Considerations for Reopening Institutions of Higher Education for the Fall Semester 2021
Page content transcription
If your browser does not render page correctly, please read the page content below
MAY 25, 2021 ACHA Guidelines Considerations for Reopening Institutions of Higher Education for the Fall Semester 2021 I n this second year of the pandemic, institutions of in preventing transmission of the SARS-CoV-2 virus. The higher education (IHEs) and their faculty, staff, and capability of COVID-19 vaccines to disrupt transmission students are optimistic that the fall 2021 academic and reduce disease incidence is the single most valuable term will be far different than last fall, with a gradual lesson learned in the past four months. Shifting resources return toward normalcy. Even with the resumption of to vaccinate the campus community will have wide- research, academic, and co-curricular activities ranging positive implications for higher education, the characteristic of a thriving campus, the unprecedented economy, the health of the public, and the health of disruption to campus communities and the widespread individuals. financial, academic, social, emotional, and physical impacts resulting from the pandemic will require institutional attention, resources, and planning on multiple COVID-19 Vaccination fronts for the foreseeable future. On April 29, 2021, the American College Health Association (ACHA) published specific guidance on Although COVID-19 vaccine is now widely available, not COVID-19 vaccination, stating that: every eligible American will be vaccinated, making achievement of community (herd) immunity elusive. The where state law and available resources allow, ACHA emergence of more transmissible variant strains of SARS- recommends COVID-19 vaccination requirements for CoV-2 may necessitate masking, hygiene, distancing, all on-campus college and university students for fall cleaning, and disinfection to some extent this fall, and semester 2021, in accordance with the IHE's normal perhaps beyond. The testing, contact tracing, quarantine, exemption practices, including exemptions for medical isolation, and remote monitoring systems established over contraindications. This recommendation applies to all the past year should also be retained to some extent, with students who live on campus and/or participate in on- modifications made in accordance with case prevalence campus classes, studies, research, or activities. and as vaccination uptake increases in the campus On a campus where COVID-19 vaccination is required, all community. faculty, staff, and students are fully immunized, except for In some respects, preparing for fall 2021 may be more those with medical or religious exemptions. In such a complicated than it was for the two previous academic setting and where there is also low transmission in the off- terms, as IHEs must maintain monitoring and surveillance campus community, it will be possible to relax testing processes, enforce masking and distancing, distinguish requirements and other mitigation strategies, such as between a vaccinated and unvaccinated cohort, provide a masking and physical distancing (see CDC’s guidance for rich and robust learning and living experience, and people who are fully vaccinated). Testing will be optimize the health and safety of a fully occupied campus. necessary on an as-needed basis for diagnostic purposes. It is a tall order in the face of two key unknowns—the If vaccination requirements are established only for extent of variant strains of SARS CoV-2 and the level of students, relaxation of testing and mitigation strategies for vaccination of the campus community. students is also possible. Existing CDC guidance states Since the December 2020 release of the ACHA that fully vaccinated persons who are exposed to COVID- Guidelines: Considerations for Reopening Institutions of 19 do not need to quarantine or, in most cases, be tested. Higher Education for the Spring Semester 2021, three With comprehensive vaccination, indoor classes, group COVID-19 vaccines have received emergency use sizes, residence hall occupancy, eating establishment authorization (EUA) by the US. Food and Drug operations, and sporting events may default to pre- Administration (FDA). In addition, several vaccines have pandemic guidance. Such an environment will be a new been authorized for emergency use by the World Health normal, but with continued need to seek local health Organization (WHO). These vaccines have proven safe department guidance and readiness to elevate COVID-19 and highly effective in preventing COVID-19; according precautions depending on campus or community to CDC, early data suggests the vaccines are also effective transmission.
Considerations for Reopening Institutions of Higher Education for the Fall Semester 2021 / page 2 If a COVID-19 vaccine requirement is not implemented, it must be given to physical distancing, masking, airflow and will be extremely important for IHEs to remain at filtering, and other infection prevention strategies. heightened alert with their current oversight of population- PODs are usually classified as open or closed. Open PODs based strategies to mitigate and contain the spread of are, as the name implies, open to all persons. This would COVID-19. Physical distancing, masking, control of include campus members and non-campus members. Most group sizes, appropriate ventilation, advanced testing state and federal vaccine sites have an open POD strategies, and rapid contact tracing would likely need to designation. Closed PODs are limited to a specific be continued. Communicating and reinforcing behavioral population, generally defined at a community level. interventions will be particularly important as students College and university community definition would arrive in the fall. New students may be unaware of the typically include all faculty, staff, and students. Spouses campus culture, rules, and procedures for COVID-19 and household members may be included. A closed POD containment, and they may be less likely to have would not, however, include members outside of that previously been infected and therefore lack immunity. community. Establishment of a Memorandum of Fraternity and sorority rush; welcome events; the arrival Agreement with a local public health entity may be of incoming students, including international students; bar beneficial in defining the POD and planned use of patronage; congregate living, and various other group vaccines. 1 events may precipitate outbreaks when participants are not fully vaccinated. As outlined by ACHA’s Mass Vaccination Clinic Guidance and Resources, COVID-19 mass vaccination Some colleges and universities may choose a plan of events will require additional planning such as: voluntary vaccinations but require a COVID-19 vaccine declination. The declination process serves to inform the • Attention to the event site layout and flow patterns individual of the benefits and risks of vaccination vs. non- for efficient and safe events, as well as a registration vaccination and documents the individual’s choice. process for the event. Additionally, the document provides an estimate of • Access to vaccine doses. community risk. Any declination process should be thoroughly reviewed by legal counsel and approved by the • Security for vaccines and supplies. governing body. Similar processes for vaccine declination • Appropriate cold-chain management of vaccines. have been used with health care employees for many years (e.g., for hepatitis B vaccination) and on many campuses • Consideration for providing appropriate PPE for for students (e.g., meningococcal vaccination). staff, masking requirements for patient participants, and easy access to hand sanitizer/hand hygiene. At this time, the need for COVID-19 vaccine boosters is not known. Variants may demonstrate resistance to • Strengthening of community partnerships (e.g., with vaccines and result in a need for boosters. Colleges and local pharmacies, hospitals, health departments). universities need to be well informed about booster • Addressing the needs of vulnerable and special needs recommendations and be prepared to advise and populations. potentially provide booster doses or referral to a local resource. • Management of records, including connecting to state registries; sending reminders for additional doses as Mass immunization involves distribution of vaccine to needed; and tracking of student immunization status. large groups of persons in the most efficient manner. These sites may be referred to as a “Point of Distribution” • Encouraging use of CDC’s v-safe post vaccination or “POD.” Efficient vaccine PODs may deliver each shot health check tool for COVID-19 vaccine symptom in one to two minutes and have door-to-door experiences tracking and reporting. of 25 or 30 minutes. PODs may be drive-through or walk- In addition to the considerations included in ACHA’s through. Drive-through PODs offer advantages such as recommendation for COVID-19 vaccination requirements reduced mixing of persons getting vaccinated but require for all on-campus students for fall 2021, campuses should: large spaces for car access, and accessing the site is • Develop strategies utilizing best practices to difficult or impossible for those without a vehicle. Indoor maximize acceptance of vaccination, including PODs are more accessible for persons by foot and offer understanding and addressing vaccine hesitancy, climate control for workers and patients. Careful attention 1 The Center for Infectious Disease Research and Policy (CIDRAP) provides templates, checklists, and other resources for planning a closed dispensing site.
Considerations for Reopening Institutions of Higher Education for the Fall Semester 2021 / page 3 communicating messages targeted to the appropriate campus COVID-19 mitigation plan. Testing is used for audience, providing incentives for vaccinations, or diagnosis, screening, and surveillance. Viral testing with implementing vaccine requirements for subgroups either a molecular test or antigen test is the mainstay of (such as those using campus housing, students in testing. Molecular tests identify genetic material from the health professions, and athletes). ACHA’s Campus virus and include the reverse transcription-polymerase COVID-19 Vaccine (CoVAC) Initiative will be chain reaction (RT-PCR) tests and nucleic acid providing tools and resources to help IHEs address amplification tests (NAATs). Molecular tests are highly vaccine hesitancy and promote vaccine uptake, sensitive and have high specificity. However, most of • Utilize established resources and toolkits such as the these tests need processing in a lab and have one to two Association of Immunization Manager’s COVID-19 days of turnaround time. Tests with a turnaround time of Vaccine Communication Resources or CDC’s 15–45 minutes require specialized equipment and may be Vaccination Communication Toolkit to optimize and difficult to implement at large scale. RT-PCR testing may tailor communications based on the audience . identify many post-infectious cases and therefore have diminished usefulness when used for screening. • Stay up to date with FDA guidance on vaccines. Attributes specific to the different COVID-19 Antigen tests identify specific proteins from the virus. vaccines, such as the requisite number of doses, Antigen tests provide convenient, low-cost testing with storage requirements, and timing of doses, may rapid results. However, they are less sensitive than influence vaccination strategies. Availability of molecular tests and may require RT-PCR confirmation. vaccine and cold storage freezers may be primary Their specificity is similar to that of molecular tests, and determinants of vaccine choice. their sensitivity correlates closely with the period of COVID-19 infectiousness. • As vaccines become more widely available, college health centers should maintain an inventory of Per CDC’s interim guidelines, antibody testing currently COVID-19 vaccines for routine administration. has limited utility. Its primary uses are with the diagnosis Student health programs should anticipate providing of multisystem inflammatory syndrome or other access to vaccines within their establishment or via complications from COVID-19 and for epidemiologic other means, such as pop-up vaccination sites, and studies. Currently, antibody tests are not to be used to should be prepared to vaccinate or direct to local assess immunity status after COVID-19 vaccination, nor resources any students arriving to campus who are are they to be used to determine the need for vaccination. not adequately immunized. In some countries, antibody tests are being considered to allow participation in international travel in lieu of a • IHEs should determine the adequacy of vaccine passport. immunization with vaccines not authorized by either FDA or by WHO in accordance with updated CDC Home collection and at-home tests are becoming more recommendations regarding people vaccinated common but are still relatively expensive for frequent or outside the United States. serial testing. If used for asymptomatic screening, these antigen tests are most accurate if used on day 0 and again • Educate and train student-facing staff and faculty on on day 3. Those tests that require samples collected at vaccination benefits, venues, and other resources. home and sent away for testing may incur delays with • Provide guidance on getting a second dose of results. Only those at-home testing products that have vaccine. If the initial dose of a two-dose vaccine was FDA authorization should be recommended to patients. received prior to arrival on campus in fall 2021, IHEs Large retailers are now providing rapid at home tests should share strategies with students for getting the directly to consumers without a provider prescription. second dose by the same manufacturer either on The data increasingly supports the frequency of testing, campus or in the local community. the speed of turnaround time and results notification, rapid containment of positive individuals, contact tracing COVID-19 Testing efficiency and quarantine as more important than test sensitivity. How frequently to test asymptomatic COVID-19 testing remains a cornerstone for containment individuals will vary depending on the level of immunity and mitigation of the pandemic. Even with a fully achieved on campus either through vaccination or vaccinated campus, testing will still be required in some recovery from natural disease, as well as the impact of circumstances. It is crucial to have a clear understanding susceptibility to variant strains and disease prevalence in of the available tests; their uses, advantages, and the community. limitations; and their place in the context of the larger
Considerations for Reopening Institutions of Higher Education for the Fall Semester 2021 / page 4 Testing strategies on campuses have evolved significantly the community itself, wastewater flow, viral shedding since the onset of the COVID-19 pandemic. Most have in feces, etc. remain constant, but trends may assist established well-defined systems independently or in with forecasting and mitigation. Sampling collaboration with internal or external partners. Campus wastewater is specialized and needs coordination strategies now include an array of options such as with campus environmental health services and diagnostic testing, move-in screening, random screening, facilities. Testing of the samples may be provided by pop-up testing, wastewater surveillance, or genomic campus-based labs, state labs, or vendors. surveillance. CDC provides interim guidance for SARS- • Genomic testing can determine the presence of CoV-2 testing and screening at IHEs here. COVID-19 variants. Since November 2020, CDC has • Diagnostic testing is usually considered testing of regularly been receiving samples for sequencing and persons with symptoms or potential exposure. This evaluation from state and other public health may include testing persons with symptoms who are agencies. They are also partnering with large being evaluated by a healthcare provider, testing as commercial diagnostic labs and universities to scale part of contact tracing, testing unvaccinated persons up sequencing. This work has led to the development exposed to COVID-19, or testing unvaccinated of the SARS-CoV-2 Sequencing for Public Health persons at an event attended by an individual with Emergency Response, Epidemiology, and COVID-19. Whether fully vaccinated or Surveillance (SPHERES) consortium. Multiple unvaccinated, immunocompromised individuals, public health and scientific organizations, including including those taking immunosuppressants should 53 academic institutions, participate in SPHERES to be evaluated for testing if symptomatic, exposed to share genomic data. In addition to sequencing, which COVID-19, or at an event attended by an individual can be time consuming, labs could also re-test with COVID-19. For most persons, testing is not positive samples using PCR probes that are specific recommended for determination of resolution of to the more commonly circulating variants. infection. Considerations: • Screening tests may be used to test all students who • Entry testing remains a valuable strategy to reduce move into campus-managed residential facilities at the spread of COVID-19. Some IHEs might opt to the beginning of the semester and may also include continue entry testing in order to identify testing all competitive athletes on a frequent basis breakthrough infections among vaccinated persons, (see NCAA's testing recommendation). When particularly when students are coming from community transmission of COVID-19 is moderate numerous points of origin. The IHE’s plan must (10 or more cases per 100,000 persons each week) or include the means to isolate and provide services and higher, CDC advises serial screening of all campus support for those who test positive. members on at least a weekly basis. This testing is contingent on resources. In response to an outbreak, • Those who have been fully vaccinated and those who increased serial screening with contact tracing is have been diagnosed with COVID-19 within the past likewise advised. Testing may take place with 90 days may be exempted from entry testing and random selection of community members with surveillance testing. When designing campus testing molecular or antigen tests. To best function, results programs, an individual or small select group should should be available as soon as possible and no longer be assigned to monitor all the results in a systematic than 48 hours. and regular basis. These results may give timely forewarning of an outbreak. An emerging challenge • Pop-up testing is a means for providing testing on an for institutions is assimilating multiple COVID-19 as-needed basis in areas where individuals would data sources in a meaningful fashion. most benefit. Depending on the patient’s circumstance, this could be considered a diagnostic • Pooled sampling can be used to reduce costs and save test or screening test. time. It is a technique that is more beneficial when only a small number of positive results are expected. • Wastewater surveillance is a newer public health With pooled sampling, several patient samples are strategy which complements but does not replace tested together. If the test is positive, individual established surveillance methods. COVID-19 virus samples must be tested. This may result in a need for may be detected in wastewater preceding a rise in resampling those persons. case counts. Using wastewater surveillance results to estimate community prevalence is challenging unless
Considerations for Reopening Institutions of Higher Education for the Fall Semester 2021 / page 5 • Diagnostic testing should remain available for • Refer to the testing algorithm published by CDC to symptomatic people and those who have been assess when a confirmatory molecular test is exposed to an individual who is positive for SARS- necessary after a positive antigen test: CoV-2. Source: U.S. Centers for Disease Control and Prevention, Interim Guidance for Antigen Testing for SARS-CoV-2 • Generally, weekly asymptomatic testing should focus Local health departments are responsible for leading on unvaccinated students, faculty, and staff, particularly case investigations, contact tracing, and outbreak those living in a congregate setting. investigation. However, during the pandemic, many student health services assumed contact tracing • Health equity remains an important principle and responsibilities on campus to improve timeliness. should be considered in testing plans. All students, Contact tracing follows case investigation and is a faculty, and staff deserve equitable access to testing. critical mitigation strategy to prevent the further spread Testing criteria must be transparent, simple, and of COVID-19. According to CDC, contact tracing consistent. Positive results should be accompanied by “involves identifying cases and their contacts then referrals to accessible care or resources. Race and working with them to interrupt disease transmission. ethnicity must be reported with test results to local This includes asking cases to isolate and contacts to health departments. See CDC’s health equity quarantine at home voluntarily.” information and resources here. Contact tracing is a confidential process that has been • CDC does not currently recommend routine used for years to curb the spread of infectious diseases surveillance testing on fully vaccinated individuals or and avoid outbreaks. To be effective, tracers must those individuals within the 90-day window following connect with known patients to identify and quickly infection, unless COVID-like symptoms occur. alert their close contacts of possible SARS-CoV-2 exposure. Contact Tracing In addition to notification of exposure to an infected Campuses should continue to offer testing, contact tracing, individual, contact tracers provide disease and and isolation/quarantine of ill and exposed individuals on transmission education; gather information such as campus. This approach will require access to immediate demographics, living arrangements, school and daily testing for all students, faculty, and staff with symptoms. As activities, and other pertinent data that will assist in case counts fall, the contact tracing workload should also slowing the spread of COVID-19; and manage the decrease. The capacity to expand and contract the contact individual’s case. Contact tracers will also ask about tracing workforce to meet demand will optimize efficiency signs/symptoms and underlying medical conditions and and conserve tight resources. should have a system in place to direct those with symptoms to the appropriate health care or service provider. All contact tracers should complete a formal
Considerations for Reopening Institutions of Higher Education for the Fall Semester 2021 / page 6 training to ensure consistent and quality information. • Provide formal training and resources for campus The training may be provided by the local health contact tracers. department, CDC, or via a program such as the Johns • Recruit students in health-related fields such as Hopkins University COVID-19 Contact Tracing course. medical, nursing, and public health to augment All communications should be consistent with the contact tracing staff. institution's protocols, and the definition of a close contact • Develop public service announcements and must be clearly understood. The definition of a close contact campaigns outlining the importance of contact is an individual who was within 6 feet of an infected person tracing and cooperation with contact tracers. for a cumulative total of 15 minutes or more over a 24-hour period starting from two days prior to illness onset (or, for asymptomatic patients, two days prior to test specimen Masking and Physical Distancing collection) until the time the infected person is isolated. Masking and physical distancing continue to be two of Contact tracers must be able to provide recommendations the most effective means of combating the spread of for quarantine and understand local health department and COVID-19. By now, IHEs have well-established institutional policies for quarantine on and off campus. policies, procedures, and physical reminders to comply Many IHEs may not have the resources to offer quarantine with mask mandates and distancing requirements. and isolation accommodations for students who live off CDC’s interim public health recommendations for fully campus. However, as case numbers fall due to widespread vaccinated people required IHEs to accelerate a review vaccination, some IHEs may choose to offer quarantine and of their current policies and procedures. Unless isolation accommodations to students who live off campus, vaccination is required or vaccination status is known, particularly those with housing and food insecurity. the IHE must rely on the individual to demonstrate personal responsibility and comply with campus Resourcefulness may be the greatest skill needed for a masking and physical distancing guidelines. contact tracer on a college campus since contacts may be difficult to reach or reluctant to engage in conversations. CDC’s updated recommendations for fully vaccinated individuals includes discontinuation of masking and Additional contact tracer skills include: physical distancing requirements. IHEs must determine • Deep understanding of the structure of the IHE, how to implement these new recommendations in including names of residence halls, terms that are consultation with public health authorities; in frequently used by students and employees, and accordance with the governing body or local, state, activities that are common among campus community territorial, or tribal regulations; and with consideration members. of rates of immunization, infection, hospitalization, and • Knowledge of the resources on campus and in the deaths in the campus and local community. community, such as testing, medical and mental health Therefore, implementation of masking and distancing care, academic support, financial aid, and food or meal guidelines could potentially include any of the delivery options for those in quarantine. following: • The ability to gain the trust of the contact to gather • Fully vaccinated students, faculty, and staff may sensitive and accurate information. resume pre-pandemic instructional, research, and • The ability to conduct interviews without violating co-curricular activities without physical distancing patient confidentiality. or masking. Those who are unvaccinated (including those who are not fully vaccinated) must continue • Current knowledge of medical terms and principles of to wear masks and maintain physical distance or exposure, incubation, vaccination status, infectious attend class remotely. The IHE would need to periods and interactions, and symptoms of COVID-19 designate a section of the space or a percentage of for both pre-symptomatic and asymptomatic infection. seats to accommodate unvaccinated individuals. • Exceptional communication skills and cultural Notably, without regulatory oversight or proof of sensitivity. vaccination, some may choose to disregard campus guidelines. Considerations for contact tracing: • Require face masks and physical distancing for all • Partner with local, state, tribal, and territorial health indoor public spaces, including classrooms, lecture agencies to augment contact tracing efforts and halls, gyms, etc., and all large outdoor gatherings optimize efficiency. regardless of individuals’ vaccination status.
Considerations for Reopening Institutions of Higher Education for the Fall Semester 2021 / page 7 • Establish a threshold of vaccination of the campus (without the use of fever reducing medications) and population before a blanket lifting of mask and physical with improvement of other symptoms. distancing requirements. • An asymptomatic individual diagnosed with • Develop a vaccine passport or other means to establish COVID-19 should self-isolate for 10 days from the vaccine status to allow entry into classrooms or other date of testing. public campus facilities. • Individuals who have tested positive for COVID-19 CDC continues to recommend six feet of physical distancing with severe symptoms may need to extend self- if not fully vaccinated. A notable exception is the decrease isolation to 20 days. in physical distancing standards from six feet to three feet Quarantine (for those who are not fully vaccinated and for children in K-12 classrooms, with the caveats of who have been in close contact with someone diagnosed concomitant universal mask wearing, meticulous hand with COVID-19): hygiene, and optimal ventilation. See the most up-to-date CDC recommendations on masking and physical distancing Although CDC still recommends 14 days of quarantine for unvaccinated people; see also CDC recommendations for for a close contact, they have provided other options. fully vaccinated people. • Unvaccinated individuals who have come in close Considerations: contact (within 6 feet for more than 15 minutes) with someone diagnosed with COVID-19 could • IHEs should require unvaccinated individuals to end quarantine without a test for SARS-CoV-2 on continue to wear well-fitted masks and adhere to day 10. campus physical distancing guidelines. OR • All campus transit riders, regardless of vaccination status, should be required to wear masks and physically • Quarantine can be ended on day 7 with a negative distance. SARS-CoV-2 test. The test must be performed no earlier than day 5. Individuals should continue to • Masks should be required in health care facilities or self-monitor for symptoms through day 14, wear a locations providing health or counseling services. mask, maintain physical distancing, and avoid • Local businesses and services may continue to require crowds. If symptoms develop, quarantine should their patrons to wear masks. Local policies should be resume and SHS or a private health care provider widely shared throughout the campus community. should be contacted. • Campuses should encourage individuals to carry masks, Individuals who have been previously diagnosed with even if they are outdoors, in case they encounter a symptomatic COVID-19 and have recovered and remain situation in which physical distancing is not feasible. asymptomatic should not repeat testing for 90 days. Those who develop new symptoms consistent with Isolation and Quarantine COVID-19 within three months may warrant retesting. Individuals who have been fully vaccinated and are Most campuses have provided spaces for isolation and exposed to someone with COVID-19 do not need to quarantine (e.g., designated residence halls or floors, quarantine or undergo testing for SARS-CoV-2 but contracted hotels, apartments) and have provided dining and should continue to monitor for symptoms. Unvaccinated support services for ill or exposed individuals. Generally, individuals who are antibody-positive within 90 days of but not always, quarantine and isolation housing are exposure to someone with suspected or confirmed reserved for students who live in on-campus housing. COVID-19 do not have to quarantine if there is limited However, some IHEs may choose to offer quarantine and or no risk of exposure to persons at higher risk for isolation accommodations to students who live off campus, severe illness with COVID-19. See the full CDC particularly those with housing and food insecurity. guidance on isolation and quarantine. Current CDC guidance for quarantine and isolation are as Considerations for isolation and quarantine: follows: • Policies should be coordinated and widely Isolation (for those who have been diagnosed with COVID- communicated so all members of the campus 19): community have a clear understanding of the • A symptomatic individual diagnosed with COVID-19 requirements. should self-isolate for 10 days from the start of symptoms with resolution of fever for at least 24 hours
Considerations for Reopening Institutions of Higher Education for the Fall Semester 2021 / page 8 • Protocols and procedures should be developed and • Students in quarantine should have up to 60 made available to all individuals involved in the minutes of scheduled time outdoors daily for management of isolation and quarantine spaces. physical activity, if possible. While outside, students should wear their masks and maintain • Campuses should be discouraged from sending students physical distance from others. home to isolate or quarantine in order to help prevent further community spread during transit. • To the degree possible, students should continue academic activities remotely or be provided with • If adequate housing inventory exists, isolation and note takers. quarantine rooms should be physically separated from other residential student rooms. If possible, a specific • A team of designated student affairs/campus life residence hall or specific floors of a residence hall staff should be appropriately trained and on call to should be designated for quarantine or isolation. assist students with their urgent personal needs (medication pickup, delivery of personal hygiene • Ideally, rooms should have private bathroom facilities supplies, etc.). and be supplied with a thermometer, sanitizing wipes, tissues, soap, hand sanitizer, and toiletries. • Policies and safeguards should be developed to avoid in-person socializing among students who are • Rooms should be identified and labeled with being housed in isolation and quarantine spaces. appropriate signage and access restricted to essential personnel providing services to these students. • Plans should be developed for transportation to and from isolation or quarantine rooms as well as to • The number of quarantine and isolation rooms needed and from medical appointments as needed. will be dependent on factors such as campus size as well as the level of community spread of COVID-19. • The IHE must provide appropriate PPE (as per Preparation and planning must be made for the CDC guidelines) and require custodial and possibility of increased case numbers. maintenance staff and live-in professionals to wear that PPE when cleaning or entering isolation and • Students should develop a “COVID Plan” prior to quarantine spaces. arrival to campus that includes a list of items (medications, clothing, academic supplies, etc.) to bring with them to a quarantine or isolation room. Plans Campus Access for Visitors and the should also identify individuals (i.e., family or friends) who will assist in securing and delivering needed items Public while in isolation. In addition to students, faculty, and staff who access • Student health services and/or residential life staff, or campus spaces in a more controllable fashion, campuses their designees, should remotely monitor students daily should also be prepared with policies and protocols (temperature checks and symptom screening). Plans regarding other persons who might need or wish to gain should be developed for further clinical evaluation if access to these spaces (e.g., official guests, informal symptoms progress or worsen or the patient requests. visitors, and the general public). Such access might include brief visits for meetings and tours; informal • Dining services should arrange food delivery in visits for the purpose of casual interaction with specific collaboration with housing/residence life staff for students, faculty, or staff; participation in youth students on the campus meal plan. Student affairs or programs; and attendance at conferences, symposia, campus life, in collaboration with housing/residence sporting events, performances, convocation, life staff, could arrange for the purchase of a campus commencement, or other special events. Moreover, meal plan or coordinate meal delivery for those campuses might include spaces that were traditionally students who have not purchased the campus meal plan. used by the general public (for example, restaurants, Consider food vouchers or gift cards for contact-free food courts, museums, parks/gardens, etc.). delivery. Visitors include family members, significant others, • Counseling services and/or the office of spiritual and alumni, sports fans, students from other colleges and religious life should be available remotely to students universities, vendors, contractors, opposing athletic in isolation or quarantine. Mental health care should be teams (players, coaches, support staff), patients and prioritized in recognition of the lack of physical and families at academic medical centers, off-campus EMS social contact during this time. Support teams could crews and law enforcement officers, public health provide virtual wellness and entertainment activities to officials, financial donors, and tourists. help decrease feelings of loneliness and isolation.
Considerations for Reopening Institutions of Higher Education for the Fall Semester 2021 / page 9 Campuses should assess multiple factors including the • Decide how restrictions might be modified based health of visitors and the overall health of the campus upon variations in the level of community risk community to determine the level of access available to the (e.g., community infection rates, vaccination levels, public. When disease prevalence is increasing on campus or etc.). in the surrounding community, campuses should • Consider whether there will be age restrictions for explore modified, lower risk alternatives such as virtual some activities or spaces. platforms, outdoor activities, and limited in-person capacity. Specific rules will vary from campus to campus • Review local and state public health guidelines to based upon resources and local risks. ensure compliance with applicable regulations. Rules that are specific to the IHE may not apply Questions and considerations when planning for the when the spaces are also used by the general presence of visitors, guests, and the public: public. • Decide which campus spaces are open to visitors and which are limited to official students, faculty, and staff. Student Health Services • Determine the behavioral expectations of visitors while on campus (e.g., masking, distancing) and how will this The role of student health services (SHS) has continued be conveyed and enforced. to expand during the COVID-19 pandemic, with SHS often adding testing, contact tracing, and case • Assess the origin of visitors and whether that influences management to their responsibilities. As vaccines have the level of risk: are visitors from the local vicinity or become available, many SHS are also providing on site more distant places? Are they arriving from higher risk COVID-19 vaccinations. Campuses will continue to countries? look to student health services for medical and public • Determine whether any type of screening will be health expertise, and SHS leadership should be poised to required upon entry (e.g., verbal symptom attestation). deliver current, sound, evidence-informed recommendations. Maintaining essential services to • Whenever possible, rules for visitors should mirror students while providing pandemic-related care and those for students, faculty, and staff who use the same campus support continue to challenge the campus health space. system. • Determine the occupancy limits of each space in which visitors will be permitted and how the limits will be Patient Care Considerations enforced. As campuses begin to reopen more fully to in-person • Decide whether viral testing will be required for certain learning, there will likely be an increased demand for visitors (e.g., for visitors participating in higher risk health care services. Student health services should plan activities such as large gatherings, events with food and for and anticipate more requests for in-person visits. To drink, or other mask-free interactions). be fully prepared, SHS should: • Place masks and hand sanitizer at highly trafficked • Develop protocols for in-person visits. Consider building entries. designating providers for telemedicine and in- • Decide which segments of the campus population will person visits on a daily basis. If possible, allocate a be permitted to have guests (e.g., undergraduates living separate area of the clinic for acute illness. in residence halls). • Continue the delivery of routine clinical preventive • Where feasible, maintain a registry of guests to services when possible to prevent health facilitate contact tracing. consequences of delayed care. • Place increased signage at entrances to (and within) • Continue to provide options for telemedicine or spaces used by the general public, as visitors will be telephone consults when appropriate. Students with less knowledgeable about campus rules and protocols. conditions placing them at higher risk for • For performances, consider the safety of performers as complications from COVID-19 and who have not well as audiences. Distancing between audiences and been vaccinated should be encouraged to seek care performers may need to be greater when performers are via telemedicine when possible (some symptoms projecting their voices or blowing into instruments. Use may require in-person clinical assessment). masks and instrument bell covers to reduce droplet • Advise patients to call before coming to the SHS spread. for any type of visit.
Considerations for Reopening Institutions of Higher Education for the Fall Semester 2021 / page 10 • If possible, utilize an online or telephone process for • Work closely with the marketing and patient check-in. communications department to provide updated messaging about COVID-19 protocols, policies, • Limit student contact with SHS computers/keypads. and services as well as the importance of COVID- Have students complete and submit forms (health 19 vaccinations. Use a variety of platforms history, immunizations, consents, etc.) via the patient including websites, social media, and signage. portal or utilize EHR templates. Involve as many campus entities as possible in • Require all patients and clinic guests to wear well- communicating these messages (housing, dining, fitted, multi-layer cloth face masks or provide patients recreation services, etc.). with a medical procedure (surgical) mask. • Work closely with residential life staff to identify • Limit visitors, children, or accompanying guests who and manage students who require isolation or are not receiving care or services from entering the quarantine. facility. • Develop relationships and agreements with local • Screen all patients and staff for COVID-19 symptoms emergency departments (ED) to accept ill patients before entering the clinic when local conditions suggest requiring a higher level of care. ongoing risk. • Consider embedding a mental health clinician • Develop a plan for students with respiratory symptoms within the SHS to provide easier access to mental who need transportation to SHS, housing, or local health services and improve collaboration and hospitals. Ensure after-hours care options are included. coordination of care between health and counseling • Update screening forms to incorporate COVID-19 services. symptoms, including but not limited to: fever, cough, shortness of breath, chills, muscle pain, headache, sore SHS Facility Considerations throat, congestion, nausea, vomiting, diarrhea, and loss • Design facility layout to provide in-person clinical of sense of smell and taste (anosmia and dysgeusia). services for needed preventative care and care for • Include a question about COVID-19 vaccination status illnesses/injuries other than COVID-19 in the safest on screening forms. manner possible while minimizing transmission of COVID-19. • Establish protocols for managing patients with acute respiratory symptoms, including masking the patient, • If possible, segregate waiting areas for ill and well quickly rooming the patient, limiting and tracking the patient visits. number of staff who enter the room, limiting the • Perform COVID-19 testing in a separate location of movement of the patient throughout the SHS, and the clinic or outdoors when possible. cleaning of spaces where the patient was present. • Configure all waiting and other clinic areas to • Avoid use of nebulizers and peak flow measurements promote physical distancing. which can generate additional aerosols. Follow best • Ensure adequate amounts of alcohol-based (at least practices to reduce risk when nebulizers are used (e.g., 60%) hand sanitizer, surgical masks for patients distancing, PPE, separation of patients who require who do not bring their own mask, tissues, and nebulizer treatment behind closed doors, use disposable closed bins for disposal are available. tubing and other supplies). • Provide plexiglass/clear barriers between reception • Ensure a COVID-19 testing plan is in place for staff and waiting areas. students, faculty, and staff, either on- or off-site. Frequency and type of testing may vary depending on • Develop protocols for environmental management, community and campus resources. including frequency of and responsibility for clinic cleaning and decontamination. • If possible, provide vaccinations at SHS and offer the vaccine to unvaccinated students at all routine visits. If • Assess air exchange and filtration in care, this is not feasible, provide community resources and treatment, and administrative spaces and determine locations for vaccine appointments. time required between uses in the event of a known or suspected COVID-19 patient. Facilities may • If dental operations are within the scope of services, need to consider updating air handlers and review updated CDC Guidance for Dental Settings.
Considerations for Reopening Institutions of Higher Education for the Fall Semester 2021 / page 11 negative-pressure rooms/tents and conducting some • Identify appropriate charges (if indicated) for visits, visits outside. Portable HEPA filters may be necessary, telehealth services, testing, and supplies, including but they should be placed so that airflow is not directed medications or vaccines. Identify correct billing from one person to another person. codes to facilitate prompt, accurate reimbursement if billed to insurance. • Ensure adequate IT network, wi-fi, hardware, and expertise to support telemedicine and telemental health visits. Mental Health The COVID-19 pandemic has significantly increased SHS Administrative/Staff Considerations the mental health needs of our campus communities due • Utilize patient satisfaction surveys to obtain feedback to the consistent stress related to fear and uncertainty; about telemedicine or phone visits as well as clinic burnout; and a sense of powerlessness, sorrow, and loss services. Develop a system to review the quality of care that has characterized life for so many. There is clear provided and incorporate into existing peer review consensus that there will be a considerable processes. psychological and psychiatric aftermath to this • Ensure adequate PPE is available and that all staff are pandemic, resulting in high demand for counseling and trained in its use. Monitor staff compliance with PPE psychiatric services when students return in the fall. use. Enough PPE supplies should be stocked to meet The pandemic’s mental wellness impact was widely both patient care and testing needs. Establish Periodic experienced but affected some more than others. Those Automatic Replacement (PAR) levels for PPE who reported the poorest mental health were young restocking, if such guidelines are not already in place. adults and individuals with financial adversity or those • Maintain situational awareness of COVID-19 incidence unable to receive care for other medical conditions. and prevalence in the state and city and on campus. According to CDC, one in four young adults age 18–24 seriously considered suicide in spring 2020. The 18–24- • Require frontline SHS staff to be vaccinated for year age group appears to be especially vulnerable, COVID-19. possibly due to many of the drastic transitions they were • Consider a mandatory COVID-19 testing policy for all required to make and the isolation they experienced at unvaccinated SHS staff. what is typically a highly social stage of life. Factors such as inadequate sleep, exercise, or face-to-face • Implement effective patient-centered policies to safely socialization also increased the risk for poorer mental meet the health and counseling needs of students. well-being. One of the most salient factors is not • Develop employee health program protocols for knowing when the pandemic and its consequences will management of exposed and ill staff members. Develop end. return to work protocols for staff who have become ill Other risk factors associated with poor mental well- or were exposed to COVID-19. being include: • Document all providers and support staff involved in • Having a pre-existing mental health condition or the care of every patient so that exposures can be substance use disorder. tracked. • Identifying as a sexual or gender minority, • Ensure staff are knowledgeable about COVID-19 including transgender and nonbinary. symptoms, transmission, relevant protocols, and • Being a first-year college student or high school updated CDC guidance. senior. • Develop plans for alternative work assignments for • Being a member of a marginalized population. unvaccinated staff at higher risk of severe COVID-19. • Lacking social support. • Continue to track costs and funding mechanisms for • Having previously experienced trauma, having a testing, contact tracing, and case management. childhood history of traumatic experiences. Consider the financial impact of mass vaccination with COVID-19 vaccine. • Experiencing poverty or lack of resources. • Develop plans for mass immunization with COVID-19 • Being a community college student and/or adult vaccine, including necessary personnel, supplies, and learner. locations for vaccination administration and delivery. • Having a chronic illness, including long-term effects of COVID-19.
Considerations for Reopening Institutions of Higher Education for the Fall Semester 2021 / page 12 According to the Center for Collegiate Mental Health anchored with the campus in their first year. (CCMH), students who perceived that their “mental health” • Facilitating the diverse responses to the transition was negatively impacted by COVID-19 and sought back toward pre-pandemic daily routines. counseling treatment reported higher levels of mental-health distress in the following areas: • Attending to the basics of food, shelter, and finances. • Depression, • Generalized anxiety, • Addressing academic worry, a key factor of reported distress as well as the anxiety related to • Academic distress, and the uncertainties surrounding the pandemic. • General distress symptoms and overall wellness. • Embracing resiliency programming that includes The data indicates that 85% of students seeking counseling providing credit courses and implementing skill- services report that COVID-19 has negatively impacted at based practices within student affairs and academic least one aspect of their life: programs. • Mental health (65%), • Motivation or focus (61%), Counseling and Psychological Services • Loneliness or isolation (60%), Since the onset of the pandemic, counseling services • Academics (59%), and implemented new and expanded services and delivery methods including: • Missed experiences and opportunities (54%). • Transitioning to digital and virtual platforms vs. in- Mental Health Strategic Planning person individual and group sessions. Now more than ever, a comprehensive public health • Expanding crisis services. approach is needed to address the looming mental health • Providing on-demand virtual psychoeducation, impact of the COVID-19 pandemic. Mental health must be support, and therapy sessions. viewed not just from an individual psychopathology level but from a public health standpoint. College counseling • Providing training and education that help students centers do not have the capacity to provide treatment to so at risk, including bystander intervention and many students on an individual level, nor should they. This gatekeeping suicide prevention programs. is the time to engage and unite the campus in the goal of • Enhancing partnerships with other departments to providing a safety net for students, faculty, and staff. There provide consultation and support. is an acute need to bolster resilience and create an environment of compassion and understanding. The campus • Enhancing web presence with digital offerings and should engage in strategic planning that is inclusive and self-help options. considers not only the impact of COVID-19 but also Counseling services will likely retain or expand many of proactively addresses the intersection of related academic, these offerings this fall. social, and institutional issues. Colleges and universities should anticipate the need for College and university leadership should prepare to address enhanced mental health services and develop plans to the continuous and future challenges encountered by the support the mental health needs of students returning to campus community caused by the pandemic. As students re- campus. This has been a year of distancing from social integrate into campus, leadership’s focus should include: and interpersonal interactions and friendships. Students • Improving access to mental health care, improving may have greater levels of anxiety upon return to a students’ experience of mental health, integrating social campus environment and greater opportunity and mental health issues and resources into class syllabi, access to alcohol and other drugs. and creating space for listening. Considerations for counseling centers: • Supporting resilience through consistent engagement • Make an institutional commitment to providing with peers, leadership, and decision makers. more resources to college counseling centers. • Promoting healthy coping strategies through social • Provide clinician training and utilization of norming. evidence-based trauma-informed practices specific • Fostering social connections and opportunities, to assessment and treatment (see appendix A). especially for second-year students who may not have
Considerations for Reopening Institutions of Higher Education for the Fall Semester 2021 / page 13 • Provide clinician training about substance use parents, faculty, and staff. The Jed Foundation and disorders. the Suicide Prevention Resource Center (SPRC) provide valuable resource options. • Continue diversification of services by providing a menu of service options for students to include virtual, • Coordinate medical and counseling services. digital, and in-person options. Collaboration between medical services and counseling and psychological services must be • Continue providing crisis management services; seamless, with a focus on eliminating barriers and SAMHSA provides a comprehensive guide on best promoting access to care. Since students often practices in providing mental health crisis services. initially present to SHS, it should adopt a wellness • Continue collaborations with campus partners. assessment in addition to a depression inventory to • Focus on in-person and virtual same day appointments proactively address the magnitude of physical, and “on demand” counseling options. emotional, and spiritual effects resulting from the pandemic. Screenings need to embrace a trauma- • Provide options for drop-in counseling. informed approach with clear pathways for • Create stepped care venues that provide the correct type intervention and referral. and level of service based on the student’s presenting • Provide easy access to behavioral health providers. needs and functioning. The practice of embedding behavioral health • Provide counseling services through remote service providers in primary care has had enormous options, taking services to where the students are success in both the private and public sector and (residence halls, academic buildings, etc.). Collaborate allows for improved access to care, coordination, with campus partners to ensure secure, private spaces and a welcome warm hand-off. for students to access remote care. • Provide opportunities for virtual telehealth sessions • Focus on normalizing and increasing help-seeking and consider safe in-person visits without masks, through consistent marketing, timely triage, and with adequate distancing, ventilation, and improving ease of access. immunization; this acknowledges the value of facial expressions in providing accurate • Designate peer-based outreach and peer-based support assessment, evaluation, and rapport building. groups provided virtually or in-person. • Create service-learning opportunities on campus and in Health Promotion the community to encourage students to get involved as a part of the solution. Health promotion is a process—a network of coordinated actions—that supports individuals’ • Promote a work/life balance and a healing autonomy in creating health and well-being. Health environment. Counseling staff are consistently promoting actions include implementing health- addressing diverse and acute mental health needs of supporting public policy, developing healthy working students while balancing their own personal stressors. and living environments, coordinating collaborative Provision of therapy services through video can be community action, providing health education, and more emotionally draining for mental health working with health care systems to think beyond professionals. There is a need for acknowledgment and treatment to promoting health as an everyday resource. recognition for the important work that is done. The work climate must encourage and embrace self-care, Health promotion processes can be applied to any health collaboration, and focus on staff retention. outcome of interest, and every institution selects focus areas for health promotion activities based on its unique • Enhance gatekeeper strategies. Students will need a contextual characteristics. comprehensive approach to help maximize their strengths and engage in healthy habits such as finding Senior health promotion professionals often have social/academic balance, eating a nutritious diet, expertise in coordinating multi-layered, broad exercising, and developing healthy sleep patterns. It community action. They are uniquely skilled at takes all campus stakeholders to encourage wellness, developing and coordinating a comprehensive but also to identify those in distress. The need to cross- framework that effectively engages students in train all front line personnel to recognize and respond supporting healthy behaviors while utilizing best public to trauma and identify risk factors needs to be a health and prevention practices. Adapting policy and priority. The training should include students as well as institutional operations to support health are core
You can also read