Coronavirus (Covid-19) and new cases: When should schools shut down?

Filed Under: Patients

- photo by Akbarali on Wikimedia Commons

By BEN GLICKMAN and PHOEBE PINDER

In June, the University of North Carolina at Chapel Hill was planning to return for in-person classes, at least partially. Addressing concerns about what would happen when cases rose on campus, UNC leaders said that there would be “off-ramps” — plans to scale back in-person activities — but the specifics were left vague. At a faculty meeting in July, leaders said that they planned to consider metrics like positive cases, the rate of increase and testing capacity, but had not finalized a plan, The Daily Tar Heel reported.

Less than three weeks into the school year, the school has now identified at least 130 positive students, shifted all classes to online and asked most on-campus students to move back home. One day before the shift to online-learning was announced, The Daily Tar Heel noted in a now-famous editorial that there was still no public information about what would trigger the use of “off-ramps,” and what these measures would entail.

Reopening schools brings new community spread of Covid-19. But while almost all reopening colleges and K-12 schools admit that some cases will arise, few have plans in place for how many cases will lead to a shutdown, and what shutdown plans will be – which could lead to more confusion like what we’re seeing in Chapel Hill.

A threshold for shutting down

Robert Kelchen, an associate professor of higher education at Seton Hall University, argued in a blog post on his website that colleges must take a data-driven approach to when to shut down operations.

Kelchen uses the example of local ICU capacity: “A college could create a plan stating that if the surrounding area has 50% of ICU beds available, campus operations will continue as planned with social distancing. If 25% of beds are available, only the most essential courses could be on campus and residence halls would be emptied. And if just 10% of beds are available, the physical campus would be closed like what happened this spring.”

Central in Kelchen’s proposal is the publicity of these plans — he suggests that students and the surrounding community should all be made aware of the specific circumstances that would merit closure.

Kelchen also argues that a data-driven plan would benefit both the college and the students. Students can make a decision about whether or not to return based on their and the college’s tolerance for cases, while colleges can avoid pressure to shut down at the first sign of cases.

Dr. Karen Coffey, an epidemiologist with the University of Maryland, says that the decision to shut down schools is more complicated than a data cutoff.

“You can have a threshold that gives guidance, but they tend to be somewhat arbitrary,” Coffey said in a video interview with ClearHealthCosts. “What it really comes down to is your acceptance of a degree of risk of having an outbreak versus the benefit of whatever service is being provided.”

Coffey said that those making decisions on shutting down should consider other factors as well, including the type of spread. One single incident that causes a spike in cases — like a superspreading event — should be treated differently than rampant community spread, she said.

“You’re never going to get a black and white answer as to the right time [to shut down],” Coffey said.

Lessons from Taiwan

One shining example of successful K-12 schools and colleges reopening abroad is in Taiwan, which had fully opened schools as of March 2 with little community spread of Covid-19.

Researchers at National Taiwan University published a paper on July 2 in the Annals of Internal Medicine detailing best practices used in Taiwan to reopen schools. The paper notes that the Taiwanese government adopted a number of guidelines to ensure safety in schools, including mandating the creation of task forces for each school, risk-based screening of students and faculty, hygiene measures (like masking) and a method of reporting cases.

Perhaps the most stringent of Taiwan’s measures were its strict conditions for schools closing: a class would be suspended if one case of Covid-19 was found among students or faculty, and a whole school would temporarily shutter if two or more cases were found. Once officials have tested those exposed for infection and ensured that there was no further spread, classes and schools are allowed to return.

At the time of the paper’s publication in June, only one university had shut down during the entire pandemic; it quickly reopened with the help of contact tracing and quarantining. No other universities have shut down since, although a number of students have had to quarantine because of suspected cases of Covid-19 (none were confirmed).

“They separate their monitoring mechanism down to the unit — all the way down to individual classes — and they keep it at a very strict benchmark,” William Yang, an East Asia correspondent for German broadcaster Deutsche Welle, said in a video interview with ClearHealthCosts.

Taiwan has not seen a new case of coronavirus since April 8. Yang said that Taiwan controlled Covid-19 with swift and centralized action by the government. Early in the pandemic, the government adopted strict border controls, controlled the supply of masks and carefully tracked cases. The result: only 486 confirmed cases and seven deaths in a population of more than 20 million since the pandemic began.

Yang believes that a lack of significant community transmission made management of individual cases in schools easier.

“It’s hard for me to tell you what they would do if there are widespread cases because there just haven’t really been cases like that in Taiwan,” Yang said. In the U.S. where community transmission is still rampant, Yang said that he is unsure if the strategy would be as effective.

K-12 schools

Coffey said that a conservative approach to cases in schools like Taiwan’s is effective at preventing any spread, but comes at a cost — students who may never have been exposed lose valuable in-person instruction. Plus, she added, with community spread in the United States, the virus could be introduced again to the school a week later.

“Any period of long quarantine is unlikely to prevent reintroduction when there’s transmission in the community,” Coffey said.

Some K-12 schools have followed Taiwan’s example. In New York City — the largest school district in the U.S. returning with a hybrid model — public schools will close a classroom if two or fewer cases are discovered within a single classroom, but two or more cases that are in different classrooms will cause the whole school to close temporarily while an investigation is conducted.

Still, other large school districts around the country have no specified plans for shut down. Three of the five largest school districts in the U.S. — L.A., Chicago and Miami-Dade county — will go fully online. Fifth-largest Clark County, Nev. will return with a hybrid model like New York, but includes no plan for when to shut down. Instead, the district’s plan says that it will contact trace when cases are identified.

Schools in some parts of the country have already returned to in-person instruction — and seen outbreaks.

Cherokee County School District in Georgia opened for in-person learning in early August. The district’s plan said it would leave the option to “institute closures at the class, school, zone or district level depending upon student and staff exposures and positive COVID-19 cases,” but gave no more specifics. Just over a week after opening, the district announced that it would close one of its high schools — across the district, there were 59 positive tests for Covid-19 and 925 students and staff were isolating because of potential exposure.

Colleges and Universities

Like U.N.C. Chapel Hill, colleges and universities across the country have been struggling to determine the best way to handle the impending fall semester. Some educators feel that online courses are simply not adequate learning environments for students, and some schools have decided to hold in-person classes — usually in some sort of modified schedule format, which attempts to allow for social distancing.

Scott Galloway, a professor of marketing at NYU Stern School of Business, argued in an opinion piece in Business Insider that colleges are undergoing the serious risks to college students, staff and surrounding communities because they have no other choice. Colleges are dependent on students’ tuition money in order to cover salaries and expenses, Galloway wrote. “If students don’t return in the fall, many colleges will have to take drastic action that could have serious long-term impacts on their ability to fulfill their missions,” he wrote.

Even though certain colleges have settled on their own criteria for shutting down campus again, many are not publicizing their calculus, The Wall Street Journal reported. Among the few to clearly identify their shutdown thresholds is Syracuse University, which has laid out five levels of outbreaks in its plan, as well as how to respond to each level.

The University of Michigan made the call to switch to online learning for the fall semester before students began returning to campus. “it has become evident to me that, despite our best efforts and strong planning, it is unlikely we can prevent widespread transmission of COVID-19 between students if our undergraduates return to campus,” said college President Samuel Stanley in a letter to students.

Some attendees of schools returning to in-person teaching are upset that school administrators are calling for a return to campus, and feel unsafe. Students at Georgia Tech University hosted a die-in on the first day of classes, in which they, according to the Associated Press, “mimed their deaths and called on administrators to send people home, refund room and board fees and better protect employees.”

Spikes in cases

Students have been returning to campuses across the country, and the resulting spikes in Covid cases have revealed that, for now, online courses may be the best route to limit further outbreaks. As of Aug. 20, at least 15 states have reported cases of Covid at colleges and universities, CNN reported.

The University of Notre Dame, which had initially been expecting to proceed with in-person classes, announced on August 18th that it would be reverting to online courses for the time being. Notre Dame is the second prominent university after U.S.C. Chapel Hill to have made the move to online classes.

In a joint effort with LabCorp, Notre Dame’s nearly 12,000 students were tested before arriving on campus for classes on Aug. 10. At the time, only 33 students tested positive. By August 18, however, 147 students had tested positive, and officials decided to temporarily pull the plug on in-person courses.

“Our contact-tracing analysis indicates that most infections are coming from off-campus gatherings,” University of Notre Dame President Rev. John I. Jenkins, C.S.C., told students in a virtual address on August 18th. “Students infected at those gatherings passed it on to others, who in turn have passed the virus on to others, resulting in the positive cases we have seen.”

Notre Dame has requested that students not visit campus until further notice, and that on-campus students should refrain from leaving campus except for emergencies. Student gatherings of any sort should be kept to 10 or under, and students, faculty, and staff must complete daily health checks.

Certain varsity athletics programs have been allowed to continue to gather for sanctioned activities, and are subject to routine surveillance testing.

As is the case at Notre Dame, outbreaks of coronavirus amongst students can largely be attributed to parties and sorority and fraternity houses, the New York Times reported. The Times has definitively linked at least 251 new cases of the virus to sororities and fraternities across the country.

According to the Times, “at least 165 of the 290 cases at the University of Washington’s Seattle campus have been associated with its Greek Row.” An entire sorority has been placed in quarantine at Oklahoma State University after 23 members tested positive, and a dorm at Colorado College has been quarantined due to a student testing positive.

Update Aug. 25: The University of Alabama announced that as of Aug. 24, there were 531 confirmed cases among students, faculty and staff. Classes resumed at the university on Aug. 19. When asked about whether the school would shut down because of the spike in cases, University of Alabama president Stuart Bell said that “there really is no single answer,” AL.com reported. “I don’t want to point you all to look at this graph or look at this data and know we can draw a line and say this is what we’re going to do because it’s a very dynamic situation — very dynamic over the weekend as we saw positive cases increasing to again, today, cause us to take more steps.”