EAB’s latest recommendations on de-densification: The start of the fall term has shown that even the best-prepared institutions must alter course for their campus operations to keep their campuses safe from further COVID-19 outbreaks
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Steps to take to reduce the risk of COVID-19 transmissionREAD THE INSIGHT
College and university task forces continue to revise institutional repopulation plans as new information is gained about the realities of the COVID-19 virus. In addition to redesigning their course offerings and physical campus structures, executives are thinking through critical questions on how to contain the virus once faculty, staff, and students have returned to campus.
Containment can be categorized into three main categories: testing, contact tracing, and quarantine and isolation units. Once you have identified infected individuals through testing and traced their networks, you must separate them from your campus community to prevent further spread. Without the ability to separate infected and suspected-infected individuals from the rest of campus, there is limited utility in testing or tracing. Thus, colleges and universities must develop a rigorous protocol for both isolation and quarantine (IQ) units.
What are isolation and quarantine units?
Isolation and quarantine are strategies used to triage and separate individuals infected or exposed to a virus. Although often used interchangeably, isolation and quarantine units serve different objectives and should be uniquely operationalized.
Isolation units are used to separate and restrct the movements of those who have tested positive for the virus. The only path into an isolation unit is through a confirmed positive test.
Quarantine units are designed to restrict the movement of those who have been exposed to the virus but have yet to be confirmed as positive. There are two paths into quarantine: contact tracing and self-reported symptoms. If a campus member has been exposed to a confirmed case or reports symptoms consistent with possible COVID-19 infection, they should go into quarantine while awaiting test results.
The graphic below highlights the various paths to entry into either a quarantine or isolation unit.
Isolation and quarantine units (I/Q)
Key questions to consider:
- Who will have access to I/Q units? (e.g., resident students, off-campus students, staff)
- How will you triage individuals into quarantine?
- How many units can you arrange for isolation and/or quarantine?
What is required for an IQ strategy?
An effective IQ strategy is one that considers three main factors: access, triage, and capacity. Each of these factors present important decisions that a university must make to operationalize their isolation and quarantine units.
It is important to remember that it is highly unlikely that your campus can insulate itself from its surrounding local region due to the paths of mobility of your campus members (i.e., students, staff, faculty). Any transmission between your on and off-campus populations can significantly thwart your containment efforts and risk the public health of your community. Your IQ strategy should consider the following:
- Will your IQ units be restricted to only your residential population?
- Will you make them available to staff and faculty?
- How will you manage IQ for off-campus students that live in congregant settings (e.g., sorority houses)?
Individuals on your campus must know where to go if they suspect having been infected or have a confirmed test. Managing triage and IQ units requires collaboration with your institutional testing and contact tracing efforts to ensure that all positive and potential cases are effectively identified and contained. Consider the following in your triage management strategy:
- How will campus community members know where to report potential infection or request an IQ unit?
- What symptoms would warrant quarantining a student in a university unit versus self-quarantine?
- How will you coordinate across your institutional testing, contact tracing, and IQ management efforts?
The CDC has a robust set of recommendations for ideal isolation and quarantine unit conditions which are designed primarily for healthcare providers. Some are essential conditions (e.g., individual living quarters and restrooms) whereas others (e.g., negative pressure ventilation systems) are valuable but difficult to achieve given the infrastructural realities of college residence halls and facilities. Importantly, while students are in these units, you will need to assist in taking care of their basic needs like food, medicine, laundry, sanitation, and academic accommodations.
Consider the following questions when determining your capacity investments for IQ units:
- Are your campus facilities capable of providing the required accommodations for isolation and quarantine units?
- How will you coordinate across campus functions to provide basic accommodations to those in IQ units?
- How many quarantine units relative to isolation units will you allocate?
- In the case of an outbreak, how will you safely convert quarantine units into isolation units?
How do I design an IQ strategy best suited for my campus needs?
As critical as it is to prioritize an isolation and quarantine strategy as part of your repopulation strategy, it is just as important to determine what approach works best for the needs of your campus community. Inherent in every decision is a balance between cost and risk to public health. EAB has spent the past few months speaking to higher education leaders about their IQ strategies and have catalogued the spectrum of approaches into the following tiers. Further details on all tiers can be found in our COVID-19 Containment and De-Densification Diagnostic.
Review the approaches sampled below to best determine what is needed on your campus.
This approach poses the highest level of risk to the roommates or suitemates of the infected individual. There are also downsides to the decentralized provision of care. It is more labor-intensive to handle laundry or delivery of food in an environment where all isolating individuals are not in the same location.
Designated isolation units must be physically separated from other student residences to prevent transmission. Triage and accommodations are centrally managed with a potential high risk of viral spread across quarantined rooms (i.e., personal rooms either on-or-off campus).
This approach affords a lower public health risk by investing more in designated isolation and quarantine facilities on campus. These facilities are centralized, and estimates based on student-campus interactions suggest that institutions need approximately seven quarantine units for every isolation unit at minimum.
Example Institution: SUNY New Paltz
- Reserved an entire residence hall for both quarantine and isolation units for residential students
- Facility accommodates 33 quarantine units and/or up to 211 isolation units; can be reallocated as needed
- Provided refrigerator/microwave, food, support, wellness checks, laundry, and trash services
This approach allows for active containment of potential viral spread between your on and off campus communities. Campuses with significant off-campus populations must consider how to prevent localized outbreaks in high congregant settings (e.g., sorority and fraternity properties, multi-unit homes and apartment buildings).
Example Institution: Purdue University
- In addition to IQ units for residential students, Purdue is offering limited self-quarantine for off campus students for $400 per week
- Price includes meals and linens and access to medical staff
The last and costliest option is to use a local hotel or apartment property as your isolation and quarantine units. Some hotels are eager for the business right now and are positioned to quickly modify their units into appropriate accommodations. Medical, service, and academic accommodations may require additional coordination to provide adequate care for students in these facilities.