Considerations for Reopening Institutions of Higher Education for the Spring Semester 2021 - Holmes Murphy
Page content transcription
If your browser does not render page correctly, please read the page content below
DECEMBER 29, 2020 ACHA Guidelines Considerations for Reopening Institutions of Higher Education for the Spring Semester 2021 n seven months since the May 7, 2020, release of the • United leadership is critical to a sustained and I ACHA Guidelines: Considerations for Reopening Institutions of Higher Education in the COVID-19 Era, unprecedented research, diagnostic testing, vaccine, and treatment developments have advanced our effective response. The leadership must have accurate and reliable data, a clear understanding of crisis management, and an in-depth knowledge of policies/procedures. They must leverage the research approach to SARS-CoV-2, the novel coronavirus that enterprise and campus and local experts and gain the causes COVID-19. For many campuses, the short-term trust and respect of the campus community through goal upon entering the fall semester was to reach honesty, clear communication, transparency, and Thanksgiving break and provide a safe environment to concern for the overall health and well-being of the carry out the institution’s academic, research, and service campus and its surrounding community. missions; adhere to public health guidance; meet the • Multilayered mitigation strategies with universal expectations of students, faculty, and staff; and avoid masking, physical distancing of 6 feet or more, and fatalities. At the time of this writing, the nation is deep good hand hygiene accompanied by a coordinated within a third wave of the pandemic and breaking daily public health strategy of robust testing, contact records for confirmed cases, hospitalizations, and deaths. tracing, and expeditious isolation and quarantine The emergency use authorization of two safe and effective processes are the most effective measures for COVID-19 vaccines is bringing new hope at the end of an decreasing the risk of transmission of SARS-CoV-2. arduous semester and calendar year. • Most campus outbreaks have been related to small After several months of experience, research, and practical and large gatherings without masking and without applications, we know more, have learned from early physical distancing that have occurred in bars, in on- missteps, and are better prepared for spring semester. For and off-campus residences, and in Greek housing. months, institutions of higher education (IHEs) have been in perpetual motion to retrofit facilities; acquire personal • Managing a campus outbreak requires a coordinated protective equipment (PPE) and cleaning supplies; educate response and a close partnership among state and and train the campus community; implement technology local public health authorities, community leaders and testing programs; transition to telemedicine and and the IHE’s COVID-19 emergency response team. telemental health services; and create new processes, Identifying key indicators and triggers to implement a systems, and partnerships to address the pandemic. This change in campus operations should be established document serves to provide updated considerations and early, widely communicated, and continuously guidance for IHE presidents and chancellors, senior monitored. The health services director or designee leaders, and college health professionals to inform their should play an integral role in this effort. planning for the upcoming semester. • Students with COVID-19 are frequently asymptomatic. Preventing transmission by Lessons Learned asymptomatic and presymptomatic individuals • Planning and preparation, including contingency requires universal masking, physical distancing, swift plans are essential for an organized, effective, and identification through testing and contact tracing; and timely response. The response must include strategies isolation and quarantine. for recovery and future preparedness. Flexibility and quick adaptation to the changing environment are critical for success.
Considerations for Reopening Institutions of Higher Education for the Spring Semester 2021 / page 2 • SARS-CoV-2 is primarily transmitted via staff, physical therapists, equipment staff, and aerosols/droplets; therefore, proper physical distance officials. In the “Appendix, Sport Transmission Risk, among people in classrooms, along with appropriate Sample Testing, and Masking Strategies” to its ventilation and universal mask requirements will Resocialization of Collegiate Sport: Developing minimize transmission in instructional settings. Standards for Practice and Competition, Second Edition (Updated), the NCAA provides details of • There is little evidence to show secondary testing recommendations. transmission is occurring either student-to-student or student-to-faculty member in instructional settings where everyone is wearing masks and proper The Work Force physical distancing is maintained. Since the release of ACHA’s Reopening Guidelines in • Though fomites and surfaces pose a lesser threat, May 2020, CDC has continued to update and expand the high touch areas must be cleaned and disinfected list of conditions that place individuals at increased risk of regularly, and all must practice meticulous hand severe illness if infected with SARS-CoV-2 and has also hygiene and avoid self-contamination with unwashed developed a list of conditions that might place individuals hands. at increased risk (see both lists here). Campus human resources (HR) leadership should continue to monitor • Student adherence to public health practices and the these conditions and evaluate and modify policies and campus COVID-19 plan is essential for success. accommodations based on updated CDC guidance. • Students must be involved in planning, messaging, Faculty and staff, particularly those on the front line and the development of safer social activities. providing in-person services/instruction, must have ample • Fostering healthy behaviors requires a social norming and appropriate personal protective equipment (PPE) and approach and the use of all available channels of cleaning and sanitizing materials available. communication including social media, texts, and The pandemic-fueled economic downturn, social isolation, email. and “Zoom fatigue” have exacerbated stress levels, • The frequency of testing and rapidity of turnaround anxiety, and burnout, particularly in health, counseling, time are more important than the sensitivity of the and health promotion staff and those faculty and staff who test. Surveillance, screening, and diagnostic testing have shouldered the front-facing, day-to-day activities of strategies are all important in reducing the spread of the in-person campus. At a minimum, the IHE should COVID-19 on college campuses. ensure all faculty and staff have access to employee assistance programs and other wellness resources. • Because of the numerous unknowns, the rapidly evolving nature of the pandemic, and the inability to Considerations for the work force: predict student behavior, IHEs have established • Update COVID-19 safety educational and training surveillance systems and thresholds to quickly materials to include new campus policies, new change course. Planning must account for different isolation/quarantine durations, revised definitions and scenarios and exit strategies. reminders to wear masks, maintain physical distance, • Herd immunity will only be achieved with delivery practice good hand hygiene, clean and sanitize, and and widespread public acceptance of a safe and to promote vaccine adherence to influenza and the effective vaccine. COVID-19 vaccine. • Recognition of the mental health effects on the • Have faculty, staff, and students review the updated campus community cannot be minimized. The educational and training materials in a timely emotional impact of loss, uncertainty, isolation, and manner, ideally within the first two weeks of return quarantine have been notable. to campus. • The NCAA has continued to revise their • Review and update HR policies and employee recommended testing strategy for each sport. Testing accommodations based on current CDC guidance. is important in all intercollegiate sports, with the • Develop plans for alternative work assignments for frequency and timing determined by the sport’s risk high-risk staff. level. Testing strategies should include, at a minimum, all “Tier 1” individuals, which includes • Develop employee health program protocols for student athletes, coaches, athletic trainers, medical management of exposed and ill staff members.
Considerations for Reopening Institutions of Higher Education for the Spring Semester 2021 / page 3 • Develop return to work protocols for staff who have • Screen all patients and staff for COVID-19 symptoms become ill or exposed to COVID-19. before entering the clinic. Temperature checks may also be considered. • Strongly encourage both flu vaccination and COVID- 19 vaccination (when available). Consider • Develop a plan for students with respiratory implementing a requirement for active declination of symptoms who need transportation to SHS, housing, both. or local hospitals. Ensure after-hours care options are included. • Address faculty/staff mental wellness and provide resources such as employee assistance programs, • Incorporate telehealth options as well as in-person financial literacy information, mindfulness teachings, visits into triage protocols. and “care for the caregiver” programs. • Continue to utilize telemedicine visits and provide • Provide coaches and mentors and/or workshops to students with options for telemedicine or telephone assist faculty with technology and innovative consults when appropriate. Students with conditions instruction tools. placing them at higher risk for complications from COVID-19 should be encouraged to seek care via • Continue daily symptom checking and reinforce telemedicine. messages to stay home or leave work if sick. • Develop protocols for in-person visits. Consider Student Health Services (SHS) designating and scheduling providers for telemedicine and in-person visits on a daily basis. The role of student health services was expanded during Allocate a separate area of the clinic for acute illness. the pandemic, often with SHS staff adding testing, contact tracing, and case management to their responsibilities. • Update screening forms to incorporate COVID-19 Campuses will continue to look to student health services symptoms, including but not limited to: fever, cough, for medical and public health expertise, and SHS shortness of breath, chills, muscle pain, headache, leadership should be poised to deliver current, sound, sore throat, congestion, nausea, vomiting, diarrhea, evidence-informed recommendations. Maintaining anosmia, and dysgeusia. essential services to students while providing pandemic- • Continue the delivery of routine clinical preventive related care and campus support have challenged and services when at all possible to prevent health strained the campus health system. consequences of delayed care. Patient Care Considerations • Ensure protocols for managing patients with acute respiratory symptoms include masking the patient, In concert with the recommendations outlined in the May quickly rooming the patient, limiting and tracking the 2020 ACHA Guidelines: Considerations for Reopening number of staff who enter the room, limiting the Institutions of Higher Education in the COVID-19 Era, the movement of the patient throughout the SHS, and SHS should: cleaning of spaces where the patient was present. • Advise patients to call before coming to the SHS for • Avoid use of nebulizers and peak flow measurements any type of visit. which can generate additional aerosols. • If possible, utilize an online or telephone process for • Ensure a COVID-19 testing plan is in place for patient check-in. students, faculty, and staff, either on- or off-site. • Limit student contact with SHS computers/keypads. Frequency and type of testing may vary depending on Have students complete and submit forms (health community and campus resources. history, immunizations, consents, etc.) in the patient • If dental operations are within the scope of services, portal or utilize EMR templates. review updated CDC Guidance for Dental Settings. • Require all patients to wear face masks (or cloth face • Work closely with the marketing and coverings if adequate face masks are not available). communications department to continue to provide • Prohibit visitors, children, or accompanying guests updated messaging about COVID-19 protocols, who are not receiving care or services from entering policies, and services. Use a variety of platforms the facility.
Considerations for Reopening Institutions of Higher Education for the Spring Semester 2021 / page 4 • Ensure adequate PPE is available and that all staff are including websites, social media, and signage. trained in its use. Monitor staff compliance with PPE Involve as many campus entities as possible in use. Enough PPE supplies should be stocked to meet communicating these messages (housing, dining, both patient care and testing needs. recreation, etc.). • Maintain situational awareness of COVID-19 in the • Work closely with residential life staff to identify and state, city, and on campus. manage students who require isolation or quarantine. • Consider a mandatory COVID-19 testing policy for • Develop relationships and agreements with local all staff. emergency departments (ED) to accept ill patients requiring a higher level of care. • Implement effective patient-centered policies to safely meet the health and counseling needs of SHS Facility Considerations students. • Design facility layout to provide in-person clinical • Develop employee health program protocols for services for needed preventative care and care for management of exposed and ill staff members. illnesses/injuries other than COVID-19 in the safest Develop return to work protocols for staff who have manner possible while minimizing transmission of become ill or exposed to COVID-19. COVID-19. • Document all providers and support staff involved in • Segregate waiting areas for ill and well patient visits. the care of every patient so that exposures can be If separate waiting rooms are not available, consider tracked. placing a tent outside or identifying a satellite space • Ensure staff are knowledgeable about COVID-19 for patients with respiratory symptoms. Deploy symptoms, transmission, relevant protocols, and signage providing clear guidance on how to proceed. updated CDC guidance. • Perform COVID-19 testing outdoors when possible. • Develop plans for alternative work assignments for • Reconfigure all waiting and other clinic areas to high-risk staff. promote physical distancing. • Continue to track costs and funding mechanisms for • Ensure adequate amounts of alcohol-based (at least testing, contact tracing, and case management. 60%) hand sanitizer, face masks (or cloth coverings if Consider the financial impact of mass vaccination masks are not available), tissues, and closed bins for with COVID-19 vaccine. disposal are available. • Develop plans for mass immunization with COVID- • Provide plexiglass/clear barriers between reception 19 vaccine, including necessary personnel, supplies, staff and waiting areas. and locations for vaccination administration and delivery. • Develop protocols for environmental management, including frequency and responsibility for clinic • Identify appropriate charges (if indicated) for visits, cleaning and decontamination. telehealth services, testing, and supplies, including medications or vaccines. Identify correct billing • Assess air exchange of care, treatment, and codes to facilitate prompt, accurate reimbursement if administrative spaces and determine time required billed to insurance. between uses in the event of a known or suspected COVID-19 patient. Mental Health • Ensure adequate IT network, wi-fi, hardware, and expertise to support telemedicine and telemental Addressing the mental health and wellness needs of our health visits. students and campus community has proven to be a tall order for college health and counseling centers and SHS Administrative/Staff Considerations campuses at large throughout the pandemic. Even before the pandemic, college and university presidents placed • Utilize patient satisfaction surveys to obtain feedback student mental health needs at a high priority. College about telemedicine or phone visits as well as clinic counseling centers moved quickly to develop new services. Develop a system to review the quality of platforms for providing services, forge new campus and care provided and incorporate into existing peer review processes.
Considerations for Reopening Institutions of Higher Education for the Spring Semester 2021 / page 5 community partnerships, and establish a diverse array of Technology and Telemental Health services using hybrid and fully virtual venues to support In spring 2020, most college health and counseling centers student mental health and wellness through these difficult pivoted to virtual platforms, establishing eligibility and times. exclusion criteria and practice guidelines for the provision JED’s Comprehensive Approach identifies key areas that of telemental health services. Counseling centers will colleges should address to support student mental health likely continue to refine, expand, and deliver their services and to limit substance misuse and suicide. Within each in this manner throughout the upcoming spring semester. strategic area, there are multiple activities and efforts that Widespread temporary state-by-state exemptions helped colleges can implement to support student mental health. address legal barriers that prevented counseling across The Jed Foundation emphasizes that a campus-wide state lines. The sustainability of telemental health services systemic approach is integral in efforts to prioritize the will be based on evaluative outcome data, identified mental health needs of students, especially at a time when needs, and demand. students may have fewer interactions with peers, athletic coaches, and advisors and that faculty may have an even Ongoing Assessment and Evaluation greater responsibility as gatekeepers. IHEs are encouraged to consistently assess the prevalence The extreme academic, social, and economic pandemic- and acuity of student mental health symptoms on their related disruptions, the transition to virtual environments, campuses. It is important to collect data to support and constant uncertainty continue to take a toll on strategic planning, resource management, and service students’ well-being. For many, the pandemic can be delivery models, including student satisfaction with classified as a disaster with uncertainty being the main telemental health services, as well as outcome data related component; those with pre-existing mental health to efficacy of care. Campuses are encouraged to identify conditions, low frustration tolerance, and/or limited how best to collect data without further burdening a coping strategies have been heavily impacted. The virtual-weary population with additional electronic American Psychological Association indicates that the surveys. negative mental health effects of the pandemic will be serious and long-lasting. Faculty and Staff Mental Health ACHA and Healthy Minds survey data collected early in The ACHA and Healthy Minds data indicate that there is a the pandemic showed an increase in student incidence of direct correlation between feeling valued and supported depression and feelings of stress and anxiety. Student and a sense of wellness. A strong predictor of wellness is perceptions of loneliness and isolation have been cited as believing that your voice matters and feeling like you are a contributing factors. Some students report that mental part of the decision making. For faculty and staff these health services have been more difficult to access since tenets are equally important. Campus leadership must the pandemic. Early data suggesting increased incidences continue to recognize and validate efforts on a consistent of stress and mental health symptoms are juxtaposed with basis and ensure that health, counseling, and health data indicating improvements in student resiliency by promotion staff as well as faculty and other staff continue 2.5% and decreased prevalence of risky drinking patterns. to receive support, care, and resources on stress reduction, anxiety and depression management, and self-care. Access to Care and Diversity of Services The pandemic has accelerated the need for campuses to do Mental Health Considerations “business differently”. Now more than ever the need to • Ensure mental health providers continue to comply provide a menu of mental health and wellness services is with current environmental, physical distancing, PPE, vitally important. Counseling centers are creating options and public health infection control measures. other than the traditional in-person or virtual 50-minute • Institute appropriate safeguards for in-person psychotherapy session. Students often want “just in time” sessions, including symptom screening, physical services that are timely, convenient, and accessible. To distancing, and face masks for both client and meet the need, counseling centers are offering “on provider. demand” same day appointments, virtual walk -in clinics, mental health chat groups, and encouraging the use of • Develop and/or revise policies related to telemental self-directed skill building modules and apps. health that are in line with accrediting bodies and best practice standards of care, including policies on education, training and credentialing of staff, and
Considerations for Reopening Institutions of Higher Education for the Spring Semester 2021 / page 6 processes for monitoring competence with telehealth comprehensive framework for supporting student protocols and practices according to local, state, and compliance across multiple campus operational units and national requirements. utilizing best public health and prevention practices. Adapting policy and institutional operations to support • Develop and/or revise policies that guide clinical health are core concepts of health promotion. The intent is practices and service provision, including policies on to make healthy behaviors the easy choice through changes to the scope of services, patient identification and removal of barriers to healthy action. In confidentiality and privacy, informed consent, crisis this area, institutions have adopted a variety of health management, risk management, clinical promoting actions during the pandemic: documentation, and system security. • Changes to grading and attendance policies to allow • Outline steps required to offer services across state students greater flexibility. lines and communicate policies clearly to students. • Changes to academic terms to reduce needed travel. • Encourage partnerships with faculty and other support departments such as financial aid and the • Enhanced food security and aid for students in registrar’s office to promote connections and quarantine and isolation. opportunities to reinforce training on how to • Enhanced access to technology for distance appropriately identify, intervene, and refer students in education. distress. • Increased temporary aid for students in financial • Add mental health questions to existing surveys, distress. check-in processes, and functions to continuously take the wellness pulse of the campus population. • Detailed infection control plans across the institution to provide structured, in-person opportunities to • For training facilities, ensure policies address how support well-being. trainees’ telemental health sessions will be supervised and whether sessions will be recorded for Student Engagement and Community supervision. Mobilization • Address the issues of compassion fatigue with the Student engagement with institutional response to health and counseling staff and promote venues for COVID-19 varies by campus, depending upon sharing and ongoing support. Identify wellness institutional values and structures and operational factors resources, including the employee assistance such as whether classes are remote or in person. Many program. institutions that have transitioned to a primarily online education model have seen a notable decrease in student Health Promotion engagement. Some institutions report lower student Health promotion is a process—a network of coordinated engagement across the board. Others report low student actions—that supports individuals’ autonomy in creating engagement generally, but consistent and sometimes health and well-being. Health promoting actions include increasing student involvement in health promoting implementing health-supporting public policy, developing activities, specifically those supporting mental and healthy working and living environments, coordinating emotional health. collaborative community action, providing health Students want opportunities to talk about and process how education, and working with health care systems to think COVID-19 has affected their college experiences and their beyond treatment to promoting health as an everyday lives. They want support in understanding the constantly resource. evolving information about the virus and mitigation Health promotion professionals are experienced in efforts and applying these facts to everyday life. They applying processes to multiple and varying focus areas. want to know what they can do safely, as they are now Health promotion processes can be applied to any health well-versed in what they should not do. Students also are outcome of interest, and every institution selects focus clear that the pandemic has only exacerbated the already areas for health promotion activities based on its unique widespread concerns about mental and emotional health. contextual characteristics. A foundational tenet of health promotion is creating health Senior health promotion professionals often have expertise with the people and community served. Because of this, in coordinating multi-layered, broad community action. health promotion professionals are experienced in using a They are uniquely skilled at developing and coordinating a
Considerations for Reopening Institutions of Higher Education for the Spring Semester 2021 / page 7 range of tools for community engagement and abilities to follow some public health guidance, such as mobilization. As the pandemic evolved, health promotion physical distancing. professionals significantly expanded their use of Harm reduction in application requires a belief that technologies such as texting, social media, online meeting students can make positive choices. It includes the software, and apps. None of these tools are provision of non-judgmental information, with a variety of straightforward substitutes for in-person activities, and all options for taking action. A principle of harm reduction is require skill development for optimal implementation. meeting people “where they are” and supporting However, many of these tools are working well and may autonomy in creating action plans. The overall goal is to continue to be utilized post-pandemic, advancing recognize that some students can’t comply with all opportunities for community engagement. physical distancing or mask guidelines while supporting Pandemic response is complex, multi-faceted work and an them in moving forward with implementing the guidelines excellent learning opportunity for students in a wide range that they can and are willing to do. of disciplines. Inviting students to participate in The harm reduction approach is easier to practice in one- institutional planning and response allows them to see that to-one conversations than in mass communication. this type of work is not simple or one dimensional. They Finding the balance between stating clear policy and can observe and explore complex interactions of policy, encouraging harm reducing behavior can be delicate. organizations, and people. Additionally, students provide People who have not previously practiced harm reduction invaluable perspective on how to frame institutional may have a steep learning curve to determine how to decisions to best meet students’ needs. Institutions that implement this approach. Health promotion practitioners fully engage students in the pandemic response planning have been key collaborators in making this work. and implementation appear to have better results in reducing negative impacts. Health communication campaigns, often the result of collaboration between health promotion and Health Education and Behavioral communication professionals, remain a critical tool during Interventions the pandemic. Institutions have used every communication channel (e.g., social media, email, text messaging, etc.) at Many health education teams have pivoted to virtual their disposal to ensure all students know physical programs, sparking broad conversation about translating distancing and mask guidelines, understand the facts of evidence-based interventions designed for in-person coronavirus transmission, and to motivate students to implementation to the online environment. Health follow guidelines. Specific tactics range from educators have quickly gained knowledge in effective use straightforward factual repetition of guidelines to social of online meeting software to maintain privacy, allow for norms and social marketing campaigns. actively engaged participation, and support accessibility. While sometimes difficult, the shift is also rapidly Simple campaigns focused on factual repetition of public expanding knowledge in ways that may forever change the health guidelines are the most straightforward to delivery of health education programs in higher education. implement, especially with the plethora of resources available from the CDC and other public health agencies. In addition to transitioning standard programs, health Effective social norms and social marketing campaigns educators have developed programs specific to COVID- are designed to enhance both motivation and factual 19. These programs are designed to influence individual knowledge and require more depth of theoretical behavior and enhance motivation to comply by increasing knowledge, more detailed student information, and more knowledge about physical distancing, mask wearing, and resources for implementation to shape campaign hand hygiene. It is important to note that none of these messaging. Collaboration with the institution’s COVID- tools are effective as singular interventions but rather 19 planning and response committee, marketing and should be used in combination with complementary health communications leadership, and the local community are promoting activities. critical for tailored, cohesive, branded, unified messaging. Harm reduction, an approach that focuses on providing Behavior pledges appeared as a widely used tool with non-judgmental, non-coercive resources to reduce varying levels of success. Some institutions used behavior transmission of COVID-19 while acknowledging that the pledges as an actual behavioral contract with clearly disease can cause significant harm, appeared early in the defined negative consequences if not followed. However, pandemic response conversation. This approach allows many institutions attempted to use the pledge as a social opportunity for social justice, recognizing that many contract, with efficacy coming from the aspects of social factors—including social inequities—affect peoples’ accountability.
Considerations for Reopening Institutions of Higher Education for the Spring Semester 2021 / page 8 For the social contract approach of pledges to work, it is On-Campus Testing Procedures recommended that: To enhance the health, safety, and well-being of the • Whenever possible, student representatives campus and broader community, frequent testing is participate in the creation of their campus’ behavior important and enables the institution to find asymptomatic pledge. or presymptomatic students and employees who may be • Students can personalize their own pledge, consistent unknowingly spreading SARS-CoV-2. with their values and views of self. Until recently, CDC maintained its guidance to prioritize • Elements of the pledge be specific (e.g., I will wear a testing to symptomatic individuals and close contacts and face covering when I ….) rather than general (e.g., I briefly removed recommendations to test close contacts will social distance.). altogether. Cumulative research and data led to CDC’s revised tiered testing plan for IHEs. • Reasons why pledging to the behavior be included, possibly even combined with a dedication to Hierarchy for selection of persons for IHE-based testing someone important to the individual (e.g., I’m doing depending on community resources can be as follows: this for ______ because _____.). 1. Persons with symptoms of COVID-19 • Pledges be in writing. If a written pledge is not 2. Persons who have had close contact with someone possible, e-signing or initialing is more effective than with COVID-19 a click or social media share. 3. All students, faculty, and staff with possible • Pledges be made publicly, to combine private as well exposure in the context of outbreak settings as group accountability. 4. Random sample of asymptomatic students, faculty, • Reminders of the commitment be systematically and staff to more rapidly detect increasing SARS- shared for reflection on match to behavior. CoV-2 incidence, with consideration for • Students receive positive reinforcement when pledge incentivizing voluntary testing behaviors are demonstrated. 5. All students, faculty, staff and members of their place of residence as part of a community-based Testing and Surveillance testing strategy by health departments outside of outbreak settings Testing must be integrated with swift identification and containment of positive patients and contacts, physical Diagnostic Testing distancing, face coverings, and hand hygiene practices to control the spread of COVID-19 on campus and within the Diagnostic testing is performed when there is a reason to community. COVID-19 diagnostic (PCR) testing for the suspect that an individual may be infected with SARS- virus allows for early identification, intervention, and CoV-2. It is used to diagnose active infection in effective contact tracing of COVID-19 cases. Testing symptomatic individuals or those with recent exposure results may also help the institution better understand and and is sometimes used to determine resolution of the mitigate the spread of the virus. infection. Daily health monitoring is an important adjunct to diagnostic testing. Health monitoring allows students A clearly defined comprehensive campus testing plan and employees the opportunity to observe symptoms based upon available resources, current scientific quickly so that diagnostic testing can be performed as evidence, and the needs of the campus community is vital. early as possible. Examples of diagnostic testing are Diagnostic screening and surveillance testing strategies testing symptomatic individuals presenting to the health are both important in reducing the spread of COVID-19 center and those who indicate that they were exposed to an on college campuses. Evidence continues to mount in individual with a confirmed or suspected case of COVID- favor of frequent testing of campus constituents on a 19. Those with COVID-19 symptoms or deemed a close recurring schedule. Campuses with limited resources contact should immediately isolate/quarantine while should consult with their local public health authorities awaiting test results. and/or local hospitals, labs, health care organizations, or other IHEs for assistance.
Considerations for Reopening Institutions of Higher Education for the Spring Semester 2021 / page 9 Screening or Asymptomatic Testing strategies such as physical distancing, wearing face coverings, and avoiding large crowds. Testing an individual when there is no reason to suspect infection is known as screening. Screening is intended to True random selection of the appropriate percentage of the identify infected individuals prior to the development of campus population can help the campus determine what symptoms. Identifying asymptomatic positive cases of percentage of the population may be infected with the COVID-19 will allow campus officials to implement virus. This is essential to planning, implementing, and containment measures such as isolation/ quarantine to evaluating public health practice on the campus. prevent wider transmission. Screening for COVID-19 may Typically, local, state, and federal authorities do not be beneficial for individuals where physical distancing is regulate surveillance testing; however, a sample of the more difficult, such as first responders, emergency campus population to test randomly and at regular medical services staff, health care workers, those living in intervals should be determined by the university using congregate housing, and workers in other essential campus local infection rates and trends and other epidemiologic departments/services, such as food services. data. An example of surveillance testing is to select a percentage of a random sample of the campus population Pre-arrival testing is one example of screening. Some on an ongoing basis, such as every 30 days. institutions required pre-arrival documentation of a negative test result before arrival to campus. The primary Wastewater Surveillance purpose of this testing is to identify individuals who test positive, immediately isolate them, initiate contact tracing, The emergence of COVID-19 has resulted in an increased and prevent them from coming to campus while interest in wastewater surveillance. CDC considers infectious. wastewater surveillance to be a promising public health strategy as an early warning system for COVID-19 Entry testing or on-arrival testing is another example of infection and initiated the National Wastewater screening. This involves testing all students and Surveillance System (NWSS) which coordinates the employees returning to campus regardless of exposure, assimilation of data from communities to health signs, or symptoms. The results are then used to determine departments and CDC. Approximately 30 U.S. IHEs have what protective measures, such as quarantine or isolation, implemented wastewater surveillance since students are needed on an individual basis. moved back to campus. Screening may also involve frequent recurring testing of COVID-19 virus is shed in the stool by approximately 50 individuals. More testing options, which are less invasive percent of infected persons. It is considered an early and conducive to point of care use, are becoming community surveillance indicator since positive stool available. The advantage of less expensive antigen tests samples may precede case data by four to six days. Stool has been somewhat offset by their lesser sensitivity. can be positive in persons who are asymptomatic, However, increasing evidence points to testing frequency presymptomatic, or symptomatic. Persons who become and rapid turnaround times as more important than the test infected may shed the virus for weeks. sensitivity for ongoing screening. The availability of testing, as well as the funding and staff necessary to Although wastewater surveillance is an emerging public sustain frequent testing of students, faculty, and staff, are health surveillance tool for COVID-19, there are some key considerations driving institutions' decisions to limitations. A positive test merely indicates the presence implement a screening program. of the virus and cannot be extrapolated to estimate the prevalence of the virus within a community. Positive tests Surveillance Testing also do not necessarily indicate the presence of infectious disease, since persons who are no longer infectious may Surveillance is very important to gain information about continue to shed virus. In addition, the absence of viral the population rather than the individual person. biomarkers in wastewater samples does not necessarily Surveillance testing for COVID-19 includes ongoing indicate absence of infection from a group, since not all regularly scheduled testing and is helpful in determining persons shed virus in their stool when infected. the incidence and prevalence of COVID-19 on campus Nonetheless, wastewater surveillance provides a real and/or in the campus community. Surveillance testing can benefit as an early indicator for the presence of the virus provide an early warning system to identify hot spots or trends within a tested community. within the residence halls, off-campus community, or the workplace and can help the campus understand if the Various approaches can be used for establishing a campus population is practicing effective mitigation wastewater surveillance system. Universities may focus on geographic areas on campus with elevated case rates,
Considerations for Reopening Institutions of Higher Education for the Spring Semester 2021 / page 10 or instead broadly assess samples from across campus. them to interrupt disease transmission. This includes Sewage lines need to be mapped and access to specific asking cases to isolate and contacts to quarantine at home building drainage is necessary. Samples are best collected voluntarily.” at least bi-weekly via site sampling or on a continuous Contact tracing is a confidential process that has been intermittent basis with an automated system. If testing is used for years to curb the spread of infectious diseases and too infrequent, or is of inconsistent timing, the benefit is avoid outbreaks. To be effective, tracers must connect diminished. with known patients to identify and quickly alert their Wastewater testing may be performed by various entities. close contacts of possible SARS-CoV-2 exposure. These include commercial labs or vendors, state public Therefore, many student health services assumed contact health labs, and university labs. These testing entities will tracing of student cases to improve timeliness. calibrate alert levels based upon their individual testing In addition to notification of exposure to an infected results. This data must be available to college health individual, contact tracers communicate extensively to centers in a timely fashion. They may use the data to provide disease and transmission education; gather advance testing or other public health mitigation strategies information such as demographics, living arrangements, in an affected area. school and daily activities, and other pertinent data that will assist in slowing the spread of COVID-19; and Testing and Surveillance Considerations manage the individual’s case. Contact tracers will also ask • Though CDC does not specifically recommend entry about signs/symptoms and underlying medical conditions testing all students, faculty, and staff, it does and should have a system in place to direct those with acknowledge its value, stating that “In an IHE symptoms to the appropriate health care or service setting, with frequent movement of faculty, staff and provider. All contact tracers should complete a formal students between the IHE and the community, a training to ensure consistent and quality information. The strategy of entry screening combined with regular training may be provided by the local health department, serial testing might prevent or reduce SARS-CoV-2 CDC, or via a program such as the Johns Hopkins transmission.” University COVID-19 Contact Tracing course. • Students, faculty, and staff with documented All communications should be consistent with the COVID-19 within the past 90 days should be institution's protocols, and the definition of a close contact exempted from the entry testing requirement. must be clearly understood. In October 2020, CDC refined the definition of a close contact as an individual who was • The campus community should be tested on a within 6 feet of an infected person for a cumulative total scheduled, recurring basis, with the ideal timing of of 15 minutes or more over a 24-hour period starting from twice weekly for students with test result turnaround 2 days prior to illness onset (or, for asymptomatic patients, times of
Considerations for Reopening Institutions of Higher Education for the Spring Semester 2021 / page 11 • Ability to gain trust of the contact to gather sensitive disease outbreaks. With the emergence of COVID-19, the and accurate information. relationship between SHS and state, tribal, territorial, and local health departments has proven to be extraordinarily • The ability to conduct interviews without violating important. Various models of relationships between SHS patient confidentiality. and local public health entities have evolved. These may • Current knowledge of medical terms and principles involve SHS reporting COVID-19 testing results, serving of exposure, incubation, infectious periods and as a resource for testing and education, providing interactions, and symptoms of COVID-19 for both community COVID-19 telephone support, or assisting presymptomatic and asymptomatic infection. with contact tracing. More closely shared models often • Exceptional communication skills and cultural enhance the level of communication between the sensitivity. institution and the public health department with purposeful location of public health contact tracers on There are many different formulas or ratios that can be campus and university volunteers or employees providing used to determine the number of contact tracers an contact tracing via the public health department. institution must have in order to effectively manage the case load. The estimate will be affected by the number of Many public health jurisdictions have issued IHEs specific cases over time, the percent positive rate, the guidance requiring certain public health activities—for responsiveness of the persons being traced, the skill level example, requiring the IHE to perform contact tracing on of the individual contact tracers, and the technology that is campus and provide community notifications, or to used to streamline the information. identify and report outbreaks. The SHS should be aware of these requirements and coordinate closely to ensure that Many public health experts estimate a minimum need of these obligations are fulfilled. 30 contact tracers per 100,000 population during a pandemic. There are several contact tracing estimator Traditionally, community public health entities have calculators that can help campuses determine how many provided hotlines or dedicated telephone numbers for contract tracers are needed. One example is from the community health questions. These COVID-19 hotlines Fitzhugh Mullan Institute for Health Workforce Equity at have been an important resource for many colleges and George Washington University and is supported by the universities. Some colleges and universities have Health Resources and Services Administration (HRSA) of implemented their own hotline and coordinated that the U.S. Department of Health and Human Services resource with their local public health entity. (HHS). These estimator calculators will need to be Bidirectional, timely, and frequent communication adapted to the campus population. between the SHS and public health agencies is critical in Considerations for contract tracing: the management of individual patients; early identification of outbreaks; or development of new tools, treatments, or • Partner with local and state health agencies to messages. Communication ideally includes scheduled augment contact tracing efforts and optimize frequent meetings with the public health epidemiologist, efficiency. public health officer, and SHS medical director or clinical • Provide formal training and resources for campus leader. contact tracers. Colleges and universities are a logical site for COVID-19 • Recruit students in health-related fields such as vaccine distribution. As vaccines become available, it will medical, nursing, and public health to augment be important for SHS to plan with their local public health contact tracing staff. agency how best to rapidly vaccinate their students, faculty, and staff. Potentially, this collaboration could • Develop public service announcements and range from receiving vaccines from the public health campaigns outlining the importance of contact program to distribution of the vaccine by the public health tracing and cooperation with contact tracers. authority on campus. Each community is unique and therefore communication with the public health authority Coordination with Local Public Health will best determine an approach that is practical and achievable. Coordination of campus public health initiatives with local public health resources remains a vital component of college health. College health has had a longstanding campus public health responsibility to coordinate activity related to reportable diseases, vaccines, and infectious
Considerations for Reopening Institutions of Higher Education for the Spring Semester 2021 / page 12 Housing and Residence Life • Campuses should continue to engage and meet the needs of vulnerable and marginalized campus Careful preparation remains the key to an organized, residential populations, including (but not exclusive effective, safe, and medically informed reopening of to) students at higher risk for complications from campus housing in Spring 2021. Though deemed the COVID-19 and students with disabilities. Such lowest risk approach, many colleges and universities were students may benefit from enhanced priority for unable to reduce on-campus housing to one student per single rooms if this can be accomplished without room or provide students with individual bathrooms. This stereotyping, stigmatizing, or isolating the student. was particularly challenging on smaller campuses with a Additional recommendations can be found in the high residential population. ACHA Guidelines: Supporting Vulnerable Campus The following, in conjunction with two person per room Populations during the COVID-19 Pandemic (August assignments, may be viable alternate and supplemental 2020). approaches: • Campuses should ensure that custodial and residence • Placement of physical barriers between beds such as life staff have access to sufficient and appropriate shower curtains or Plexiglas personal protective equipment (PPE). Staff should review PPE donning and doffing procedures prior to • Rearrangement of beds/placement head to foot for the start of Spring 2021 semester. maximized distance • High-touch surfaces should be cleaned and • Enhanced cleaning and sanitizing of high touch areas disinfected regularly, and all residents strongly • Universal masking requirements in common areas encouraged to practice meticulous hand hygiene. • Early campus arrival with entry testing, modified • The professional and student staff living in the quarantine, and rigorous recurring, scheduled SARS- residence halls are particularly susceptible to mental, Co-V-2 testing programs (either all residential emotional, and physical exhaustion and are at an students or random sampling) increased risk of exposure to SARS-CoV-2 as they reside and work in a congregate setting. These staff • Pods, cohorts, or bubble assignments for students need defined work schedules with time off as per who were then viewed as “family units” institutional policies, regular exercise and break • Decreased occupancy in community restrooms to opportunities, and psychological/counseling support accommodate physical distancing as needed. • Wastewater surveillance was utilized on some • Resident advisers, college health services staff, and campuses as an early warning system to effectively “student ambassadors” should begin educating identify SARS-CoV-2 and implement targeted testing residential students about the importance, efficacy, in the residence halls before widespread transmission and safety of the SARS CoV-2 vaccine. If possible, occurred. campuses should provide quick access to vaccination for residential students when their priority group is Considerations for housing and residence life: reached, expediting high-risk individuals. • Campuses should consider their capability to isolate on-campus students from the larger community. Isolation and Quarantine Campuses with a high proportion of students living on campus may be more effective in limiting spread Most campuses provided spaces for isolation and than campuses with larger off-campus populations quarantine (e.g., designated residence halls or floors, who may be mixing with on-campus students contracted hotels, apartments) and provided dining and socially. support services for ill or exposed individuals. Generally, but not always, quarantine and isolation housing were • To maintain safe on-campus housing for students and reserved for students who lived in on-campus housing. residential staff, campuses must continue to offer widespread testing, contract tracing, and Campuses experienced varied utilization of their isolation isolation/quarantine of ill and exposed individuals on and quarantine spaces as cases of COVID-19 spread campus. This approach will continue to require throughout campuses. Many developed systems to provide access to immediate testing for all students, faculty, wraparound services to support students in isolation or and staff with symptoms. quarantine. These services were resource intense and required partnerships throughout campus to execute.
Considerations for Reopening Institutions of Higher Education for the Spring Semester 2021 / page 13 CDC made several significant changes to its isolation and • Campuses should be discouraged from sending quarantine guidance during the fall semester. In October students home to isolate or quarantine in order to help 2020, CDC decreased the length of isolation to 10 days prevent further community spread. after symptom onset with resolution of fever for at least 24 • If adequate housing inventory exists, isolation and hours (without the use of fever-reducing medication) and quarantine rooms should be physically separated with improvement of other symptoms. For asymptomatic from other residential student rooms. If possible, a individuals, isolation could be discontinued 10 days after specific residence hall or specific floors of a their initial positive RT-PCR test for SARS-CoV-2. Those residence hall should be designated for quarantine or individuals with severe illness may need isolation isolation. extended to 20 days. Individuals previously diagnosed with symptomatic COVID-19, who recover and remain • The rooms should have private bathroom facilities asymptomatic, do not need retesting within three months and be supplied with a thermometer, sanitizing wipes, after the date of original symptom onset. Those who tissues, soap, hand sanitizer, and toiletries. develop new symptoms consistent with COVID-19 within • Rooms should be identified and labeled with three months after symptom onset of the original COVID- appropriate signage and access restricted to essential 19 infection may warrant retesting if no other diagnosis is personnel providing services to these students. plausible. • The number of quarantine and isolation rooms Though 14 days of quarantine remains CDC’s needed will be dependent on factors such as campus recommendation if deemed a close contact to a person size as well as the level of community spread of with confirmed SARS-CoV-2 infection, CDC revised COVID-19. Preparation and planning must be made quarantine guidance in December 2020, providing options for the possibility of increased case numbers. for reduced time in quarantine. Potential options to release an individual from quarantine if permitted by local public • Students should have a “COVID Plan” that include a health authorities are: list of items (medications, clothing, academic supplies, etc.) to bring with them to a quarantine or • After Day 10 without testing isolation room. • After Day 7 after receiving a negative test result (test • Student health services and/or residential life staff, or must be performed on Day 5 or later) their designees, should remotely monitor students If quarantine is reduced to less than 14 days using either daily (temperature checks and symptom screening). option, the individual must: Plans should be developed for further clinical evaluation if symptoms progress or worsen or the • Continue to monitor for symptoms through Day 14 patient requests. after exposure. • Dining services should arrange food delivery in • Monitor health and immediately self-isolate and collaboration with housing/residence life staff for contact the SHS, private health care provider, or local students on the campus meal plan. Student affairs or public health authority if new symptoms develop. campus life, in collaboration with housing/residence • Wear a mask, maintain 6 feet physical distance from life staff, could arrange for the purchase of a campus others, practice hand hygiene, and avoid crowds. meal plan or coordinate meal delivery for those students who have not purchased the campus meal Considerations for isolation and quarantine: plan. Consider food vouchers or gift cards for • IHEs should discuss any changes in contact-free delivery. isolation/quarantine policies with their state, tribal, • Counseling services and/or the office of spiritual and territorial, or local public health authority. religious life should be available remotely to students • Policy revisions should be coordinated and widely in isolation or quarantine. Mental health care should communicated so all members of the campus be prioritized in recognition of the lack of physical community have a clear understanding of the and social contact during this time. Support teams requirements. could provide virtual wellness and entertaining • Protocols and procedures should be developed and activities to help decrease feelings of loneliness and made available to all individuals involved in the isolation. management of isolation and quarantine spaces.
You can also read