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College COVID-19 Policies Controversial as New Semester Begins

Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.

With cases of COVID-19 fueled by the contagious Omicron variant still racing across the United States, many colleges and universities from coast to coast have started their spring terms with remote learning during the month of January, with the goal of eventually returning to in-person instruction.

Many of these schools insist these decisions are driven by examinations of available science. For example, University of California/Davis chancellor Gary S. May explained in a video why the school would begin the semester with remote instruction: “We are making decisions based on the science and public health guidelines that we’ve been following from the beginning.”

However, some critics have charged that institutions of higher learning in the US have ignored science and are enforcing COVID-19 policies that are unfair to students. “Universities are supposed to be bastions of critical thinking, reason, and logic,” wrote Johns Hopkins Medicine surgical oncologist Martin Makary, MD, MPH, in an essay that appeared on the online publishing platform Substack. “But the Covid policies they have adopted…have exposed them as nonsensical, anti-scientific and often downright cruel.”

Makary’s essay, titled “Universities’ Covid Policies Defy Science and Reason,” offers several examples of what he considers wrongheaded campus practices intended to combat COVID-19: Routine testing of all students, whether or not they have symptoms. Requiring all students who test positive to isolate for long periods, even if asymptomatic. Strongly recommending mask wearing, even when outdoors. Stay-in-room orders that confine students to their residence halls except for classes and tending to other essential needs.

Makary (who did not respond to a request for comment) insists there’s no scientific data to support these and other restrictive rules, and that many of what he calls “Draconian Covid policies” on US campuses do more harm than good.

However, WebMD spoke with several public health authorities who argue that some — though not all — recently enacted campus requirements and restrictions are, indeed, based on solid research. And that policies aimed at curbing COVID-19 on campus must strike a balance between science and other factors.

Harrison Shapiro was already frustrated with Princeton University’s COVID-19 policies — enough so that the mechanical and aerospace engineering student condemned them as counterproductive and ineffective in an editorial that appeared in the Daily Princetonian last December 5. But then Princeton upped the ante. 

During December, outbreaks of COVID-19 infections on campuses such as Cornell University (where more than 900 students tested positive late in the fall semester) undoubtedly caught the attention of college administrators across the country. On December 27, Princeton officials announced that undergraduate students, like Shapiro, would not be permitted to leave Mercer County, New Jersey, where the campus is located, until at least mid February, when the policy would be revisited.

Exceptions, the university stated, are made only for “extraordinary circumstances” and for university-sponsored travel, such as athletic teams crossing the county line to compete. The new policy does not apply to faculty, staff, or graduate students. “So my professor or a graduate student could fly to Johannesburg and go clubbing all weekend long, then come back, no problem,” says Shapiro. “Meanwhile, if I go visit a friend in Philadelphia, I could be suspended.”

In a statement, Princeton officials said that the goal of keeping undergrads close to campus was to establish a “bubble” that would help limit their exposure to the coronavirus. The stay-in-county order adds to other restrictions Princeton had already placed on undergraduates — such as limits on how many students (20) can gather in one place — that have created a somber atmosphere on campus, says Shapiro. “You have a bunch of depressed students,” he says, noting that demand for mental health services on campus spiked last year.

Is there a scientific rationale for telling Princeton students they can’t leave the county? “No, that’s sort of crazy,” says infectious disease specialist Davidson Hamer, MD, a professor of global health and medicine at the Boston University School of Public Health and School of Medicine. “That sounds a little excessive.”

Likewise, this advice from Cornell officials — “we strongly recommend masking outdoors when physical distancing is not possible” — strikes some observers as extreme. “I don’t understand the rationale for that decision. The science says that the problem is with indoor air,” says nurse practitioner and public health expert Anita Barkin, DrPH, MSN, co-chair of the American College Health Association’s COVID-19 task force. Masks may be a good idea outdoors in large crowds where people gather closely, says Barkin, but otherwise the science indicates that face coverings are primarily beneficial when worn indoors.

Meanwhile, other strategies now required at some schools have solid science behind them, says Hamer, including surveillance testing of all students and faculty, regardless of symptom status. In the early stages of the pandemic, says Hamer, “the universities that didn’t do this got into trouble and had fairly large outbreaks.” On the other hand, he says, schools that conducted surveillance testing were better protected.

Hamer saw this firsthand during the fall of 2020, when transmission of COVID-19 was worsening, yet BU opened up to in-person instruction. To reduce the risk for outbreaks, university health officials had students, faculty, and staff undergo PCR tests twice a week, in addition to enacting other measures, such as requiring mask use,  contact tracing, and rapidly isolating people who tested positive.

“We were able to keep things under control for the whole semester, with no evidence of in-classroom transmission of COVID-19,” says Hamer, lead author of a study describing the effort that was published last June in JAMA Network Open. Testing all students and employees routinely, symptomatic or not, “is a strategy that can help control spread on a campus,” says Hamer.

Similarly, Hamer says that requiring students who test positive for COVID-19 to isolate makes sense, whether or not they have symptoms. “There are a number of studies showing that asymptomatic individuals can transmit the virus, and if you’re not isolating them, there’s a risk for spread,” says Hamer.

The question facing colleges, however, is how long students who test positive should remain apart from others. The Centers for Disease Control and Prevention (CDC) recently changed its recommendation on isolation after positive tests, shortening the period from 10 days to 5 days, after which people who are asymptomatic or whose symptoms are clearing up can resume normal activity as long as they wear masks for 5 more days. But the CDC didn’t say whether that recommendation applies to colleges, says Barkin, adding “we’re working with the CDC to clarify their recommendation.”

Some campus COVID-19 policies are at least partly influenced by nonscientific factors, however. For example, requiring students to be tested upon arrival on campus allows health officials to identify those who are positive and prevent them from spreading the virus to other students. But there are practical reasons for testing students on arrival, too. “Requiring everyone to test gives you an accurate determination of the burden of disease arriving on campus at the beginning of the semester,” says Angela Clendenin, PhD, an instructional assistant professor of public health at Texas A&M University. “That allows you to make decisions such as how many students you will allow in classrooms and helps you determine whether you have enough resources on campus to respond if you have a large number of cases.”

Laws can shape campus COVID-19 policies, too, though not always for the better, says Barkin. “Some states restrict the use of certain public health mitigation strategies on campuses, which has handicapped schools in those states in responding to outbreaks and decreasing the transmission of disease,” she says. Florida, for instance, forbids colleges from asking students for proof of vaccination, while in Texas public educational institutions cannot require vaccination. 

In his essay, Makary points to research indicating that young people between ages 15-24 account for just 0.001% of patients who die of or with COVID-19, suggesting that the benefits of tight rules and restrictions may not be worth the sacrifice and inconvenience. But Barkin says that argument leaves out a lot of vulnerable people.

“You can say, ‘Just let COVID-19 burn through this population because it only causes mild disease,’ ” she says. But that ignores the fact that every campus includes people who are elderly, have chronic diseases such as diabetes, or have compromised immune systems as a result of disease or medication — all of whom are at risk for serious cases of COVID-19, says Barkin, even if they’re vaccinated. “That population needs to be considered in your planning,” she says. “And the message to students is: You’re a member of a community, where we value every member. So get vaccinated and get a booster.”

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