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An individual is tested for COVID-19 at Cornell University.

Courtesy of Cornell University

The decision to bring University of Vermont students back to campus for an in-person fall was not a popular one with local residents in Burlington.

Like residents of many college towns, they worried the university students might spread COVID-19 among themselves and in the broader community.

"The community was very concerned in May and June," said Suresh Garimella, UVM’s president. He said he was asked, "'How many people have to die before you go back on your decision?' But now we hear praise."

Through a program of weekly required testing for all students and enforcement of social distancing and masking rules -- and the luck of being located in a state with the lowest COVID rates of any state in the nation -- the university has kept the virus largely at bay. Vermont reports just 27 total positive coronavirus tests among students since Aug. 7, and zero among faculty members and staff.

Vermont celebrated the milestone of its 100,000th test administered on campus last week.

“I’m very proud of what the students did,” Garimella said. “We have 0.01 percent positivity, and lately for the last three weeks, 10,000-plus tests a week with one positive or zero positive, and we’re in the middle of the ninth week of classes. But I’m not exhaling yet. This remains scary.”

Colleges are now well past the midpoint of this unprecedented semester and less than a month away from Thanksgiving, when many institutions plan to end in-person classes for the semester.

The fall semester started inauspiciously with the University of North Carolina at Chapel Hill sending students home during the first week of classes after seeing a spate of infection clusters. A number of other colleges have cut their planned in-person semesters short in response to concerning positive test numbers. Many more colleges have quarantined whole dormitories, or temporarily suspended in-person classes and issued shelter-in-place directions for students for one- to two-week periods to allow for contact tracing and to get case numbers under control. Meanwhile, some universities with some of the highest reported case numbers in the country pressed ahead with in-person semesters with no plans or transparent threshold for shutting down.

Other colleges, like Vermont, have seen relatively few cases, and with the end of the fall semester fast approaching, administrators at some of those institutions are cautiously claiming some measure of success, even as they stress the challenging circumstances they continue to face.

It's an open question how success can even be defined in the context of a pandemic that’s worsening in the U.S. by the day. The total number of COVID-19 cases nationally surpassed nine million on Friday, and the numbers are surging in 47 states.

"I do believe that there have been many college campuses that have been able by one way or another to keep this in check, either through strict mitigation strategies, or bubbles -- they’ve been able to keep their college bubble pretty small and not let a lot of virus in -- or through testing," said Rochelle Walensky, a professor of medicine at Harvard University and chief of infectious diseases at Massachusetts General Hospital. "But I also worry that for those that are not doing asymptomatic testing, especially colleges that are situated in communities that have a lot of disease, that there is unknown disease on those campuses that will then be returned to [Thanksgiving] dinner tables, unwittingly."

Walensky added that any measurement of success should look beyond questions about safety.

"I think there have been numerous universities that have demonstrated that what they’re doing is safe, it may be enough to get students back, but many university presidents are saying [their students] are not having fun. They're here, they’re learning, but they’re not getting the college experience that we wanted them to, and I don’t think the professors are happy. Many are worried that they are at high risk, and many are worried that they’re not actually doing their jobs.

"Do I think this whole thing is going well? No, I think it’s abysmal. Does that mean they’re not being kept safe? No. It just means they’re not being given what college is intended to give to them."

Testing, Testing, Testing

Some colleges that have reported low case counts share certain characteristics: they have aggressive testing programs combined with robust contact tracing and quarantine/isolation capacities, and they're located in Northeastern states that have been relatively less hard hit by the pandemic in recent months.

“My S-word is, ‘so far, so good,’” said Gary Koretzky, vice provost for academic integration and professor of medicine at Cornell University. Cornell currently reports a weekly test positivity rate of 0.2 percent. Cornell built its own lab for processing samples and is testing all undergraduate students in the Ithaca, N.Y., area twice weekly and all graduate and professional students once weekly. Employees that are in regular close contact with students are tested twice weekly while other employees on campus are tested on a weekly basis.

“To be perfectly honest, it’s gone remarkably well so far and in many ways better than we anticipated, but we also realize that everything is in evolution and constant vigilance is needed,” Koretzky said.

Across the state of New York, the Commission on Independent Colleges and Universities reports that its 108 private, not-for-profit members, including Cornell, have collectively conducted more than 854,000 tests and obtained only 1,354 positive results between Aug. 1 and Oct. 27.

"I think they have in the scheme of things been wildly successful," said Mary Beth Labate, the commission's president. "When we started planning for a reopening, our numbers in the state were so high. Not only has the state been able to bend the curve, but the schools have done an amazing job of keeping the virus at bay on their campuses."

Labate noted that many New York colleges required proof of a negative COVID test before students could return to campus.

Northeastern University, in Boston, has also kept case numbers down in part through frequent testing. Students get tested every three days, and faculty members, staff and contractors get tested twice weekly. Since the start of the semester, Northeastern has completed 320,764 tests and turned up 165 positive results -- 135 among students and 30 among faculty and staff members and contract employees.

“We’re testing within the virus transmission cycle,” said David Luzzi, Northeastern’s senior vice provost for research. “We identify positives so quickly and get them isolated that we keep the transmission rate on campus effectively well below 1, which is why if we didn’t have additional cases being introduced into the campus from the surrounding communities, we would have no cases at Northeastern because of our testing regimen being that aggressive.”

All of this testing does not come cheaply. Northeastern built its own testing lab and is handling contact tracing itself.

“We passed $50 million in terms of investment,” Luzzi said. “It’s the reality of higher education today, and we understand how some institutions are really struggling with the ability to do this. Northeastern has the advantage of being in a strong financial position going into COVID.”

Some experts see frequent testing of college students as important in preventing outbreaks in light of the risk of transmission by infected individuals who are asymptomatic or presymptomatic.

A recent analysis of testing strategies at more than 1,400 colleges by researchers affiliated with the College Crisis Initiative at Davidson College in North Carolina found that two-thirds of colleges and universities have no clear testing plan or are only testing “at-risk” students, those who are symptomatic or who have had contact with an infected individual. The analysis by the College Crisis Initiative, which is researching effects of COVID on higher education, found just 25 percent of colleges are conducting mass screening or random “surveillance” testing of students, and only 6 percent are routinely testing all of their students.

The stakes for higher education institutions extend not just to the health and safety of their own students and employees but also the safety of their broader communities.

Researchers from four different universities have estimated in a working paper that in-person college reopenings this fall were associated with increases in cases in surrounding counties and were associated with an additional 3,000 COVID cases per day in the U.S. A recently published working paper led by researchers at Wisconsin’s Gunderson Medical Foundation uses genomic sequencing to link a virus substrain that circulated during a September outbreak among college-age residents in La Crosse, Wis., to one that subsequently infiltrated two skilled nursing facilities, resulting in deaths among its more vulnerable elderly population. Neither working paper has been peer reviewed.

The New York Times has tracked more than 214,000 COVID cases, and at least 75 deaths, at U.S. colleges and universities since the pandemic began. Most of the deaths involved college employees, but there have been at least three reported deaths of students from COVID or COVID-related complications.

Some colleges that saw large surges in cases at the beginning of semester are pointing to declines to cases since then as evidence that their COVID-19 control measures are proving successful.

Richard Barohn, executive vice chancellor for health affairs at the University of Missouri-Columbia, wrote an Oct. 22 op-ed in the Columbia Daily Tribune citing an almost 90 percent drop in reported cases on campus since early September as evidence that the university’s COVID strategy is working. Missouri reported 79 active cases among students on Friday -- down from a peak of 683 active cases on Sept. 5 -- and 1,917 total student cases since Aug. 19.

The 1,917 total reported cases account for about a 7 percent infection rate for students on Missouri's campus this fall. The university reports that no students have been hospitalized.

Barohn's op-ed describes Missouri's public health control measures such as hiring contact tracers and providing quarantine and isolation housing, as well as campus policies requiring face masks, social distancing and daily symptom screening and restricting large gatherings, among other measures. It's possible, however, that a lower proportion of disease is being detected at Missouri than at other colleges with more intensive testing programs. Missouri is not doing randomized or mass surveillance testing of individuals who are not symptomatic or who have not had known contacts with infected individuals.

"We have been operating under the principle that our community should take precautions as if everyone and anyone could have the virus, a strategy that has had success containing the virus," Barohn wrote in the op-ed. "While mass testing strategies have a role in non-socially mobile, high-risk populations such as nursing homes and other closed communities, they have not been successfully identified as an effective public health measure in preventing spread among populations of young, asymptomatic and otherwise healthy adults."

Missouri is not alone in seeing a reduction in reported case numbers after an initial surge earlier in the semester. Anton Ivanov, an assistant professor of management information systems at the University of Illinois who is tracking data on COVID testing and positivity rates at more than 100 colleges, said cases on college campuses have been on a downward trajectory nationally after “a considerable spike” about five weeks ago.

Ivanov said such a trajectory is to be expected. “If a university as a closed network of people is implementing some significant steps in order to contain the spread, such as testing, such as compliance [with behavioral expectations], then why won’t these universities observe a decline in their overall cases?” he asked.

Benjy Renton, a senior at Middlebury College who tracks COVID cases on college campuses nationally for his weekly newsletter, said he has seen a similar pattern among the 94 colleges in the data set he is tracking.

"The general curve in the aggregate in the number of cases that we’ve seen each week throughout these 94 schools has decreased from that initial kind of shock period in August and September," Renton said.

Renton said while it's good colleges have brought case numbers down, he would have liked to see more colleges do entry testing at the start of the semester. While some colleges chose to do entry testing, guidance for colleges from the Centers for Disease Control and Prevention that was available over the summer did not recommend entry testing; that guidance has since been updated to say that "a strategy of entry screening combined with regular serial testing might prevent or reduce" virus transmission.

"The problem is we’ve kind of become numb to numbers that are really terrible," Renton said.

As Thanksgiving approaches, some colleges say they made the right decision to reopen for in-person classes. Senior administrators at the University of Kentucky recently wrote an op-ed in the Courier Journal highlighting declines in new and active case numbers observed over the course of the semester.

Kentucky -- which was among those colleges that required entry testing upon students' return to campus -- reports 2,341 cases over the course of the semester, including 87 active cases and 2,254 recovered cases. About 9.2 percent of the 25,339 students on campus have been infected.

“We also know the widespread uncertainty makes it tempting to look at one statistic -- the cumulative number of positive tests over several months -- and draw conclusions that sow seeds of concern. Yet, we believe the decision we made months ago to return to campus was the right one,” wrote Eli Capilouto, president of the university, and Robert DiPaola, dean of the College of Medicine and project lead for the expert team that advised the university on health and safety protocols for reopening.

"Because of the public health infrastructure we have built on our campus, UK has tested and detected more cases of the virus in our university community than any other institution in our local community," they wrote in the op-ed. "We are several times larger than the next employer. We test more than anyone. We contact trace more than anyone, and we report our numbers, more frequently and more transparently, than anyone. We are doing more to mitigate and manage."

DiPaola said in an interview that he and other administrators didn't know what to expect at the start of the process.

"At the midpoint [of the semester], a number of things we hoped to achieve were achieved, in terms of keeping the campus open for students to have an opportunity for a residential experience. Obviously we've been very clear in terms of guidelines and spacing in classrooms and so forth. We redesigned how housing would be structured" -- every student on campus has a single bedroom -- "how classrooms would be structured.

"We've gone past the midpoint and felt at least at that point, at this point, that those things that we sought to achieve by keeping a residential experience were achieved. Granted, we still have to get to Thanksgiving. We're getting there."

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