Epidemiologists say risk of college reopening diffused by regulations

Emerson%27s+testing+site+at+Tufts+Medical+Center.

Photo: Hongyu Liu

Emerson’s testing site at Tufts Medical Center.

By Dana Gerber, News Editor

Emerson is marshaling thousands of students from their homes across the country for the second time this academic year, as the 7-day average of confirmed COVID-19 cases in Massachusetts sits at over ten times what it was when students returned in the fall. However, some public health experts believe the measures Emerson has in place may be sufficient to contain the virus and prevent spread among community members.

To do so will require a bevy of new, intense on-campus restrictions: Twice-weekly testing for students, staff, and faculty at Tufts Medical Center. Registration for overnight travel to stay with people outside the Emerson community. Mandatory faculty and staff testing. Fully remote classes and a partial quarantine are instituted until Feb. 1.  

When students first flocked back to Boston in late August, the seven-day average of confirmed COVID-19 cases hovered around 300. That figure climbed to about 2,600 when students departed for Thanksgiving break. As students return, the state is averaging about 3,000 cases a day, after infections were topping 6,000 each day just two weeks ago. 

Dr. Todd Ellerin, director of infectious diseases at South Shore Hospital in Weymouth, cited “decreased mobility,” such as not bringing students back to campus following the Thanksgiving holiday, as a primary factor in keeping Emerson’s cases low. However, he added that the measures the college takes after students travel back to Boston are more paramount to mitigating transmission than travel itself. 

“Bringing college kids back on campus, could that lead to some increase in transmission? Of course it could. But I think what’s more important is what you’re doing before you take off for travel and what you do after you get there,” Ellerin said in an interview. “The amount of transmission right now that’s going on is more than we’ve ever had at any other point since the beginning of the pandemic, so it is uncharted waters.”

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In the fall, early campus outbreaks in Boston concerned epidemiologists, many of whom anticipated an onslaught of cases in the urban area. Instead, the college town was heralded as one of the nation’s few reopening success stories. 

Emerson racked up 60 positive tests over the course of the fall semester—a positivity rate of about 0.1 percent—among students, faculty, and staff. Cases were contained on Emerson’s campus through nearly all of the in-person semester until the final week of classes brought 16 new positive tests, as cases in the city and the state ticked up. 

“Do I think colleges drove this epidemic? Absolutely not,” Ellerin said. “I’m super impressed with how safely most of these college campuses have reopened in the setting of COVID transmission.”

Testing has been a key cornerstone of the college’s plan to keep cases contained, both on campus and within the community, especially after the student migration back to campus. Over the fall and spring semesters, the college will have spent more than $5 million on testing alone, according to Vice President for Administration and Finance Paul Dworkis. 

Professor Jamie Lichtenstein, a biologist who was one of three health experts the college recruited over the summer as a consultant on reopening, said the new twice-a-week testing program will catch most cases before they get a chance to spread. 

“That’s actually catching people in the incubation period—in almost all cases we’re going to catch them before they can actually transmit,” Lichtenstein said in an interview last week. “Is there some theoretical possibility that we could miss a case? Yes. So nothing is risk-free. I think it’s a very low possibility.”

Dr. Daniel Kuritzkes, chief of the Division of Infectious Diseases at Brigham and Women’s Hospital, said higher education had “a surprisingly small effect” on virus transmission in Boston after students returned in late August. 

On Nov. 25, the day the campus closed for Thanksgiving break, the statewide positivity rate with higher education testing included was 3.6 percent—without higher education, it was 5.2 percent, indicating a large volume of higher education tests came back negative. 

“That’s good evidence that colleges and universities, and people attending them, have done a much better job than the population as a whole in containing the spread of coronavirus,” Kuritzkes said of the higher education positivity rate. “Whether its contribution of testing and case finding and then isolation… the net result is that I think there was a minimal impact overall on the epidemic by having all the students come back.”

Boston institutions’ relative success at containing the virus stood in contrast to the failure of some other U.S. colleges in keeping infections low. One study published earlier this month indicated some colleges nationwide had a superspreading effect on their local communities, underscoring the potential impact of an uncontrolled outbreak on a college campus.

For Emerson, the difference this semester is the rate of virus transmission in the state and the nation, which is now far higher than when students were on campus in the fall. 

The increase in cases and hospitalizations in December prompted Governor Charlie Baker to roll back the state’s reopening on Dec. 8. This measure precipitated the Executive Office of Health and Human Services asking all Massachusetts colleges to push back bringing students back to campus, forcing Emerson to institute a weeklong delay in residential move-in. 

The influx of positive tests at Emerson near the end of the fall semester, Assistant Vice President for Campus Life Erik Muurisepp, who heads the college’s COVID response, said were all unrelated and picked up somewhere in the city.  

Last week, as Resident Assistants began funneling back to campus, the college reported five positive tests. 

“We’re going to probably have some more positive cases than we want to see in the city and maybe in our campus in the coming weeks, but I don’t think just shifting online would have kept the ethos of what Emerson is all about,” Muurisepp said. “We really do feel we can safely operate our campus community.”

Initial repopulation of the Boston campus may also prove a difficult barrier of spring reopening. In the same study that indicated colleges may be superspreaders to their communities, an analysis of 30 colleges—including Boston University—demonstrated that campuses are highly susceptible to outbreaks during the first 14 days of instruction.   

“I think the hardest time period will be those first two weeks,” Lichtenstein said.  

However, the riskiest and most volatile variable, both administrators and epidemiologists agreed, was community behavior. According to the American College Health Association, campus outbreaks in the fall were tied to social gatherings either on or off-campus, especially at colleges with a high number of off-campus students, such as Emerson. 

“Could pandemic fatigue change the trajectory and lead to more outbreaks on college campuses? Absolutely,” Ellerin said. 

Even if campuses stayed closed, one study published in late December by the Annals of Internal Medicine, said infections would still result from faculty living in the community and off-campus students living in the area. 

“I think the students at highest risk are probably students living, say, with four other Emerson students in a crowded apartment off-campus,” Lichtenstein said. “That wouldn’t change if Emerson at this point said, ‘Hey, we’re going to be remote for the entire spring semester.’” 

Lichtenstein urged students who travel often on public transport or who have off-campus jobs to wear higher quality masks. Muurisepp said he hoped students would inform the college if they observed their peers flouting masking, traveling, or social distancing regulations. 

Another new challenge the college must combat this semester is the new variant of COVID-19 first discovered in the United Kingdom, which has spread to the U.S. and Massachusetts. Initial studies estimate this variant may be between 50 to 70 percent more infectious than other strains. 

Despite the high levels of community transmission in the Boston area, Lichtenstein said bringing students back to Emerson may pose no greater risk than having them remain in their communities.  

“A student from L.A. might be safer coming back to Emerson—it’s hard to say—but maybe safer coming back to Emerson, with all of the surrounding layers of precautions, than they could be staying in L.A., where they’re having such high levels of transmission and overwhelmed hospitals,” Lichtenstein said. 

The average daily cases per 100,000 individuals over the last seven days in the U.S. is 60; in Massachusetts, sits at 66, according to the Centers for Disease Control. 

“Given the rates that we’re currently having in the state overall, I’m not sure that the risk of coming from elsewhere is worse than the risk of coming from Massachusetts,” Kuritzkes said. “It remains a serious issue, but it’s hard—it’s a bit like the pot calling the kettle black at this point.”

When students return to Emerson this spring, many will pass through Logan Airport. (Media: Chris Van Buskirk)

But epidemiologists have warned in the past that travel, especially among young people, who are more likely to be asymptomatic carriers of the virus, presents a dangerous potential for the virus to spread as cases spike from coast to coast.

The college asked students to self-quarantine for 14 days prior to returning to Boston. Upon arrival, residential students must quarantine in place until they receive a negative test result, receiving delivered meals. After producing a negative test, a ‘soft quarantine’ will continue until Jan. 29, wherein students can leave their dorms only to pick up meals, check mail, go to work at off-campus jobs, and attend medical or testing appointments. Off-campus students are also asked to leave their homes only for essential tasks. 

Classes will remain remote until Feb. 1 to “safely rebuild our Emerson bubble and help limit the risk of exposure of our community, but also to the Boston community,” Muurisepp said. 

Public health experts lauded this remote run-in period paired with rigorous testing as a way to catch any asymptomatic or presymptomatic infections as students return to campus. In the Annals of Internal Medicine study, routine laboratory testing on college campuses was estimated to prevent 96 percent of infections. 

Kuritzkes said the protocols at Emerson were what differentiated it from the sites of higher education outbreaks, such as the University of North Carolina at Chapel Hill or the University of Nebraska-Lincoln, which both have far higher student populations than Emerson. Sporadic testing was blamed as one of the variables leading to the 81-person outbreak at Boston College in September. 

“Particularly in contrast to some of the large state universities in the Midwest, which had huge outbreaks because they weren’t doing the kinds of things that would have been done here in Massachusetts, that people have done a great job,” he said. 

Colleges like Emerson, with quarantine housing, accessible testing, and contact tracing protocols, may have better infrastructure than students’ homes to monitor and manage cases when they arise, Kurirtzkes said. 

“The key thing is identifying cases and having something to do once you’ve identified the case,” Kuritzkes said. “In many respects, colleges are in a better position to be able to act on that information than the health department is with people who test positive in the general community.”

Although some schools in the Boston area, like Harvard University, have opted for completely online learning as a method of containing the virus, Muurisepp said that option was never on the table for Emerson for the spring semester. The college’s contact tracing program found no classroom-based transmission of the virus in the fall, even when students who were infected attended an in-person class, Muurisepp said. 

Despite being cited as the lowest-risk scenario by the CDC and the only option for some immunocompromised or other individuals vulnerable to the virus, remote learning isn’t necessarily a catch-all solution, Kuritzkes said. 

“The challenge is not so much having people in a classroom,” Kuritzkes said. “The challenge is all the social events, dining, and how you organize meals in a way that continues to promote sufficient distancing that you minimize the risk of transmission from people who may have been unwittingly infected.”

In-person learning is also in the college’s financial interest. Emerson is a heavily tuition-dependent institution, according to the college’s most recently available 990 tax form. In 2019, about 89 percent of Emerson’s $264 million revenue came from tuition and housing charges. A July 6 letter from President M. Lee Pelton said a fully online academic year would result in a deficit topping $100 million, though the college is now predicting the “best case scenario” of $30 million in losses during the 2021 fisical year.

As the one-year milestone nears since students’ lives were first upended by the virus after being sent home and shifting to virtual learning in March, some worry this disruption is fated to repeat, even as vaccine distribution picks up in the state.

Muurisepp said there is no one metric the college is using to guide their decision on shuttering once more, but rather a collection of guidance from Tufts Medical Center, the state, and the college’s own data. 

“There’s also a lot of contingencies before going fully remote,” he said. “It could be like we’re doing in January, saying we’re going to pause in person for a certain amount of time, and let’s just go remote. So we don’t have a definitive marker point, because I think that would also be too rigid.”

Muurisepp said the new restrictions represent a decisive shift from last semester. 

“It wasn’t like the olden days of Fall ’19, but we sort of got spoiled [last semester],” Muurisepp said in an interview with The Beacon. “This is a new chapter of this new world that we’re entering for the spring semester.”

Ellerin said Emerson has succeeded thus far in “shifting with the epidemic.”

“I would continue doing what you’re doing,” Ellerin said. “Emerson has done it right so far. And I think you’re continuing to think about it in the right way.”

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