Until vaccines against COVID-19 are available to all, the public will need two things: a reason for hope and a vision of how to live more safely and productively in the meantime. For both, Americans can look to the examples set by a number of colleges and universities—a surprising turn, perhaps, given the widespread anxieties that these institutions’ reopening in the fall created.
Since last summer, many news stories have highlighted failures by individual universities to manage the pandemic. Outbreaks have occurred, and some data even suggest that college reopenings led to more infections in the counties in which they are located. That’s only part of the story, though. Many schools—including the one where I work—took on the job of preventing the spread of the coronavirus among their students, employees, and host communities and have sought to manage the problem in a comprehensive manner. Schools that have succeeded have done so by learning from one another, by redeploying people and resources, and by employing the tactics that epidemiologists all over the world have advocated but too few areas of the United States have adopted.
I am a pediatrics professor at Indiana University. Our seven campuses, like most of their counterparts across the country, shut down quickly in March. Administrators soon called together a committee of experts in medicine, public health, and public safety to create a plan for how the school might function safely during the pandemic. I serve on that committee, am one of four leaders of IU’s medical-response team, and currently oversee our testing system for asymptomatic students, faculty, and staff.
Whether our campuses should even reopen was a contentious subject, but we committed to finding a way to safely resume classes. A large majority of our more than 87,000 students, we reasoned, would be living in our campuses’ host communities, regardless of whether the university reopened its dorms. Students would be present—and would be likely to socialize—no matter what we did. We aimed for a mix of virtual and in-person instruction, partly on the theory that masked, widely spaced face-to-face interactions would satisfy some of the students’ appetite for normalcy and offer a better educational experience than fully remote learning.
To meet these goals, we needed to prepare our health-care system to diagnose COVID-19 cases and care for those who tested positive. At the time, getting a coronavirus test was incredibly difficult, even for people who were quite sick. With the help of IU’s school of medicine and its partner health-care system, we developed a mechanism where any of our approximately 120,000 students, faculty, and staff could get a virtual visit with a health-care professional if they felt ill. If symptoms warranted, this process then connected them to a diagnostic test.
Diagnosing individual COVID-19 patients was just the first step. We also needed procedures and infrastructure to allow them to isolate, and intense contact tracing to identify and assist anyone else who might have been exposed. These measures required money and significant personnel, neither of which was widely available from the federal or state government. But our school had an advantage: Through a partnership with medical educators and government officials in Kenya, many of our local faculty and staff had gained expertise in health-care initiatives requiring substantial community outreach. With their help, we hired and trained a corps of contact tracers. Early in the pandemic, I had marveled at how Singapore had a goal of tracking down the source of each identified COVID-19 infection within two hours. In the fall, IU’s median time to close a case was half of that.
In June, while most of the country could not manage to supply enough tests for people with COVID-19 symptoms, researchers at Cornell released a paper outlining a scheme of frequent testing of asymptomatic people. They believed that if their university tested a large number of people often enough, being part of the Cornell community could become safer than not being part of it. In other words, far from posing a risk to its host city or town, a university could become—by supplementing behavioral measures such as masking and social distancing with widespread surveillance testing—a model for detecting and suppressing the virus.
This was a vital insight. Other studies produced similar findings. At IU, we set a goal of creating a safer environment for students, faculty, and staff on and around campus than they would experience if the university simply shut down. Unfortunately, by August and well into the fall, testing capacity was still limited. No infrastructure existed to test those without COVID-19 symptoms, and we did not want to be a burden on our host communities by co-opting resources—including medical capacity—that might otherwise be used for those who were ill.
Fortunately, large universities can find ways to tackle society’s toughest problems, including the need for new ways to detect infections en masse. Last spring, Rutgers developed a saliva-based test that didn’t rely on medical professionals to collect nasopharyngeal swabs. It was so successful that companies started using it to offer mail-in coronavirus testing from anywhere in the country. It was somewhat expensive, but it was available. IU made use of it.
Lab work is only one part of a testing system. Collecting a huge quantity of samples was an additional logistical nightmare. But at IU, we realized that our event staff—which has experience at moving massive numbers of people and equipment for football and basketball games, concerts, and commencements—could run our testing operation. Our information-technology services, adept at collecting and processing data as well as building websites and apps, could create dashboards, set up tracking systems, and process test results. And when other institutions found ways to innovate, we copied them. In our own backyard, Purdue University announced that it would develop its own COVID-19 testing lab. We committed to opening labs of our own and looked around for a cheap method of testing a lot of people quickly. We eventually chose a saliva-based testing method pioneered by the University of Illinois.
After purchasing liquid-handling robots and PCR machines and training a testing staff, we aimed for 25,000 tests a week in January. When students return to campus in February, we plan to test about 50,000 people a week to detect any viral surges like the ones we and other colleges saw in the fall. Our labs have become so efficient that we expect many of these test results to be returned on the same day a sample is taken. When individuals test positive on campus, our contact-tracing team gets in touch immediately and makes arrangements to isolate them in housing reserved for this purpose. Close contacts are also identified and instructed to quarantine following CDC guidelines.
All told, the testing and safety measures that we adopted will cost about $700 a student. This was a huge investment for a state university, but it also shows that establishing reasonable protections for the people who depend on IU is possible on a realistic budget. Through a combination of measures, Indiana University, and other schools using similar approaches, kept the prevalence of infection quite low throughout the fall semester, even as case counts rose dramatically in the state. Now that vaccines are available, we’re working with the government to help distribute them as quickly and efficiently as possible—not just to our students, faculty, and staff, but also to the communities in which we live. More than 600 students in our health-sciences schools have trained to give vaccinations and have been put to work all over the state distributing shots to those who are eligible.
Not every college or university that reopened, however, has taken enough protective steps. Unable or unwilling to invest in overcoming the testing bottleneck, too many schools did little or no asymptomatic surveillance. They couldn’t identify and isolate silent carriers of the disease, and outbreaks inevitably occurred. Too many institutions were also overconfident in their ability to persuade 20-year-olds to stop having parties. IU was among the institutions that suspended students for hosting large off-campus gatherings, but we relied much more on promoting solidarity and communicating specifics than on making threats. Everyone who studied or worked on our campuses agreed to participate in testing and follow behavioral guidelines. Our surveillance testing was robust enough that we did not rely on punishment to prevent infections; when our testing revealed disturbingly high positivity rates in most fraternity and sorority houses, the county ordered members of those living groups to quarantine themselves. (These measures did not prove necessary in our dorms or anywhere else.)
Beating COVID-19 requires resources, will, and a sense of shared sacrifice. The United States has too widely failed in the past year in providing these. Vaccines are rolling out too slowly, and new variants of the coronavirus are emerging. Figuring out how to live safely in this environment is imperative.
Universities like ours have many lessons to teach. IU wasn’t the only school to adopt a comprehensive suite of preventive measures, nor were we the only one to have achieved a level of success with them. That we didn’t perform miracles or depend on luck should make our example all the more useful to other university presidents—and to mayors, governors, and the new presidential administration.