Higher education has been hard hit by the COVID-19 pandemic. After colleges and universities took the drastic step of closing their campuses and cancelling or postponing graduations in the spring, the next important question became how—or whether—to open again in the fall, and what measures to put in place to protect students, staff, teachers, and campus visitors.
Colleges expect large numbers of commuter and residential students to return to campus. Students will be coming from different states and countries, calling for different approaches to preventing the spread of COVID-19 and different social attitudes to such measures. We know that even when there is widespread enforcement and acceptance of preventative measures such as mask wearing, temperature checks, and gel disinfectants, new cases still appear. Every college and university in America must, therefore, prepare to manage multiple COVID-19 cases. What can institutions of higher learning do to prevent a few cases from turning into catastrophes that cancel classes and close campuses again—and in some unfortunate cases, forever? This is a question that has taken on even greater importance since the announcement that international students will not be allowed to remain in the United States on a student visa if their college moves to all-online learning. The time-tested practice of contact tracing will be an indispensable part of a successful COVID-19 management program for colleges and universities.
COVID-19 Outbreaks on Campus Are Inevitable
As places where groups of people (many of them young, with delusions of invulnerability) spend extended time close together (what public health practitioners call “congregate settings”), college campuses are already susceptible to a high transmission rate of infectious diseases such as meningococcal disease. We should not be surprised to see daily news reports about new outbreaks on campuses across the country, especially on campuses in colder climates where students spend more time closed up indoors with limited fresh air.
The truth is, most students spend as much or more time socializing, or working or studying in a social environment, as they spend in formal instruction in a classroom. In a college environment, it is realistically impossible to avoid or effectively prohibit a lot of mixing of people within and between social circles. From the suites, hallways, and bathrooms of the dormitories, sororities, fraternities, and off-campus housing where students begin and end their days, to the crowded lines of the cafeteria, to the classrooms and lecture halls filled with students and instructors for an hour or three at a time, to the crowds gathered to cheer the home team, or simply the circles of friends relaxing on the grassy quad, student life is social life that realistically speaking, does not lend itself to “social distancing.”
And student life is not confined to the campus itself, nor are students the only ones spending significant time on campus. Consider the large number of people entering campus every day from the outside: faculty, staff, vendors, students returning from shopping or a night out, commuter students arriving for classes, and people coming on campus to visit a friend or loved one. All it will take is just one or two people carrying SARS-CoV-2 to enter campus. Once that pathogen enters the swirling vortex of campus social life, an outbreak can rapidly spread to nearly the whole campus community as students carry it from classroom to classroom, to their residence hall, and to everyone they meet in between.
Despite the inherent risks to higher educational institutions of widespread coronavirus outbreaks, colleges are in a good position to stand up a successful campus contact tracing program that can mitigate the risk.
How To Create a Successful Campus Contact Tracing Program
1. Forget About Smartphone Apps … Unless Your Local Public Health Authority Gives You One
Although Google and Apple have developed APIs that can potentially notify smartphone users if they have been in close contact with a COVID-19 carrier, those are restricted for the use of a single app designated by your local public health authority. Google summarizes the policy in this way: “Only public health authorities can use this system. Access to the technology will be granted only to apps from public health authorities.” In other words, unless the county or state in which the college or university is located has promulgated an exposure notification app for the public to use within that jurisdiction, the university itself is prevented, as a matter of policy, from creating or adopting a smartphone app that uses this technology.
That leaves GPS tracking apps as the last iOS or Android smartphone options available for colleges to choose. Unfortunately, because those are rife with privacy hazards, are susceptible to hacking and phishing, and drain batteries quickly, colleges are unlikely to gain widespread adoption of COVID-19 smartphone apps.
For educational institutions, therefore, there are no good options for COVID-19 exposure notification apps specifically to protect the campus community. If, however, the local public health authority has released an exposure notification smartphone app they want residents to use, the institution should by all means urge or require students to use it on campus, as this can notify close contacts of their possible exposure much more quickly than human contact tracing efforts.
2. Recruit a Contact Tracer Corps from the Student Body
Money is tight, but colleges and universities have access to an economical workforce already on campus: the student body. Graduate students in public health or social work, or undergraduates interested in human resources, health, or social work careers, will naturally gravitate to the opportunity to participate in the important work of contact tracing. International students have something important to offer in forming connections with other international students, who may especially feel vulnerable and wary of unwanted attention during a time when they are worried about their health and are far away from home. In fact, a contact tracing program could potentially be initiated and managed almost entirely by student government or a campus group.
Not only will the participation of students provide valuable work experience, for which they can be recognized by the institution, earn a good reference for a job well done, and gain something noteworthy to start building their resume, they will be helping keep the campus community safe, healthy, and open. Whether your student contact tracers are paid workers or volunteers, they will have a rewarding experience of making a genuinely important contribution to public health.
General training for your contact tracers is easily obtained. Johns Hopkins University offers a free, six hour, online course on COVID-19 contact tracing through Coursera, for which participants can earn a certificate—a valuable credential in its own right in the day when we need to hire hundreds of thousands of contact tracers just in the United States. Administrators and supervisors of your program should know the guidelines from the U.S. Centers for Disease Control and Prevention well. After digesting the material in the Johns Hopkins course and reading through the CDC guidelines, campus-specific policies and procedures can begin to be written, and these will be revised and updated as administrators learn through experience how best to conduct contact tracing in their unique setting.
How many contact tracers will you need for your college or university? The National Association of County and City Health Officials (NACCHO) estimates that 30 contact tracers are needed for every 100,000 population. Nevertheless, because transmission of COVID-19 is likely to occur faster on campus than in the population at large, and because student workers will have a limited number of hours available to work, my opinion is that colleges and universities should recruit more contact tracers than the NACCHO recommendation for the general population. One contact tracer for every 1,000 students would not be unreasonable or difficult to recruit and supervise. A college of 7,000 students would need seven contact tracers, whereas a university of 40,000 students would need 40. This would not impose an onerous cost or administrative burden on an institution of any size.
3. Give Contact Tracers the Tools They Need
The two broad goals of contact tracing are to help people who have COVID-19 maintain their quarantine successfully and to discover who else they have been in close contact with, so those people can be notified (while protecting the privacy of the person who may have exposed them), and helped to get tested and enter into quarantine for a time. This is how we slow the spread exactly at the point where we know it is most likely to leap forward in several directions at once. Contact tracers are like the firefighters digging the firebreak right in front of the wildfire’s forward line.
Under ordinary circumstances with the public at large, contact tracing is carried out using two main tools: a computer and a phone. The process of contact tracing begins when someone from the campus community reports that they have symptoms of COVID-19 or has received a positive test. The I.T. department (or an individual student) can quickly and easily create a web portal using a service like JotForm that will allow students, faculty, and staff to self-report symptoms or a positive COVID-19 test. This can be integrated with an affordable COVID-19 contact tracing software like ContactPath by Watkyn, that will help contact tracers to follow a simple process to do their work and keep track of all their cases and activities.
When they log in to ContactPath, using any device that has Web access, contact tracers see a dashboard with their currently assigned cases and a queue of new cases that they can pull from as they have time. Once they begin to work a case, their first goal is to reach the person on the phone to find out how he or she is feeling and provide information and support to help them quarantine. Once trust has been established, the contact tracer then tries to elicit voluntary information from the person about where he or she has been in recent days and with whom he or she has been in contact. If some of these contacts meet the definition of a close contact, as established by the CDC, the contact tracer then tries to notify those people about their possible exposure and help them get tested and enter quarantine. ContactPath makes the whole process simple, especially for the “digital native” Gen Z students of today’s colleges and universities.
A campus contact tracing program could benefit both the college itself and the wider local community of which it is a part. Colleges have built-in advantages over local health departments when it comes to contact tracing of COVID-19 carriers on campus. They already have phone numbers and e-mail addresses of students, official messaging channels, access to student class schedules, and are located physically closer to the students’ on-campus residences. They can reach COVID-19 carriers faster and easier than local health departments, which will result in lower transmission on campus and to the neighborhoods around the college. Furthermore, because many colleges and universities constitute a large part of the local population during the school year, taking responsibility for contact tracing will relieve the burden on the local health department, which, in many cases, will have fewer resources than the college itself. Another factor to consider is that students may be more willing to talk to other students about where they have been, and with whom, than strangers calling from unrecognized numbers at the county health department.
Prevention is key to stopping the spread of COVID-19, and right now we have no way to prevent it from spreading entirely. Contact tracing is an important preventative measure once a positive case arises, and it supplements other important protocols for minimizing transmission such as the use of masks, frequent hand washing, self-monitoring for symptoms, and maintaining a safe distance from others. University administrators will want to inculcate a culture of prevention not only by reducing classroom occupancy and making personal protective equipment available, but by making heavy use of messaging across campus to promote adoption of safe practices to reduce the spread. Colleges and universities need to be prepared by having a campus contact tracing program ready to spring into action from day one. The seeds of your first outbreak will already be sown on move-in day.