By Martin McKee
They thought they had it sorted. The University of Illinois had pulled out all the stops to ensure that it would be covid secure. Academics had modelled the movements of 46,000 staff, students, and those interacting with them, like coffee shop workers. The model even allowed for partying, with up to 7,000 students going to parties three times each week. Face coverings were compulsory and students were tested twice weekly. Entry to buildings required that they showed a negative result on an app. Yet the coronavirus circumvented all these precautions. What the university leaders had not considered was that some students would continue to party even after receiving a positive result.
Elsewhere in the United States, universities that opened several weeks ago are already locking down and moving teaching online, including some of the most renowned, such as the University of North Carolina at Chapel Hill and Notre Dame in Indiana. Between late August and September 10th, at least 61,000 new cases were linked to US universities. These events were both predictable and predicted. The coronavirus spreads rapidly in settings anywhere individuals mix in large numbers and in close proximity, a defining characteristic of a university. Worryingly, while much is made of how the death rate among young people is low, this ignores the growing numbers of previously healthy young people who have been seriously affected by what has been termed 'long covid'.
As in March, when the UK was able to learn from the experience of northern Italy, the first part of Europe to experience the full effects of the pandemic, it is now possible to draw lessons from the United States. What should British universities do? This is something that we in Independent SAGE have been reflecting on and what follows is a summary of our conclusions, both specifically in relation to universities but also, where relevant, more generally.
First, we need to remember that universities exist within wider society. Their covid safety is a function of the extent to which there is control of the virus in their communities. And as of now, the virus is not under control in most parts of the UK. Numbers of cases are rising and, as can be seen in countries such as Spain and France, once you lose control, it is very difficult to regain it.
Worse, England's testing and tracing system is not functioning adequately. It is fundamentally flawed by design, fragmented with no clear lines of communication or authority. Some components of what is needed have largely been ignored, such as intelligence-led case finding and support for those isolating.
Above all, there is no overall strategy but instead a series of announcements that attract headlines but are either inexplicable, such as the abolition of Public Health England, or in the realms of fantasy, such as Boris Johnson's Moonshot programme. As with schools, one of the most important determinants of whether it is safe for universities to reopen their facilities is the level of virus circulating in the community. Until we can reverse the current resurgence, the threat is great.
So what should universities do? We argue that, given where we are now with the pandemic, all university courses should be offered remotely and online if at all possible. We fully accept that this may not be possible for laboratory or practice-based education, such as medicine and nursing.
We also don't underestimate the challenge. I am currently converting my autumn term teaching to online format. I estimate that each one hour lecture requires about eight to ten hours to produce, with seminars being even more complicated. On the other hand, it is forcing us to innovate in ways that will improve our teaching in the long term. We feel that it is much better to start out online rather than risk major disruption if we have to close at short notice. However, this also means that our universities must ensure that all students have the resources necessary to participate in online teaching and study.
Where students have to be on campus, we must do everything possible to provide a covid-safe environment although, as we saw from the experience of the University of Illinois, we should never be complacent. First, the traditional welcome week and all teaching for the first two weeks must be virtual. Social gatherings, which are the highlight of freshers' weeks, are, unfortunately, not a good idea. This means that university societies will have to find other ways to reach out to new members. It also places a collective responsibility to the student body and university welfare staff to support students who may be living away from families for the first time ever, and who may be lost and confused.
We must make strenuous efforts to reduce the possibility of transmission in teaching facilities. These include an expectation of two metre social distancing, with measures to control traffic flow in corridors where this is difficult, face coverings where possible, enhanced ventilation, provision of personal protective equipment where appropriate, for example for health students, and enhanced cleaning. Testing will be important, as part of a clear strategy agreed with local public health teams.
Residential 'bubbles' and segmenting will make it easier to respond if cases arise, minimising disruption. This will be more effective if it is not breached by constantly changing class compositions. However, this should be supported by a social agreement on covid-safe behaviours on campus, developed collaboratively by students and university staff. Indeed, full engagement with student representatives and staff unions is crucial, ensuring that any measures taken recognise the reality on the ground, with attention to equality and diversity issues, and delivered by a well thought-out communication strategy.
Developing appropriate responses is far from easy. Knowledge about the coronavirus and its effects is developing rapidly. Inevitably, decisions will be made with incomplete knowledge. Universities vary greatly in terms of their geography, student mix and facilities, but they can work together to develop guidance, policy and practice. If they seek to compete with each other they may win the race, but to the bottom.
The truth is this: it is not clear that restarting large-scale in-person teaching is possible at present. Yet we have other ways to deliver a high quality education to students. It is not going to be easy, but if we fail, we will be part of the problem and not, as many of us hope through our work on this disease, part of the solution.
Martin McKee is professor of European Public Health at the London School of Hygiene & Tropical Medicine and a member of Independent SAGE. You can follow him on Twitter here.
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