The British Medical Journal has been looking at the reopening of campuses in the US. It concludes that the national reopening experiment “already looks to have been a disaster”.
There are three lessons for UK universities in the article. The first is the importance of curbing community transmission before reopening campuses. The second is the value of quarantining before or on arrival. Crucially, the third is that viral transmission between asymptomatic students can occur at “lightning speed” in these settings – and so adopting symptom based Covid-19 screening – the current plan across UK higher education – is “not a robust prevention strategy”.
It notes that in the US, the Centers for Disease Control and Prevention (CDC) gave universities cover by stating that it “does not recommend entry testing of all returning students”, and notes that “many universities, unfortunately, followed suit”. It argues that the recommendation “was not evidence based”, and that model based evidence shows that preventing outbreaks “requires high frequency screening of all students on campus”.
It notes that frequent testing will not be feasible in all settings, but argues that ideally testing should include lecturers and other campus staff (who may be older and at higher mortality risk from infection), and “probably students living off-campus nearby”.
And here’s the real kicker. “Any prevention strategy that is based on personal responsibility” and an expectation that “students will never go to parties or have sex” is, it says, “bound to fail”. Watching university leaders blaming students for outbreaks instead of admitting that the university’s reopening plans were dangerous has been “disheartening”, and instead we need a “harm reduction” approach – where universities provide guidance on ways to socialise more safely and facilitate and provide facilities for low risk alternatives to unmasked, covert indoor parties:
Think movies, yoga classes, and concerts—all outdoors with social distancing encouraged and school-branded masks provided.”
It concludes by arguing that reopening university campuses in the middle of a deadly pandemic is a “high risk endeavour”, and so “transparency and accountability from university leadership” are the least we can expect when they “put so many lives on the line”.
One of the co-authors is Gavin Yamey, professor of global health and public policy at Duke University. A respected university academic.
Responsibilities
When your wider industry is both a provider of services AND the principal source of scientific advice on the rules that should govern the safe operation of those services, you’re in a quite a privileged position.
You have to be careful to avoid scaremongering – you might unnecessarily damage your own industry. You have to avoid burying bad news – you might put people at risk. It means that in comparison to others, you probably have to be much more public than most about the advice you’re getting, giving, creating, synthesizing and applying.
Double all of that if you’re a charity, and triple it if your brand involves keeping people safe or educating the young. It’s why the safeguarding scandals in the development sector a couple of years ago were so potent with the public.
Our sector creates and employs scientists. Some of them are epidemiologists, and virologists, and public health specialists. They advise the government on things – including the reopening of campuses. Government can then follow or ignore (and more subtly, synthesize) the advice it gets when creating public health guidance for universities. Universities then say “we’re following public health guidance for universities”. But what if universities disagree with the government’s call?
What I’m getting at here is the basis upon which universities have been making decisions – to reopen campuses or not, to invest in a particular strategy, the intensity and density of face to face contact, whether to take “extra measures” on testing and transmission than those mandated in guidance, or whether to abandon or switch plans.
On one level for example, it’s great when universities announce their campus reopening intentions by going beyond the mandated guidance on stuff like extra testing and tracing. But on what basis, science or advice are they doing all of that? It could be a waste of an educational charity’s money. It could be nowhere near enough to keep students, staff or the community safe.
We are following public health guidance
Quietly, everyone says the guidance they’re proud to announce they’re following is unhelpful and vague, and anyway still involves making judgements about the level of risk we might deem “acceptable”, and dealing with trade offs. But publicly the message is – we’ve been following the guidance. Just like they were in the US.
What, then, if your own modelling – from either your own scientists in your own sector or even your own scientists in your own university – showed a potential problem? What if your own modelling leads you to think “blimey, the guidance hasn’t thought about X or Y but we should, or there will be a bucketload of infection/transmission”.
That BMJ article says that given that universities are centres of learning, they should be conducting research to help guide safer reopening. And because our sector “owns” science, the public will assume that a number of universities have carried out some epidemiological modelling on virus transmission on campus and within the community and the options or measures to stop it – but we’ve seen very little.
As plans have gone wrong in the US, the media and pundits and parents have all been saying “but you’re supposed to be the bloody boffins”! It’s like those moments where people point at Dom Cummings and say “haha not such a superforecaster now are we” – only much, much worse.
Consider the examnishambles. The hunt to apportion blame might be unhelpful and simplistic, but it’s inevitable. That crisis was about who knew what and when, whether modelling was done on the proposed algorithm, and the nature of the advice from Ofqual and senior officials to Gavin Williamson. If campus closures and community transmission ensue in the autumn, similar hunts will happen.
Known unknowns
An important component of the “science” when people are making decisions, is, of course, data. Right now – and remember campuses are already partly open and many courses have commenced – there doesn’t seem to be a reliable way for providers of higher education to even know if they have Covid cases. No-one seems to be mandating them to collect those numbers, and there’s no obvious obligation to publish numbers or report them in to anyone. That’s surely a problem?
The BMJ piece says that every university “should publish its safety protocols” and a “daily dashboard showing metrics” such as the numbers of tests, cases, hospital admissions, and deaths. These data need to be “disentangled from regional data” to understand rates both at the university and within the local community. But is that even possible?
Last week, Oxfordshire’s Director of Public Health was warning about a spike amongst 19-29 year olds. One of the things that was therefore press released was “we’re putting a mobile testing unit on the Cowley road” (a fairly studenty area if you look at DK’s graphs).
It’s not daft to ask Ansaf Azhar (Oxfordshire County Council’s Director of Public Health) “how many of your 18-29 spike are students”, especially if you’re coordinating Brookes, Uni of and the other higher education providers in the area – many of which will already be back in rented accommodation. But it’s not clear that the figures he gets include whether someone is a student or not – partly because the privatised NHS Test and Trace function doesn’t even appear to be collecting that data.
Narrative data is doubtless being gathered by the tracing function. But the chances of that being anything other than crushingly generalist “Nvivo throws up mentions of bars” is very low. Do any of the higher education providers have to share details of declared cases with PHE? That’s not clear. Does PHE have to share details of cases (provider by provider) with providers? It looks like they won’t have the details.
It gets further complicated if a university is offering testing. In the Oxford case, Oxford University is offering testing that’s not open to Brookes’ staff and students. It says if anyone tests positive it will tell PHE (who then does the tracing) “and your college”, to take “rapid action to protect you others where necessary” (which sounds a lot like tracing).
Will the university be providing public data, or data to PHE, on how many tested or positive via its service? That’s not clear. Will constituent colleges, when they get 2 cases, declare that “outbreak” to the central university, or PHE, or the Charity Commission as a serious incident? You would hope so. Should a student on the Cowley Road use the MTU, or the university service? Not clear. Will we see some HESA stats on Covid-19 in a year or so? We will not.
All of that sounds like a mess, and it reminds me of the problems you get around harassment victim disclosure in a large university. You need all sorts of people to be sharing information, but you need the protocols and data infrastructure in place to do it legally, because there are also real privacy concerns. If not, you run the risk of a poorly coordinated approach, or the victims thinking “well surely if I’ve told X then they must be telling Y”.
Then chuck in the fact that we might know where students live, but we don’t know who their landlords are. Or what their responsibilities should be, or are. If you were a new-to-the-UK international student with Covid symptoms after popping to a house party last night, it’s probably a good idea to tell your university (as well as your college in the case of Oxbridge and Durham), your house/flatmates, the NHS you’ve not paid the fee for yet, and your landlord. But isn’t the danger that some students think that once they’ve told one of that list, they’ve told them all?
Oh – and that MTU on the Cowley Road? It was due to be there until the end of Bank Holiday Monday. The day before thousands of students moved back to begin the year in new HMO contracts, and the day that 14 days of self-isolation started for thousands of returning international students – many of which live on or around said Cowley Road.
Gold commander
Science and data matter because they form the basis for managers and leaders to make judgements about risk. As such, students, staff and citizens do have a right to know the scientific basis on which decisions are being made, who’s making them, how the money in a charity is being spent, the actual plans that result from all that, and to have a way of measuring the efficacy of those plans – nationally, locally and institutionally.
We need to know whether providers will be told how many cases they have, or whether that data will just be “local” rather than “institutional”. We need to know who will collect that data. We need to know how it will be collected, and when it will be published.
The Covid-19 contain framework says that:
Well-established local and national arrangements for public health and emergency planning are being used as the basis of this enhanced response. The decision-making model follows the tried and tested approach to civil emergencies, based on the concept of subsidiarity, which is where decisions should be taken at the lowest appropriate level, with co-ordination at the highest necessary level.
Subsidiarity in public policy makes lots of sense in principle. But to work it requires higher levels of decision making to be both responsible and accountable for things that can’t reasonably be handled by those below them. And “we’ll give you the data”, “we’ll publish the modelling” and “we’ll back you if you make reasonable calls based on decent advice” are not the messages that people are getting.
Across the sector, I know almost everyone is doing their very very best in an impossible situation – all with no time, no additional money, no safety net and an admissions crisis to handle. Colleagues and contacts suggest that the same is broadly true inside local authorities too.
But if the pandemic so far tells us anything, it’s that to avoid a disaster we should be as open as possible – about what we know, what we don’t, and where we’re not being supported. As such it’s important that staff, students and local communities are able to interrogate, and make judgements about, whether everyone’s “best” in this impossible situation is enough.
Or, to put it as the UK BMJ does:
Reopening a campus in the middle of a deadly pandemic is a high risk endeavour. Transparency and accountability are the least we can expect when so many lives are on the line.
