Isolating With COVID … and a Roommate

Gone are the days when students who test positive for COVID-19 moved to designated isolation housing on college campuses.

As colleges prepare for projected surges in cases fueled by the highly transmissible Omicron variant, many are adjusting their isolation procedures to allow students to isolate in their dorm rooms, even if they have roommates.

Harvard University, for example, transitioned last week to such an “isolate-in-place” policy for undergraduates. Roommates of infected students can apply to temporarily move to alternative housing to wait out their roommate’s illness, but the university stressed in a message to students that such alternative housing is “very limited” and “will only be available as space allows.”

Other options Harvard lays out for students whose roommates are infected are to “reconfigure your suite to enable separate sleeping areas” and “stay elsewhere off-campus if you can safely do so.”

Harvard declined to comment beyond its written communications to students or make an administrator available for an interview about the policy change. In a Jan. 12 message, Giang T. Nguyen, executive director of Harvard University Health Services, said the changes to its isolation guidelines were informed by guidance from public health agencies and experts as well as data related to Omicron.

“With our Harvard community’s near universal vaccination, the majority of infected individuals in our community are having no symptoms or mild symptoms that resolve quickly,” Nguyen wrote. “Thus, we are confident in our ability to proceed with plans for in-person learning in late January while applying new protocols which include community-wide boosters and a shortened period of isolation-in-place followed by strict masking.”

Sandra Nelson, an infectious disease physician at Massachusetts General Hospital who sits on Harvard’s COVID monitoring committee, said isolation capacity is a challenge with Omicron.

“I wasn’t part of the group that was making the decisions, but I do know if you look at just the numbers of individuals who tested positive and the availability of isolation space, there wasn’t going to be isolation space available for everyone who tested positive,” she said.

“Part of what our group did was advise around trying to balance all of the many risks and harms, not just the COVID risks and harms,” she said. “This is sort of where it comes down—if the university had to choose between accepting a change in isolation policy or not being able to open to in-person experiences for students, which of those two is the worst harm?”

Harvard is not alone in changing its isolation protocols, as college officials stare down another semester with another variant of COVID driving a surge in cases.

Northeastern University, for example, is also allowing students to isolate in their rooms and telling roommates of students who test positive to consider themselves “close contacts” and to monitor themselves for symptoms.

Ken Henderson, chancellor and senior vice president for learning at Northeastern, said in a memo explaining the policy change that the university’s vaccination and booster requirements “necessitate a shift in our collective thinking.”

“While the omicron variant has led to substantial increases in transmission, the most current data demonstrates that the vaccines remain remarkably effective in reducing the risk of severe illness,” Henderson wrote.

“As a result, many students will be asymptomatic or exhibit only mild symptoms,” Henderson wrote. “The vaccines allow us to begin shifting our mindset and to approach Covid much more like a cold or flu season, which tends to be low-risk for healthy, vaccinated individuals of a college-aged demographic.”

Some argue these are shifts in the wrong direction.

“Harvard will have uninfected students sleep in same room as their infectious roommates unless they petition for a new room,” the noted epidemiologist Michael Mina wrote on Twitter. “I’d be pissed if it was my kid. A slippery slope for when cases are manageable & Harvard is trying to keep outbreaks at bay.”

Izzy Stephens, a student at Northeastern, said she was upset to about being “forced to go to classes where I might be sitting right next to someone whose roommate has COVID.”

“The main reason I have a problem with this change was said by the university explicitly,” Stephens said. “They want to treat COVID as endemic, as a disease that is a question of when, not if, you get it, and they’re doing this without the consent of students. There are a lot of students, a lot of professors in the community and a lot of members of the Boston neighborhoods that all the students live in that are not as healthy as Northeastern thinks their students are.”

Eric Feigl-Ding, an epidemiologist, health economist and senior fellow at the Federation of American Scientists, said it could make sense to allow students to isolate in their rooms if there are certain air-disinfecting and ventilation measures in place, including HEPA filters and fans in shared bathrooms.

“Separate isolation housing is probably best, the optimal,” Feigl-Ding said. “The issue is Omicron is so overloading everything, and now we have vaccines. Isolating in your own dorm, your own apartment seems OK if you have sufficient alternative housing for your roommate.”

Feigl-Ding said it can’t just be a matter of saying roommates can obtain alternative housing “if available”: “That is really dangerous,” he said.

New guidance for colleges released Wednesday by the American College Health Association’s COVID-19 task force recognizes that isolation space may be limited on some campuses. The group advises colleges with limited isolation space that they can allow students to isolate in place “only after the roommate(s) are thoroughly informed of the risks of infection of sharing a household with an individual who is COVID-19 positive and are given options for alternative housing, if available.”

“This option should not be offered if the roommate of the positive student is immunocompromised or in another high-risk group,” the ACHA guidance says.

Another option ACHA says colleges with limited isolation space can consider would be having students who live near campus and have their own transportation to isolate at home.

The ACHA task force’s recommendations for isolation are stricter than those of the Centers for Disease Control and Prevention in that, unlike in the CDC guidance, the college health group is recommending that colleges utilizing a five-day isolation protocol require students to test negative on an antigen test prior to leaving isolation. The task force says colleges can utilize either the CDC’s general guidance recommending isolation for five days, or its specific guidance for congregate settings, which recommends a 10-day isolation period.

Lehigh University, in Pennsylvania, is allowing students to isolate in place this semester except in instances where a roommate is at high risk for serious disease from COVID.

“In anticipation of what we’re expecting to be high positivity, we were trying to plan accordingly for that and thinking about students who are going to be most at risk,” said David Rubenstein, executive director of Lehigh’s Health and Wellness Center. “Up to this point, we’ve been able to manage with the isolation housing that we have set aside, but we’re trying to think ahead of the curve and don’t want to find ourselves on day number six, day number seven, out of isolation housing spaces.”

Connecticut College is continuing the policy it started in the fall of allowing COVID-positive students who live in single rooms to isolate in their rooms and use a specific bathroom designated for students in isolation in their building. The college is also newly encouraging students who live in multiple-occupancy rooms and whose permanent residence is a “drivable distance” from campus to make plans to isolate at home if they have a private room in their home where they can isolate.

“I see these as being steps toward future management in just living with COVID,” said Victor Arcelus, Connecticut College’s dean of students. “Having students isolate within the residence halls is a step in that direction.”

St. Lawrence University in New York has put together a plan A and a plan B for isolation this spring: plan A will use the campus’s on-campus quarantine and isolation space, which has about 37 beds, and space rented at the nearby State University of New York at Canton, which has an additional 100 beds. Plan B is for positive students to isolate in their residence halls if their roommates or suite mates agree (roommates would have to sign a consent form).

“If we have run out of quarantine and isolation space and students are unable to isolate themselves in their rooms, then students who live within 500 miles of campus would be required to isolate at home,” St. Lawrence administrators said in a Jan. 18 update. “We will do everything we can to make this an option of last resort for students who are required to isolate because we recognize the burden on the students and families.”

Gettysburg College in Pennsylvania is requiring students who live within 300 miles of campus to isolate or quarantine at home.

“We have identified additional isolation and quarantine spaces recognizing the likelihood of an increase in positive cases on campus,” the college says in a message about spring semester COVID protocols. “However, the food service, facilities, and other staffing resources available to support students in isolation and quarantine are finite, and redirecting those resources disrupts our ability to fully conduct day-to-day operations.”

Jamie Yates, a Gettysburg spokeswoman, said the policy is similar to what the college had in place last semester, when the college “expected” students who tested positive to isolate at home but had a limited number of isolation rooms available for those who could not.

“Just like we did in the fall, we will work with students to understand their individual circumstances when they are determining whether or not they can return home,” Yates said via email. “We certainly appreciate if students can go home to isolate or quarantine as it will free up our identified isolation and quarantine space on campus for students who aren’t able to travel home.”

The editorial board of the student newspaper, The Gettysburgian, published a Jan. 11 editorial opposing the policy.

“Logistically, this is a nightmare for students,” the editorial board wrote. “A large population of students does not have cars on campus, including all first-year students. Does the College then expect families to travel to Gettysburg and travel with their COVID-positive student back home in an enclosed space for up to five hours? Will those families be able to leave their work and obligations instantaneously when their student tests positive? Or potentially worse, expect COVID-positive students to take public transportation? For students who have cars on campus, will the College provide reimbursements for the gas expenses to travel back and forth up to 300 miles in five days?”

“Additionally, sending COVID-positive students home means exposing their families to COVID,” the editorial continues. “Though sending a student with COVID to their family may reduce the spread on campus, it still exposes more people to COVID than would otherwise be exposed.”