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Ko Soe, a member of the custodial staff, disinfects the door handle of a classroom building at the University of North Carolina at Chapel Hill.

The Washington Post/Contributor via Getty Images

Many colleges and universities dug deep into their budgets to test, surveil, isolate, mask and distance their students and employees this fall in an effort to proceed with in-person instruction.

Most have spent tens of thousands, if not millions, of dollars on testing, personal protective equipment and other COVID-19 prevention measures. Some have so far kept widespread infections at bay. Others have been forced to halt in-person instruction and services for weeks at a time.

Still others experienced largely uncontrolled campus outbreaks and pivoted to all-remote instruction for the bulk of the semester. Those institutions are still stuck with a significant bill for just a few weeks of in-person instruction.

Three North Carolina colleges were forced to reverse course and send students home after in-person classes began on Aug. 10.

Outbreaks at the University of North Carolina at Chapel Hill happened fast. During the first week of the semester, more than 100 students tested positive for COVID-19, and the university quickly ran out of quarantine housing spaces. Seven days after classes began, students were told to pack up and go home.

Now, only about 1,500 students live on campus. The university has counted more than 1,150 infected students to date.

The university’s budget took a critical hit. The pandemic would cost upwards of $100 million, Chapel Hill's chancellor, Kevin Guskiewicz, told faculty members at the end of August. Despite higher-than-normal enrollment, Guskiewicz expects to lose $55 million in housing and dining revenue this fall. He also said that athletics budgets would take a beating.

“Make no mistake, this is going to be a very difficult time financially,” Robert Blouin, executive vice chancellor and provost at Chapel Hill, said during the faculty meeting.

UNC billed students' insurers for COVID-19 tests, and employee tests were covered by the state's health plan. Between May 1 and Sept. 2, the university spent more than $87,000 for expenses related to testing student athletes, according to a university spokesperson.

The university also purchased PPE for students and employees, including face masks, gloves and hand sanitizer. Face masks were made available at 30 distribution locations around campus. Chapel Hill spent an estimated $1.65 million on PPE, the spokesperson said. Final costs for some COVID-19 preparation items, such as local hotel rooms used for quarantine, are still being calculated.

Soon after Chapel Hill sent its students home, so did East Carolina University. It suspended in-person classes Aug. 24, two weeks after students arrived on campus. Students moved out by the end of the month and received prorated refunds for housing and dining.

The university paid for some COVID-19 testing and also billed student and employee insurance, according to an East Carolina spokesperson. As of late September, the university had spent $41,000 on testing. It spent $212,000 on masks for students and PPE for employees, including disposable and cloth masks, cleaning supplies, Plexiglas barriers, gloves, and gowns. It also spent $30,000 on additional student housing.

North Carolina State University, which sent its students home Aug. 26, spent $860,000 on face masks and $43,000 on hotel rooms for student housing. It has invested $5.2 million “to help safely operate campus, to restart research enterprises and to help ensure the safety of students, faculty, staff and visitors,” Mick Kulikowski, director of strategic communications and media relations at N.C. State, said in an email. This included placing hand sanitizer in buildings; outfitting classrooms, research labs, dining halls and office spaces with protective barriers; and providing classroom preparedness kits to faculty for in-person instruction, among other changes.

Testing is typically the most expensive piece of college COVID-19 mitigation plans, especially for institutions that have continued to test their students on campus, said Heather Pierce, senior director for science policy and regulatory counsel at the Association of American Medical Colleges. That said, student and employee insurance will cover tests in some cases.

Testing expenses vary widely depending on the type of tests and the laboratory the college has partnered with to process them. Some colleges have medical centers that can process tests on campus. Others have partnered with private laboratories such as Quest Diagnostics and LabCorp. Another option for colleges is to partner with other institutions to conduct and process tests.

“Testing is a part of virtually every plan to reopen safely and stay open,” Pierce said. “Some combination of screening and surveillance testing is absolutely essential.”

For the most part, colleges conduct three types of testing: diagnostic, surveillance and screening. Diagnostic testing seeks to determine whether a person is currently infected with COVID-19. Diagnostic testing is used for people showing symptoms as well as those who have reason to believe they were exposed, and it requires a highly sensitive test, which can be more expensive, Pierce said.

“That’s part of university strategies, but that’s really more medical care for the student health center,” Pierce said. “Diagnostic tests far and away are covered by insurance.”

Surveillance testing involves broad testing of certain populations -- for example, the occupants of a residence hall, patrons in a cafeteria or students and employees in an academic building. Surveillance test results are used to estimate the prevalence of COVID-19 on campus and are not intended to identify specific cases, according to AAMC’s guide on tests and testing. Some surveillance tests assess wastewater to detect COVID-19.

Many colleges are conducting wastewater testing, including small colleges like Goucher College, Colorado College and Albion College, as well as large institutions like the University of Arizona, the University of Virginia and the Massachusetts Institute of Technology.

By far the most expensive testing strategy is screening tests, Pierce said. Screening tests are given to asymptomatic people to determine if they are currently infected with COVID-19. Testing all students on arrival -- a popular option for colleges this fall -- would be classified as screening testing. Testing individuals in specific groups, such as sports teams, residence halls or classes, is also an example of screening testing.

“A screening strategy could range from ‘every student gets tested once per semester,’ or ‘we do a random sample of 10 percent of students through a lottery procedure,’ to ‘every student gets tested once or twice a week on a rotating basis,’” Pierce said.

At N.C. State, the cost per test ranges between $88 and $115, a university spokesperson said. So far, the college has conducted about 11,000 screening tests.

Generally, screening tests are not covered by a person’s insurance, because it’s not primarily for their individual benefit, Pierce said.

“The costs of that are being borne almost entirely by the university,” she said.

The added expenses for COVID-19 precautions come at a tough time for college finances. To pay for the additional expenses, Chapel Hill leveraged its COVID-19 relief funds from the federal government. It has also limited nonpersonnel expenditures and paused several capital projects that did not have external funding from a donor or board referendum. East Carolina University paid for the testing, housing and PPE through its operating budget and relief funds from the CARES Act. N.C. State directed some savings from hiring freezes and reduced travel budgets to pay for extra COVID-19 bills. It also implemented “major cost-saving measures” to offset losses in auxiliary revenue, a spokesperson said.

While colleges are working to slim down their budgets, they're also hit with millions in COVID-19 preparation costs, said Jim Hundrieser, vice president for consulting and business development at the National Association of College and University Business Officers.

Colleges and universities are aiming to provide the best experience they can for students, but flexibility comes at a cost, Hundrieser said. It’s expensive for institutions to maintain multiple contingency plans and abruptly alter their instruction strategies, quarantine options and testing protocols.

“You’re trying to be flexible to give some people the ‘college’ experience,” he said. “Creative thinking costs money in the end.”

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