How will we know that an outbreak on campus has become uncontainable?

Expert Insight

How will we know that an outbreak on campus has become uncontainable?

Until a COVID-19 vaccine or therapy is discovered, campus leaders will need to continuously reassess their plans for in-person instruction. A crucial window to make this decision will be before students arrive on campus. We have already seen USC roll-back its earlier plans, and other institutions may follow suit as cases skyrocket across the South and West, driven largely by college-age populations. Even after classes begin in person, leaders will need to monitor for early signs that an outbreak on campus has become uncontainable.

The decision to pull-back from repopulation will be one of the most complicated any leadership team will make. Not only are the public health and financial consequences immense, but there are dozens of variables that could inform this decision. Some of these may contradict one another, and others—like faculty and student opinion—are not easily quantified. 

Decide on the key metrics that will guide re- and de-population

The relevant tipping point is not a set number of cases, but rather when an institution’s ability to contain an outbreak is overwhelmed. As shown in the chart below, two categories of metric must both be consulted to make this decision: first, those that measure the prevalence of disease and, second, those that measure your ability to contain an outbreak.

Disease Prevalence Metrics

LocationMetricTipping Points
On CampusDo reports of influenza-like symptoms from campus exceed those of previous years?Above last year’s seasonal average or increasing over a 5-day period
On CampusWhat percentage of tests are positive?Greater than 5% or increasing over a 7-day period
On CampusWhat percentage of cases are linked to other known cases?Fewer than 95% of cases are linked to other known cases
On CampusAre the number of infections increasing or decreasing on campus?Increasing over a 7-day period
In the regionWhat phase of re-opening is the state in?State pauses re-opening
In the regionIs the number of infections in the county increasing or decreasing?Increasing over a 7-day period

Based on OpenSmartEDU, COVID-19 Planning Guide and Self-Assessment for Higher Education.

Disease Containment Metrics

LocationMetricTipping Points
On CampusHow quickly are quarantine and isolation facilities filling?Less than 7 days remaining until Q/I capacity reaches zero
On CampusHow quickly is testing capacity being overwhelmed?Less than 7 days remaining until testing capacity is maxed out; time to process tests exceeds 48 hours
On CampusIs there sufficient PPE capacity?Less than 7 days remaining until PPE is depleted
On CampusAre stakeholders complying with public health measures?Pulse surveys reveal lack of desire to comply with interventions
In the regionIs there sufficient hospital capacity in the county?Fewer than 15% of hospital beds and 20% of ICU beds are available

Numbers in these tables are for reference only. Please consult with a public health expert to determine the right metric at which interventions should be increased.

Understand when your capacity for targeted interventions has been overwhelmed

While monitoring the above metrics can help deploy large-scale responses, more narrowly targeted interventions will also be crucial to containing an outbreak. As recent outbreaks among sports teams and on sparsely populated campuses suggests, much of the challenge this fall will be identifying and responding to clusters before they become unmanageable. Robust testing, symptom monitoring, contact tracing, and isolation capacity are prerequisites for these interventions, as EAB recently discussed in its webinar about bringing students back to campus.

Residential campuses have several unique characteristics that make it easier to roll-out interventions, potentially avoiding some of the problems with contact tracing that have plagued recent in attempts in the United States. In addition to targeting individuals who were exposed, they could target class sections with cases, residence hall floors, buildings, and Greek life buildings, and athletic teams. As the chart below shows, these interventions range from the mild to the extreme.

A Spectrum of Interventions

At some point, the targeted approach (on the left) may become overwhelmed, and a more blanket approach (on the right) is needed instead. In addition to the general public health metrics, this decision will rely on the number of new cases that are not linked to known clusters, which suggests community spread, as well as the size and number of clusters.

Communicate the key metrics behind your decision

While most institutions cannot provide full transparency into the decision to de-populate campus, at the minimum universities should share the core metrics they are monitoring that inform their decision.

For an additional level of transparency, institutions can create a public-facing dashboard that shows the current levels for several public health metrics. Since the pandemic began, states and local governments have created similar dashboards that show data on topics such as rises in cases or hospitalizations. Recent models from Center for Health Security at the Johns Hopkins Bloomberg School of Public Health, the PRAM dashboard at University of Nebraska, Omaha, and the foundation Resolve to Save Lives shows how universities could implement a similar program. A great example of how one institution created an easy-to-read dashboard is from University of Texas Austin, which tracks four key metrics.

A dashboard places all members of the community on the same page and ensures that everyone is looking at the same data. It also provides accountability to university stakeholders who may be reluctant to return to campus without a clear understanding of the risks.

Create a public-health-informed depopulation plan

The worst-case scenario for the fall—a return to fully remote operations—will be different from spring 2020. Then, the rapid depopulation of campus aimed to prevent the spread of the disease onto campus when students returned from spring break. In fall 2020, by comparison, a switch to remote operations would be deployed as a last step to contain an outbreak.

Once an outbreak is uncontrollable, sending students home risks seeding the outbreak in communities across the globe. Realistically, however, many students will not wish to remain in residence halls while taking remote courses, especially if community spread is rampant on their floor. Moreover, many parents will believe that their students are safer at home, despite the health risks of collecting their child from campus.

To balance the demands of public safety and student well-being, universities should develop policies for a safe depopulation. Like this spring, any depopulation plan requires extensive accommodations for housing- and food-insecure students, as well as international ones. In addition, it should prioritize students for departure who live in residence halls with low incidence rates, those who have just completed quarantine and isolation, and individuals who have recently tested negative. All departing students should be asked to commit to a two-week self-quarantine after departure to avoid the possibility of a-symptomatic spread to their home community.

Ultimately, both advance planning for handling an outbreak and a robust strategy to communicate these steps will be critical for the fall. Given the rate at which recent case surges have overwhelmed testing and containment on the state level, higher education leaders should recognize that they will have a very narrow window in which to roll out interventions before an outbreak reaches an uncontainable level.

EAB asks you to accept cookies for authorization purposes, as well as to track usage data and for marketing purposes. To get more information about these cookies and the processing of your personal information, please see our Privacy Policy. Do you accept these cookies and the processing of your personal information involved?