions may consider the strategy in areas with moderate to substantial community transmission "to identify outbreaks and inform control measures."

But while some colleges may feel they have no choice but to send students home, it does pose a risk, Jopp agreed.

“If you’re going to send students home, you’re not going to know 100 percent that everyone is COVID negative. That’s just not what’s going to happen,” Jopp said.

The best colleges might be able to do if they send students home, in some cases, is to be in contact with parents to quarantine and keep themselves safe, he said.

“It’s a difficult choice between two tough decisions,” he said.

‘Keep Them at the University’

But others say sending students home isn’t the thing to do. The CDC guidances do advise keeping infected students, or those who have been in contact with them, away from others.

“Keep them at the university in a place that’s sequestered enough from the other students,” said Fauci, director of the National Institute of Allergy and Infectious Diseases. “But don’t have them go home, because they could be spreading it in their home state.”

Birx urged governors to pass the message on to colleges, warning that the closure of campus housing she was seeing could lead to a major outbreak as the South saw in June, according to a staff member for one of the governors who was on the call.

Redfield, on the same day as Fauci’s appearance on the Today show, also urged colleges to isolate infected students in an interview with Yahoo! Finance.

“We don’t believe it's in the interests of our nation for students to be sent home and reseed all different parts of our nation,” he said.

San Diego State University officials were so alarmed by an additional 120 cases among its undergraduates -- which brought to 184 the number of positive cases since Aug. 24 -- that they ordered students to stay in their living units for the entire three-day Labor Day weekend. The university, which like Chico State is part of the California State University system, then extended its stay-at-home order until Sept. 14.

But it decided not to send students home, partly out of concern of spreading the virus elsewhere, said Andrea Dooley, the university’s associate vice president for student affairs. Like the other universities that did restrict campus housing, she said the university would still house students like those from out of the state or the country who would face hardship going home.

However, the university, which emphasized training resident assistants in safety, hasn’t faced an outbreak among residence hall staff.

Last Friday, the University of Alabama at Tuscaloosa announced another 846 positive cases, bringing the total number of infections among students to 2,047. However, the Alabama system announced last week that its coronavirus task force had adopted a statement by Dr. Mike Saag, an expert in infectious diseases at the University of Alabama at Birmingham, saying it’s safer for universities to remain open.

“The risk in closing a college campus and forcing thousands of students home at once is that the virus then has the opportunity to spread more widely to other geographic locations and possibly more vulnerable populations,” the statement said.

Karen Landers, assistant state health officer for the Alabama Department of Public Health, said the decision on whether to close residence halls is ultimately up to the university. “But sending students home,” she said, “seems like just moving the problem somewhere else.”

Since the decision to close residence halls, the number of daily cases is dropping, officials at the Tuscaloosa campus announced last Friday. The university attributed it in part to the city closing its bars.

However, Tuscaloosa’s mayor on Friday announced the city’s bars could reopen Sept. 8.

Chico State’s Hutchinson agreed more testing would have helped, as her students went back home throughout California.

In retrospect, Hutchinson said she would have reduced the number of students in residence halls even more. But she stood by her decision to reopen in the first place.

To other college presidents who may find themselves dealing with an outbreak, Hutchison said, “we’re all committed to helping students pursue their dreams, and we don’t want to stop them if they want to earn a degree.

“All of us have great intentions, and every institution may have stress tested their plans and think they’ve thought of everything,” she said. “But at the end of the day, you may have to pivot on a dime.”

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