Commentary: CoronaVirus and College Students

I have heard the argument over and over about how college students who get COVID-19 are at low risk.  What we know at this time about the risk to that age group is as follows:

  • 2-3 per 5000 will end up hospitalized (at least 4 students in Virginia have been hospitalized)
  • Some will die (the number is too low to estimate, but students have died -- there have been press reports)
  • There are serious mid-term complications in a significant fraction of cases, even asymptomatic cases.  Based on the impact, some of these will be long term, or permanent.  These include lung, heart, kidney, and neurological issues.  
Furthermore, even in college towns, the students are not isolated. Other people live in the town.  We are currently seeing an increase in cases not associated with college aged students lagging the dramatic increase in college age student by about two weeks.  This include more vulnerable groups.

The college environment is good place for the disease to spread.  The same factors that make college a great transition to adulthood facilitate the spread:  nominally, college is a place with (in relative safety), people can learn to live with others are be different from them, they can socialize with others (learning there limits), and they can engage in lively debates about what they consider important topics.  Oh, and they also learn about how the world works.

It is unreasonable to expect the maturing young adults to forgo these experiences while in college.  The students are the ones who can stop the spread by altering there behavior, but the colleges have a responsibility too.  For every thousand people you but in environment today, 2-3 will be either asymptomatic or presymptomatic.  Even with the best behavior, those will spread it to others (roommates, etc).  And, if there are any lapses in judgement -- something that is known to happen in that age group -- those asymptomatic or presymptomatic individuals can spread it to scores if not hundreds of individuals.  Before long, there is a major outbreak.

The solution is straight forward:  treat the colleges as a porous "safe zone".  
  • Before anyone is allowed in the safe zone, they must be verified to be COVID free, i.e., test negative in a PCR or antigen test. 
  • Once in the safe zone, the student is required to continue to practice safety measures (PPE, limit gathering, etc)
    • Punish violators by removing them from the safe zone (maybe one warning)
  • If a student tests positive, contact trace and test, but from a public health perspective and not a punitive perspective.  
    • Contact tracing must be separate from enforcement
    • There can not be any repercussions for getting sick.
    • But, the students are prohibited from campus until they are virus free.
Such an approach acknowledges immaturity of the student brain and shares the responsibility with college for minimizing the impact of COVID on the college environments.

The colleges have the responsibility to ensure anyone who steps into the space is COVID-free (understanding that testing is not perfect, so the barrier will be porous).  The students have the responsibility to ensure their behavior on campus does not facilitate the spread, with the understanding that mistakes will happen.  While enforcement is critical, is must be separated form medical needs.

Oh, and if only students in on-campus housing are tested, then you might as well test no one.  Off campus and on campus students interact.  (VA Tech, I am looking at you).  If you test no one, you will have an outbreak (JMU).  Both of those schools abdicated their responsibility; while the students played a roll in the outbreak, the ultimate blame is on the administration.  



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