Colleges grapple with online vs. in-person learning

After COVID-19 was declared a pandemic nearly a year ago, colleges across the country were forced to switch to online learning or to adapt strict infection prevention measures to prevent the spread of the novel coronavirus on their campuses.

As the spring 2021 semester begins, campuses still are debating whether to hold in-person classes or online learning.

According to recent results from the College Crisis Initiative provided to Healio Primary Care, as of mid-February, 39.62% of colleges in the U.S. are primarily online for the spring 2021 semester, 16.28% are primarily in person, 8.98% are using a hybrid model and 5.06% are using other strategies. The data further showed that just 1.98% of colleges are fully in person, and 3.48% reported being fully online for the semester.

Additionally, the initiative found that 24.61% of colleges have still not determined their reopening plan for the semester.

Healio Primary Care spoke with experts about whether campuses should be returning to in-person instruction during the COVID-19 pandemic.

College campuses as ‘superspreaders’

A recent modeling study published in Computer Methods in Biomechanics and Biomedical Engineering found that college campuses are at risk for becoming COVID-19 superspreaders.

“Our study shows that the first 2 weeks of instruction are the most critical period of campus reopening,” Ellen Kuhl, PhD, the Robert Bosch Chair of Mechanical Engineering at Stanford University, told Healio Primary Care. “Campus outbreaks can be an order of magnitude more intense than outbreaks in the general population.”

Kuhl and colleagues collected COVID-19 case reports from 30 college dashboards across the U.S. in the fall. The institutions — which were holding in-person, online or hybrid classes — reported case numbers daily and had a total cumulative number of more than 100 COVID-19 cases.

Among the 30 institutions, 14 experienced a spike in COVID-19 infections during the first 2 weeks of classes.

The researchers found that many institutions had a peak in 7-day incidence of more than 1,000 cases per 100,000 people, and that all but one college had 7-day peaks greater than the nationwide peaks of 70 cases per 100,000 people during the first wave and 150 cases per 100,000 people during the second wave of the pandemic.

While most campuses were able to rapidly reduce the number of new infections, many were not able to control the spread of the coronavirus off campus.

“For more than half of the colleges in our study, they leaked into the campus neighborhoods and triggered community outbreaks,” Kuhl said.

However, based on their findings, Kuhl said that colleges “can and should reopen now that the case numbers have gone down nationwide.”

“While we have not explicitly studied the effects of in-person vs. online instruction, we believe it is most important to open the campus to students and then gradually and selectively open up to in-person instruction, ideally with smaller class sizes,” Kuhl said.

She added that campuses should “be alerted to test-trace-isolate, and, if needed, flexibly switch to online instruction.”

Infection prevention measures

Another study published in the Annals of Internal Medicine demonstrated that strict COVID-19 prevention measures may allow campuses to return safely at reasonable costs, according to researchers.

“It is clear that two common nonmedical strategies are very effective and inexpensive — and allow for some in-person instruction,” Pooyan Kazemian, PhD, assistant professor of operations at the Weatherhead School of Management at Case Western Reserve University, said in a press release. “While it's true routine testing of the asymptomatic helps catch some infections early and reduce transmissions, they also pose the highest financial and operational burden, even if performed every 14 days.”

Kazemian and colleagues used the Clinical and Economic Analysis of COVID-19 interventions model to evaluate combinations of four prevention strategies: masking, physical distancing, testing and isolation. The model tracked infections among college students and faculty while accounting for community transmissions.

The researchers determined that mitigation strategies reduced cases among students from 3,746 when there were no mitigation strategies to 493 cases with strict social distancing and masking policies. The cases dropped even further — to 151— when laboratory testing was conducted in asymptomatic students every 3 days.

In faculty, they found that there were 164 cases without any prevention measures; that number dropped to 28 with social distancing and masking strategies, and 25 cases with the addition of testing asymptomatic faculty.

Kazemian and colleagues estimated that the costs of these strategies ranged from $400,000 with minimum social distancing, to $900,000 to $2.1 million for strategies that used laboratory testing. The costs were based on the frequency of testing, with an estimated cost of $10 per test.

The researchers estimated that strategies involving extensive social distancing and masking would cost $170 per infection prevented, compared with masks alone, and that the addition of routine laboratory tests would increase the cost per infection prevented to $2,010 to $17,210.

“While states have started offering COVID-19 vaccine to health care workers, first responders and long-term care facilities, it is unlikely that most students and university faculty and staff will be offered a vaccine until late in the spring semester,” Kazemian said. “Therefore, commitment to mask wearing and extensive social distancing, including canceling large gatherings and reducing class sizes with a hybrid education system, remains the primary strategy for minimizing infections and keeping the campus open during the spring semester.”

Should classes be in person?

Preeti Malani, MD, chief health officer and a professor of medicine in the division of infectious diseases at the University of Michigan, told Healio Primary Care that the spring 2021 semester will be different for each college across the country.

“Realistically, I'd look to fall as a time when the majority of courses can go back to an in-person format,” she said.

At the University of Michigan, Malani said courses that need to be completed in person — such as health science courses, labs, studios and performances — are done so with careful infection prevention measures, but other courses are held online.

She added that while campuses can use measures such as mask and social distancing mandates in classrooms, shared study areas, dining spaces, recreational areas, campus transportation services and other areas, individuals staying on campus often live in congregate housing with roommates, making household spread a concern.

Malani also noted that there are many strategies that can prevent the risk of outbreaks, but these risks cannot be eliminated.

“We often say campus cannot be safer than the general community, where COVID-19 risk is also a concern,” she explained.

According to Malani, a “layered approach” to public health measures that include masking, physical distancing, avoiding large gatherings and handwashing combined with monitoring symptoms, testing — including in asymptomatic people — contact tracing, and isolation and quarantine housing, has been effective.

“All of this comes at a cost — economic, academic and emotional,” she said. “It's imperfect, but many students have found ways to continue their education in a way that feels meaningful.”

References:

• Eurekalert. New study suggests that college campuses are COVID-19 superspreaders. https://www.eurekalert.org/pub_releases/2021-01/tfg-nss011121.php. Accessed February 9, 2021.
• The College Crisis Initiative. COVID-19 Data Dashboard. https://collegecrisis.org/covid-19-data-dashboard/. Accessed February 12, 2021.
• Losina E, et al. Ann Intern Med. 2020;doi:10.7326/M20-6558.
• Lu H, et al. Comput Methods Biomech Biomed Engin. 2021;doi:10.1080/10255842.2020.1869221.