College COVID-19 Restrictions No Longer Make Sense

10 minute read
Dr. Bienen is a public-health professor at Oregon Health and Science University-Portland State University School of Public Health.
Dr. Prasad is a hematologist-oncologist and Associate Professor in the Department of Epidemiology and Biostatistics at the University of California San Francisco.

Many of America’s roughly 20 million college students are (still) living with a wide range of restrictions on their lives. Some students face no restrictions—neither vaccination nor mask mandates—while others are subject to bouts of nearly total lock down, such as happened at Emerson college, which issued a “stay in room” directive that lasted through January 18 and prohibited students from leaving their room unless to get tested, obtain food, go to medical appointments, or for employment purposes. Other restrictions across the country include remote classes (10-15% of 500 prominent colleges started the spring term online), booster mandates, bans on traveling off campus or internationally, no sharing meals in the dining hall, limits on the number of people in your room at one time, masks at all times indoors and outdoors in crowded settings, bans on eating or drinking inside buildings, and testing every 72 hours to determine COVID-19 status.

With many college campuses approaching 98% vaccination rates among students, faculty, and staff, universities should jettison the strategies they relied on in 2020 and 2021.

Restrictions appear to correlate with political leanings of the surrounding area, but not entirely. Many colleges in Republican-governed states, such as Tulane University in New Orleans, LA, University of Virginia, and Duke University, in North Carolina, have vaccination and booster mandates, mask mandates, and delayed the start of in-person classes for the spring semester. Even in Florida some colleges are remote due to COVID-19 concerns, although Florida has prohibited mask and vaccination mandates for K-12 schools and in higher education, as has Virginia now that Youngkin is governor. The vast majority of schools in the Northeast, West, and Northwest, and many in the Midwest, are still requiring vaccination, masks, and boosters as well as other restrictions.

Recently, a groundswell of pushback from parents, students, and some faculty has emerged. Parents and alumni from multiple universities posted open letters to the administrations at Cornell, William and Mary, Georgetown, Stanford, and elsewhere, most focusing on booster mandates, but some on general COVID-19 restrictions. Two law professors on the faculty at Northwestern argued that remote learning violated university contracts with students.

But, so far, universities have shown little sign of backing down. Though some, like University of California, Berkeley, are finally starting to change their rules. Berkeley is dropping mask requirements for vaccinated people starting February 28th.

We think that fundamental misunderstandings about two specific questions are leading to ongoing unnecessary campus COVID-19 policies that negatively affect students’ experiences, academics, and their mental health. These policies affect the daily lives of millions of young people and, as such, should be grounded in solid data showing they are effective. We do not discuss booster requirements here, as many others have published articles and data supporting that boosters in healthy young people are not meaningfully preventing hospitalizations, or at this point, even breakthrough infections.

First, do restrictions on college campuses, such as on dining, traveling, and on how many guests students can have in their room, make sense?

A recent analysis from the IHME indicates that the answer to this question is No. IHME models suggest that Omicron spreads so quickly that even the most severe restrictions (such as Emerson College instituted) will do little to blunt its trajectory, particularly given that most Americans are living less restricted lives than college students, including faculty and staff (aside from mask requirements) at those same institutions. The large R0 (a measure of infectivity) of Omicron means, as Anthony Fauci acknowledged recently, that infection is inevitable for everyone, even the vaccinated and boosted. This also means that young healthy nearly 100% vaccinated people are living severely restricted lives only to delay an infection they likely cannot avoid, and which is unlikely to seriously affect them. Post-vaccination, hospitalizations for college-age students have been miniscule. CDC data show the weekly hospitalization rate for 18-49 year-olds at 1.8/100,000 at the peak of the Omicron wave in mid-January, and of death in all, vaccinated and unvaccinated, 18-29 year-olds at 0.8/100,000. Both will fall even further now, as cases plummet with the Omicron wave having peaked in parts of the country. No vaccinated college students have died of COVID-19, as far as we know.

Read More: Omicron Could Be the Beginning of the End of the Pandemic

The above two conditions likely mean that restrictions on between-student interactions such as confining students to their rooms, closing dining halls, and making the students eat “grab and go” are likely making little or no difference in the outcomes that matter, hospitalizations and deaths. In addition, students’ fidelity to such restrictions may be low. In a rare admission of the futility of these rules, some colleges re-opened dining halls earlier than planned, recognizing that students were simply taking food to a common room and eating together anyway. Similarly, restrictions on having a guest in your room are ineffective, when later in the evening students will be crammed together at a party. We do not have the necessary data to conclude that restrictions were successful previously, in fall 2021 for example, at controlling Covid-19 on campuses. It is more likely that universities successfully tamped down Covid-19 transmission pre-Omicron because they required vaccination at a time that vaccination was more protective for stopping transmission. During the Omicron wave, vaccines’ protection against mild illness fell, though protection against serious disease has been maintained.

What about testing, quarantine, and isolation? Given that Omicron has an asymptomatic infectious period and that, even with regular testing, people living together may spread to each other before they become aware of their test positivity (particularly in this population, since some studies have put the asymptomatic fraction at about 60% of total positives) isolating students is likely to be ineffective. This is why Northeastern and Harvard universities both recently announced they will no longer be moving test-positive students to isolation dorms, which is hard on students’ mental health and logistically challenging when many students are testing positive. The benefits in limiting transmission simply do not outweigh the harms and inconvenience. For these reasons, and the high costs to individuals associated with quarantining asymptomatic healthy people, the Children’s Hospital of Philadelphia recently recommended testing when symptomatic, rather than surveillance screening. The same logic applies to college students, and universities should follow suit and do away with surveillance testing and focus on testing symptomatic individuals as necessary.

Second, are restrictions succeeding at protecting faculty and staff, and the wider community, from the students?

Subjecting a low-risk group of people to severe restrictions such as forbidding them to travel off campus, dine in restaurants, or eat or socialize together, in order to protect higher risk people, is ethically a difficult position to justify. Is there scientific rationale to support it?

The rationale that restrictions on students’ activities somehow prevent spread to “the community,” including faculty, lacks validity for several reasons. The most important fact undermining this assumption is that there are no data showing that faculty and staff are acquiring COVID-19 from students rather than from their own life choices, i.e. visiting relatives, going to parties, traveling, or eating at restaurants. Without careful contact tracing studies, such assertions do not hold water. One of the few contact-tracing studies looking at transmissions in college classrooms, done at Cornell University, concluded the opposite, stating that the risk to faculty of acquiring COVID-19 from a positive student was very low and that “Detailed investigations of the handful of instructor cases that have occurred suggest that they were very unlikely to have been created by a classroom.” The foundation of public-health mitigations must rest on data supporting their effectiveness. When this paradigm is flipped, and the rationale for mitigations is that we do not have data showing that they do not work, public health is sliding down a slippery slope at the bottom of which lies eroded public trust.

In addition, the faculty and staff at these same institutions are also required to be vaccinated and any children over 5 in their families can also now be vaccinated, so their risk of a severe COVID-19 outcome traceable to exposure from a student is miniscule. The COVID-19 weekly hospitalization rate in vaccinated 50-64 year olds was 5.6/100,000 in late December 2021, less than weekly flu hospitalizations in a typical year for this age group, which ranged from 6-11/100,000 in average years. The fact that the most-restricted group (students) on campus has a fraction of the hospitalizations of nearly entirely unrestricted group (faculty) points to the conclusion that these policies are not in fact grounded in scientific rationality.

It is past time that colleges do away with restrictions on students’ travel, dining, and socializing on campus. All classes that were advertised as in person should be fully in person. Universities should devote resources to addressing the complex needs of the small number of students on campus who have serious health issues. While this is a tiny number in such a healthy age group, the pandemic has highlighted challenges these students face, and have always faced, due to infectious disease potential in congregate living situations. It is not reasonable, however, to expect that all students switch to remote classes every time there is a rise in COVID-19 prevalence, to protect a tiny fraction of enrolled students. While it is unclear how many truly at risk young adults there are on college campuses, a CDC study from 2013 estimated that 2.7% of all American adults had some immunosuppression but the majority of them were clustered around 50 years of age. Studies done post-COVID-19 indicate about half of moderately-to-severely immunosuppressed people still mount good immune responses to two doses of vaccination. In a recent survey, however, 95% of college students reported having at least one mental health issue.

Now that most states have set dates for indoor mask mandates to expire, colleges should lift the requirement as soon as they are able. Absent robust data showing that faculty are acquiring COVID-19 from students during classes, requiring all students to mask at all times is an onerous burden. KN95s or N95s provide protection to the wearer, if fitted properly and tightly, regardless of whether all parties are masked (one-way masking). Faculty—or students—that are concerned about being in classrooms with other people should wear an upgraded mask if they choose and universities should supply low-cost air cleaners. It is time to let people make their own decisions about masking, particularly in educational situations where masks demonstrably make communication more difficult and impair emotion recognition.

Two years into this pandemic, the potential benefits of attempting to limit COVID-19 transmission among college students, or from the students to surrounding communities, including vaccinated faculty, outweigh the negative effects on their education, and on their mental health, which has deteriorated during the pandemic. Students have been told they are living much-constrained lives right now as a sacrifice in service of the greater good. In reality, they are being forced to follow policies that today accomplish little of what they originally set out to do.

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