Managing Pandemic Health Risks on College Campuses

College life was designed around community and togetherness. Now we are attempting to retrofit it for the opposite — with physical distancing, fewer people and the elimination of most in-person gatherings.

The final days of summer offer an opportunity for incoming students and their families to prepare for a semester anchored by public health principles.

As an infectious disease expert and chief health officer for the University of Michigan, I’ve spent the past four months deeply involved in planning efforts to bring thousands of young people back to a campus as safely as possible. I have talked with public health and student services colleagues at many other colleges, and while each school may have a different approach to testing or allowing students to move into residence halls with roommates, certain aspects of campus life will be broadly similar. Following are suggestions for how to minimize the health risks on and around campuses this fall.

Since the number of people who can assist with the actual move-in process and the time allotted for unloading will be limited at most schools, pack efficiently and take care of longer goodbyes ahead of time.

Once students are on campus, nonessential travel (especially out of state) will be discouraged. Most schools have canceled fall breaks and will wrap up in-person learning before Thanksgiving, with any remainder of the semester completed remotely.

Parent and family weekends are among the many events that will not happen. With limitations on in-person visits, students should plan on alternative ways to stay connected. Create a schedule for regular video chat check-ins to provide support but also allow for independence.

Students living in residence halls can expect limits on movement (to connecting halls, for example), use of common areas, and guests. Because of the need to maintain physical distance, most students will spend a lot of time in their rooms, especially if libraries and other gathering places are closed or have capacity limits. Your room will be your “home” and the place you study, sleep, eat and attend class virtually.

Think carefully about what you need to be comfortable and productive, but resist bringing excess stuff. You will appreciate the extra space, and packing up will be easier whenever you leave. If you have a roommate, the circumstances of this semester present unique pressures. You will spend far more time in your room than ever before, and you are each vulnerable to the risks the other takes, so you need to have an honest conversation to set expectations and boundaries. Open communication, respect, kindness and patience will go a long way.

Although policies may vary, face coverings will be part of your uniform anytime you leave your room. Face coverings provide protection only if worn correctly, so try different types of cloth masks to find one that fits well and is comfortable to wear for several hours. You should be able to talk and move around without the mask requiring frequent adjustment. Think of face coverings like underwear — have several pairs, wash them often and don’t share.

Campus dining halls will continue to offer meals, but dine-in options will be limited and may require reservations. The alternative will be takeout meals consumed in designated eating areas or in your room.

Because of capacity limits and a screening process for entry, getting food may require more time. Students should have some shelf-stable snacks and meals that can be prepared with minimal equipment in their rooms, such as instant oatmeal, canned soup, dried fruit, peanut butter and crackers. A refrigerator and microwave will help. Since access to a full-service grocery store may be limited, consider options to restock, including delivery services and convenience stores.

With large, introductory classes being fully remote on most campuses, in-person learning will likely be limited to small groups and activities that cannot be done remotely such as science labs, studio work and performance programs. Explore opportunities to get extra help for classwork via office hours, review sessions and tutoring resources, all of which may be done virtually. Successful remote learning means having the right technology and ensuring stable access to broadband. Many schools have laptop programs and other ways to support students who do not have reliable equipment.

Investigate the local health resources and have a plan for what to do if you develop symptoms suggestive of Covid-19. Larger institutions are more likely to have a full-service health center on campus, while smaller schools might have longstanding relationships with health care providers in the community.

With more than 6,600 cases of coronavirus already linked to colleges by the end of July, many campus health centers have gained considerable experience managing infections and are well positioned to provide compassionate, student-focused care for mild to moderate illness. The medical staff can facilitate transfers to emergency departments if needed. Most colleges have designated living space for students who become ill or require quarantine after close exposure to someone with Covid-19. If home is within a few hours and students can safely travel by car, this may be a good option.

While student health fees often cover routine services, this is not the same as health insurance. Be sure to review policies about out-of-network coverage for your health insurance plan. Depending on restrictions, it may be prudent to purchase insurance plans offered by the school. Depending on the state, low-income students may qualify for Medicaid coverage.

Covid-19 health kits should include a functional thermometer and basic, over-the-counter medications (such as acetaminophen, cough drops, cough suppressants). Hand sanitizer and disinfecting wipes can help keep the living space clean. Fingertip pulse oximeters, which are growing in popularity, can be used to measure blood oxygen levels should symptoms of Covid-19 develop. This type of monitoring can be an early warning sign, before a patient has difficulty breathing, that urgent medical evaluation is needed.

Getting a flu shot will be especially important this year, with concerns that concurrent outbreaks of Covid-19 and influenza will quickly overwhelm health system capacity. The flu vaccine this year is expected to be available starting in September.

Depending on state restrictions, indoor fitness centers will likely remain closed. Develop a regular exercise routine, ideally with activities that can be done outdoors or with minimal equipment in your room.

Even before Covid-19, loneliness has been epidemic on college campuses. Social and emotional well-being is essential to overall health. Young adults need face-to-face interaction with other young adults. The focus should be on picking the safest options, making good decisions and managing social expectations.

Meeting in person means sticking with small numbers (10 or less), wearing masks and being outdoors whenever possible. Be open to different types of interactions — take a walk, play video games remotely, sit in a circle outside. There will be less mixing but perhaps more potential for deep friendships.

Taking care of yourself means getting enough sleep and making good decisions about drugs, alcohol, vaping and sexual activity, all of which pose health concerns during normal times and can also increase Covid-19 risk. For some, seeing pictures of other students at parties is likely to increase FOMO — the fear of missing out — but some colleges regard hosting parties as a violation that could result in being thrown out of school.

Starting college during a pandemic means taking on both shared risk and shared responsibility. While testing has a role, consistent adherence to basic public health measures — wearing a mask, washing your hands and physical distancing — is the most important aspect of prevention. A successful fall semester requires a social contract of sorts, since your behavior affects everyone around you as well as everyone they are exposed to. Ultimately behavior (not the academic calendar) will determine how long the semester lasts.

Dr. Preeti Malani is chief health officer and a professor in the division of infectious diseases at the University of Michigan.

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