Bringing College Students Back to Classrooms During COVID-19 is a Mistake

What follows is a letter sent to the Chancellor of NC State University, in response to the administration’s calls for increasing the amount of face-to-face instruction during the Fall 2020 semester, with proposed classroom spacing of 4–6 feet, including some lecture classes with up to 100 students. Some of the suggested measures are described in this news story. More context can be found in the Chancellors “3D Memo” requesting more in-person teaching, linked here. A few of the questions asked here have been answered indirectly since the date the letter was sent (for instance, apparently the planned contact tracing program will be via voluntary reporting). Nonetheless, I’m sharing the letter here in case the arguments and references contained in it are useful to others in academia facing similar proposed reopening plans in the fall. Please also see this article, which presents additional arguments from experts on why college reopening this fall cannot be justified. (The letter below is very lightly edited.)

27 June 2020

Dear Chancellor Woodson,

I have been deeply dismayed to see the recent developments as the NC State administration has walked back its efforts to protect faculty, staff, and students by pressuring departments to offer more face-to-face instruction this coming fall semester. While I fully understand that the university is facing its own pressure, both financially and in terms of the expectations of students and parents, the best current scientific understanding of SARS-CoV-2 makes it clear that reopening the campus for in-person instruction at a time when community spread is rampant in North Carolina cannot be justified. Furthermore, it is clear that the risk mitigation measures currently proposed are vastly insufficient and cannot be relied upon to be effective in preventing an outbreak on campus, even if implemented perfectly.

When in-person instruction was halted at NC State on March 17, there were 8 new daily cases of COVID-19 in the state, and about 1,400 nationwide. As of June 26, the new daily cases stand at over 1,700 statewide, and around 45,500 across the entire US. Both these numbers are rising; the level of community spread has never been higher. Over 125,000 Americans have lost their lives to this illness. While the elderly are the most vulnerable, death and permanent injury has occurred among all age groups — even among young people who had no clear risk factors. This is a virus that has existed on Earth for less than a year; the science is still developing, and neither the transmission probabilities nor effects of infection have yet been fully understood. While most people infected with the virus eventually recover, there has been evidence that some survivors can acquire diabetes [1], infertility [2], and neurological damage [3,4], along with the lung damage normally associated with the disease. This is not a virus with which we should become complacent, nor should we settle for half-measures that may or may not protect us.

As an NC State faculty member, I have been watching the guidance from the university higher-ups changing frequently, with no clarity given as to how COVID-19 policy decisions are being made. Who are the medical advisors? How are faculty and staff concerns factored in? How are pressures to provide a “campus experience” being weighed against the health and safety of the people who provide this experience? Who is liable if an NC State student or employee suffers injury or death due to exposure on campus?

It is also not clear to what extent we, as faculty, are free to make decisions to protect ourselves. If an instructor, or a member of the instructor’s household, is at heightened risk for death from COVID-19, does that instructor have the freedom to opt out of in-person instruction without penalty? What are the expectations of disclosures of pre-existing conditions, and what privacy assurances are in place? How will the safety of non-academic staff members be assured? If infections are detected and an instructor needs to quarantine, who is expected to take over the class? Will courses be cancelled if a large number of students or their instructors are infected? How will testing, contact tracing, and quarantine procedures be carried out?

If the scale of the pandemic worsens, will in-person instruction for the semester be discontinued altogether?

These are all urgent questions, and they have not been answered. Expecting faculty to prepare themselves for in-person teaching with so much still unknown puts us all in an impossible position. This is especially true considering that the safety measures the university has committed to cannot be relied on to prevent an outbreak on campus. We want to provide the best possible learning environment for our students. But we are in the middle of a global pandemic that is already devastating our community.

We are, with very good reason, afraid.

My purpose in writing this letter is to describe some of my major concerns with NC State’s reopening plans and explain why I believe the pressure to increase face-to-face instruction is misguided and puts members of NC State, and our broader community, at grave, unjustified risk.

Classroom safety

In the guidance put out by NC State describing the safety measures to be implemented on campus, there was a great deal of discussion of sanitization techniques, mask recommendations, and physical distance. While each of these measures can contribute to a reduced risk, it is clear from the most up-to-date research that they are not sufficient to provide a reasonable expectation for the prevention of outbreaks.

Masks, when used universally, can be helpful for reducing the spread of the virus, but their efficacy varies wildly based on construction and use. A recent study found that cloth face coverings can have 28%-90% efficiency in filtration [5]. On the high end, this is encouraging, but the range of efficacies makes it clear that masks should not be considered protective over extended periods of time when people are in close quarters. We also cannot rely on them being used perfectly or consistently by untrained students, faculty, or staff.

Similarly, the efficacy of physical distancing is a sliding scale. Current NC State guidance suggests some classrooms will place students as close together as 4 feet on the assumption that they will face forward and not speak to one another, thus reducing the need for distance. Even aside from requiring behavior that is unrealistic to expect, it is not sufficient protection. Studies have found that air flow within an enclosed space can transmit the virus through aerosols or droplets over much larger distances when people are sharing that space for an extended period of time [6,7]. There has been no mention in the guidance we have received as to how air conditioning and ventilation systems have been evaluated or altered in this context. In fact, we have reason to believe that air recirculation within classrooms can be occurring at dangerous levels. An informal survey a few years back of CO2 concentration in classrooms around the university being used for physics exams found that many rooms had concentrations in the vicinity of 1000 parts per million, indicating a significant amount of recirculation of exhaled air. Over the course of an exam (which can be considered an idealized situation, as students are not moving or speaking to each other), some rooms reached concentrations as high as 3000, which would be a dangerous level of CO2 even without the threat of a virus carried in the air. A portable plexiglass screen being wheeled in front of the lectern does not negate a risk factor associated with viral respiratory droplets that can circulate through air currents.

Of course, we are still learning about the risk factors. It may turn out to be true that transmission is unlikely in a classroom containing silent, masked students sitting perfectly still, staring straight ahead, thus maintaining the necessary distance and reducing the production of respiratory droplets through speech. But if that’s what it takes to hold in-person instruction, it’s not worth it. As an instructor trained in the active learning techniques encouraged across the university, which emphasize interaction and discussion, I fail to see how the pedagogy possible in such a classroom has any advantage at all over online learning. A well designed and thoughtfully delivered online course can be significantly more engaging and interactive — and more effective — than a class taught under conditions in which active learning is so constrained by these (necessary) barriers and restrictions.

Even so, the science suggests the classroom safety measures proposed are unlikely to be enough. A recent study modeling coronavirus spread in a university setting found that keeping infections low requires limiting in-person classes to fewer than 30 students, universal mask wearing, and daily testing of 3% of the university population (with quarantine instituted for positive tests) — assuming the students have no social contact outside classes [8]. These criteria are not met in NC State’s current reopening plans. While masks are said to be required, there has been no guidance as to how mask policies will be enforced, nor an acknowledgment that mask use will not be perfect. The amount of testing proposed is not sufficient, nor is it clear how quarantine and contact tracing will be instituted in cases of infections. There has been no guidance as to how social interactions among students on and off campus could be prevented. (In fact, the idea that it is even possible to prevent college students from socializing in groups strains credulity.) With all this considered, there is a good chance some subset of students will be coming to class infected, and given the number of students in a classroom, the chance that they might pass those infections on to other students and instructors is unacceptably high.

Superspreading events

One of the things we have learned since the start of this pandemic is the outsized role played by so-called superspreading events [9], in which a single gathering involving one infected person can lead to a large number of cases over a short period of time. One study of viral spread in Hong Kong estimated that “20% of cases were responsible for 80% of local transmission” [10]. Some recorded examples of superspreading events include dinner parties, funerals, church services, choir practices, and conferences — indoor settings in which large groups of people gather for an extended period of time, especially if those events involve talking, singing, or close contact among the participants. On a college campus, under ordinary operation, many normal academic and social activities such as student social gatherings (on or off campus), dining hall meals, athletic training, and classroom instruction fit the criteria to constitute superspreading events. Outbreaks among student athletes at other universities have already begun [11]. Even with mask recommendations and social distancing guidelines in place, it will not be possible to prevent such an event from occurring so long as students are resident on campus, eating in dining halls, playing sports, and attending face-to-face classes.

A superspreading event occurring on campus would be extremely disruptive, putting the health of students, staff, and faculty at risk, and potentially leading to death or long-term health problems for those infected. However, the impact would not be contained to NC State. By allowing such transmission to occur, we could be responsible for a dramatic spike in community spread, affecting the larger North Carolina population, and putting in grave danger the most vulnerable people in our community. What’s more, a superspreading event can have global effects. One recent study of virus strains showed that a single superspreading event in Boston, at the Biogen conference in late February, led to infections as far away as Australia and Slovakia [12].

This virus is highly contagious, dangerous, and, as yet, not well understood. An outbreak among a relatively small group of people can have unpredictable and catastrophic downstream effects, harming thousands. This could be especially true for NC State when the end of the semester comes and scatters our students, staff, and faculty across the country and around the world.

Your 3D memo from June 18th justified the call for more face-to-face teaching in terms of NC State’s responsibility to the larger community, as a land-grant institution, and the importance of maintaining the public’s trust [13]. How can we maintain that trust, while knowingly putting the community at such great risk? You specifically invoked the needs of under-represented and under-resourced students and their families. Given the well-documented disparities in the impact of COVID-19 on different demographic groups, due to inequalities in wealth, health care access, employment constraints, and greater levels of prevalence of pre-existing conditions due to the generational harm of racism [14], how can we, in good conscience, take actions likely to contribute to the spread of this disease?

While those calling for us to hold face-to-face instruction may be loud and influential, we must not forget that they do not represent the community as a whole. As a university, we have a responsibility of care to our students, staff, and faculty, and a responsibility to those of our community members who are impacted by our actions but whose voices may not reach the decision-makers at the top. This is true even if the result of our care and caution results in financial difficulties for our institution from which it will take time to recover. I do not take this possibility lightly. But financial or institutional damage cannot be held up as more important than the loss of life. It is up to us to base our decisions on our true responsibility to the community, and on what the latest science tells us about the risks of our actions beyond the borders of our campus.

Thank you for taking the time to read and consider this letter.

Best regards,
Dr Katherine (Katie) Mack
Assistant Professor of Physics
Chancellor’s Faculty Excellence Program Leadership in Public Science Cluster Member
https://physics.sciences.ncsu.edu/people/kmack/

[1] Mallapaty, S., “Mounting clues suggest the coronavirus might trigger diabetes,” Nature News. https://www.nature.com/articles/d41586-020-01891-8

[2] Wang, S., “The need for urogenital tract monitoring in COVID-19,” Nature Reviews Urology. https://www.nature.com/articles/s41585-020-0319-7

[3] Helms, J. et al., “Neurologic Features in Severe SARS-CoV-2 Infection,” New England Journal of Medicine (Correspondence), https://www.nejm.org/doi/full/10.1056/NEJMc2008597

[4] Cormier, Z., “How Covid-19 can damage the brain,” BBC Future. https://www.bbc.com/future/article/20200622-the-long-term-effects-of-covid-19-infection

[5] Mueller, A. V. et al., “Quantitative Method for Comparative Assessment of Particle Filtration Efficiency of Fabric Masks as Alternatives to Standard Surgical Masks for PPE,” preprint. https://www.medrxiv.org/content/10.1101/2020.04.17.20069567v4

[6] Lu, J. et al., “COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020,” Emerging Infectious Diseases. https://wwwnc.cdc.gov/eid/article/26/7/20-0764_article

[7] Bromage, E., “The Risks — Know Them — Avoid Them,” blog post. https://www.erinbromage.com/post/the-risks-know-them-avoid-them

[8] Gressman, P. T. and Peck, J. R., “Simulating COVID-19 in a University Environment,” preprint. https://arxiv.org/abs/2006.03175

[9] Aschwanden, C., “How ‘Superspreading’ Events Drive Most COVID-19 Spread,” Scientific American. https://www.scientificamerican.com/article/how-superspreading-events-drive-most-covid-19-spread1/

[10] Adam, D. et al., “Clustering and superspreading potential of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in Hong Kong,” preprint. https://www.researchsquare.com/article/rs-29548/v1

[11] Redden, E., “College Football Hit by Coronavirus,” Inside Higher Education. https://www.insidehighered.com/news/2020/06/22/college-football-programs-hit-covid-after-resumption-voluntary-workouts

[12] Lemieux, J. et al., “Introduction and spread of SARS-CoV-2 in the greater Boston area,” preprint. https://virological.org/t/introduction-and-spread-of-sars-cov-2-in-the-greater-boston-area/503/1

[13] Woodson, R. W., “Request to Increase Face-to-face and Hybrid Course Offerings,” 3D Memo. https://3dmemos.ncsu.edu/memo/request-to-increase-face-to-face-and-hybrid-course-offerings/

[14] Yaya, S. et al., “Ethnic and racial disparities in COVID-19-related deaths: counting the trees, hiding the forest”, British Medical Journal (Commentary). https://gh.bmj.com/content/5/6/e002913