Data-Driven Decision-Making to Reopen College Campuses

Data Driven Decision Making

College campuses are reopening throughout the United States with safeguards in place meant to limit transmission of SARS CoV-2, known as the novel coronavirus. It is important to minimize transmission because there are no highly effective drugs to treat COVID-19 and there is not yet an approved vaccine to prevent it. Safeguards include non-pharmaceutical interventions such as physical distancing and regularly using masks and hand sanitizer. Some campuses have also limited their population numbers by offering only online learning to at least part of the student body, although for training in healthcare fields such as nursing and medicine, in-person clinical education is essential. 

When there is in-person education, students and staff are usually required to monitor themselves for COVID-19 symptoms and when they experience them, they must visit a healthcare provider who will likely order a SARS CoV-2 virus test. If the student or staff member tests positive for the virus, they need to be isolated and their contacts should be traced. Contacts that are identified need to be quarantined. Some campuses are testing all students and staff periodically, even if they do not have symptoms. The reopening process needs to be data-driven and institutions that have robust systems in place to collect, store and use data are better equipped to measure and limit transmission. 

Data Used to Manage Transmission 

The main COVID-19 public health goal is to limit transmission by decreasing risk and contact with infected people. Data are important to manage this process. Data can be collected on symptoms, test results, contact tracing, isolation, quarantine and travel history. There are many different COVID-19 symptoms including fever, cough, shortness of breath, fatigue, 

muscle aches, headache, loss of taste or smell, sore throat, congestion, runny nose, nausea, vomiting and diarrhea, among others (Centers for Disease Control and Prevention). Patients who test positive can have 1 or more of these symptoms and so it is important for students and staff to know what COVID-19 symptoms are and to monitor them on a daily basis. Data about symptoms is also important to identify individuals who should be tested. However, some infected people are completely asymptomatic. Polymerase chain reaction (PCR) tests identify the presence of an antigen in people who are actively infected with SARS CoV-2 virus. These test results are important data that are then used to initiate isolation and contact tracing, and subsequent quarantine and testing of contacts of the infected individuals. In addition to testing when an individual has symptoms, some organizations have chosen to test all community members periodically, regardless of whether they have symptoms. This can be done using individual virus tests or using pooling methods to reduce costs. 

Collecting, storing, and effectively using these diverse datasets is one essential component of managing transmission of any organization including colleges and universities.

Epidemiological Background

It is very important that students and staff understand at least the basic epidemiology of COVID-19. The incubation period of infectious diseases, including COVID-19, is the period between when a person is infected with the virus and the onset of symptoms. The latency period is the period between when an individual is first infected and when they are infectious, which means they can transmit the virus to other people. The incubation period for SARS CoV-2 is usually between 2-14 days with a median of about 5 days (Lauer et al. 2020) and the latency period is estimated to be about 2 days longer because the infectious period often begins about 2 days before the onset of symptoms. This delay in symptoms when infected people are infectious makes COVID-19 especially difficult to control. It is important to know when a person is infectious because they need to be isolated from other people, so they do not transmit the virus. But if people do not have symptoms then they are usually not tested. People with mild COVID-19 illness or who are asymptomatic usually recover within 2 weeks but in people with more severe illness it can take much longer. Even symptomatic people are often infectious before they have symptoms and they are often most infectious at the beginning of their illness when they first have symptoms.  A recent study estimated that 40-45% of COVID-19 cases are asymptomatic (Oran et al. 2020), although the proportion of transmission due to asymptomatic infection is not yet known (Liu et al. 2020). 

SARS CoV-2 Transmission and Prevention

It is also important that students and staff understand how SARS CoV-2 is transmitted and how transmission can be prevented. Mostly, SARS CoV-2 virus spreads person-to-person through airborne transmission of infected respiratory droplets when an infected person coughs or sneezes and there is debate about the importance of airborne spread when talking or singing (Sommerstein et al. 2020). Rooms with better ventilation are thought to reduce the time that respiratory droplets are airborne (Somsen et al. 2020). One experimental study concluded that speaking causes airborne virus transmission in confined environments (Stadnytskyi et al. 2020). Transmission of viruses has been shown to be lower when there is physical distancing between people of 3 feet or more (Chu et al. 2020), however, in the United States the CDC recommends physical distancing of 6 feet (Centers for Disease Control and Prevention). The virus can also spread when a person touches a contaminated surface (i.e., fomite) that has the virus on it and then touches their nose, mouth, or eyes although this transmission route is likely rare (Sommerstein et al. 2020). Using hand sanitizer or proper hand washing prevents this type of transmission.

SARS CoV-2 transmits very efficiently in populations. Mathematical epidemiology models have shown that the number of secondary infections for each person infected with the virus is between 2 and 3. This number is called the R0 or basic reproductive number, and if the RO is above 1 then the epidemic is increasing and if it is below 1 it is decreasing. An R0 of 2 with an incubation period of 5 days means the number of cases doubles every 5 days. Thus, the goal of public health efforts is to limit transmission so the R0 goes below 1 in order to get the pandemic under control. Masks help prevent airborne transmission and the distribution of virus onto surfaces (Chu et al. 2020). Hand sanitizer with alcohol and proper hand washing with soap and water kills the virus. Testing determines who needs to be isolated and contact tracing determines who needs to be quarantined. Transmission is more likely to occur when people are in physical contact with one another or are close contacts, which are defined by the CDC as people who have been within 6 feet of for 15 minutes or more of an infected person (Centers for Disease Control and Prevention).  

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written by Dr. Michael E Emch

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