Delta a Concern on Campus: Back to College Amid COVID Surge

Damian McNamara

August 09, 2021

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center

The Biden administration has announced initiatives to promote the safety of in-person college and university this fall as COVID-19 case rates surge across the country.

A Vax to School College Checklist, adding COVID-19 vaccination discussions to sports physicals, and launching a Week of Action to promote vaccination among young people are among new initiatives announced by the administration on August 5.

Boosting vaccination rates is the major theme, with more than 20 million students returning to undergraduate and graduate studies in the US this month.

"For young people, getting vaccinated right away is the best way back to the things they love — like playing sports, completing their studies, and spending time with friends and loved ones," the administration stated in a news release.

"College campuses are really about togetherness — about roommates, parties, and sporting events. So it's not just classrooms and co-curricular spaces, but the social spaces that also need to be considered," Preeti Malani, MD, chief health officer at the University of Michigan in Ann Arbor, said at a media briefing July 27 sponsored by the Infectious Diseases Society of America (IDSA).

"We saw this play out last year. Even with good attempts at testing and masking and social distancing, it was really difficult to prevent the spread of COVID," said Malani, who is also an IDSA fellow and professor of medicine in the Division of Infectious Diseases at the University of Michigan.

"Invariably, when outbreaks occurred, there was a social connection," she continued.

In Person, if Possible

Although the Biden administration also released guidance for kindergarten through high school students returning to in-person learning, "the big difference from the K-12 space is college kids are eligible for vaccination, by and large," Malani said.

Although uncertainties remain — particularly with the summer surge in COVID-19 cases driven largely by the Delta variant — there is consensus among experts that getting back to in-person learning safely is the goal.

"We know that children need to return to in-person learning, given the significant negative impacts that have resulted from not attending school in person over this past year," Tina Q. Tan, MD, a pediatric infectious diseases attending doctor at the Ann & Robert H. Lurie Children's Hospital of Chicago, said during the briefing.

"The expectation now is that it will be fully in-person," said Tan, who is also an IDSA fellow and a professor of pediatrics at the Northwestern University Feinberg School of Medicine. But she warned that if the rise in COVID-19 cases continues, "some schools may go back to a hybrid model."

In-person learning is also expected for higher education, Malani said, but a large COVID-19 outbreak on a campus could change that.

Backpack, Laptop, and Vaccine?

The Biden administration's Vax to School College Checklist highlights eight ways that colleges and universities can increase awareness about COVID-19 vaccines. Another aim is to provide access to immunization as students come back to campus.

This initiative builds on the work by almost 900 colleges participating in the COVID-19 College Vaccine Challenge. These institutions agreed to work toward increasing student vaccination rates.

The administration also is releasing resources to help set up pop-up vaccine clinics at K-12 schools and on college campuses.

During an August 5 White House news briefing, one journalist asked about promoting vaccination among students at historically Black colleges and universities.

"I visited Howard University about a month ago, and I was so impressed with how they stood up vaccination clinics in their facilities," said US Secretary of Education Miguel Cardona, who joined White House press secretary Jen Psaki at the briefing at the time.

"And we had students from Howard University administering vaccine. They're using their name in the community to build confidence in the community — the Black community — so that they felt comfortable coming in."

Physical Education

Including COVID-19 vaccination counseling in sports physicals is another initiative announced in the Biden administration fact sheet on returning to school safely. The American Academy of Pediatrics (AAP), the American Medical Society for Sports Medicine, the American Academy of Family Physicians, and nine other organizations issued a consensus statement August 5.

These groups are urging all healthcare providers to ask about COVID-19 vaccination status and to give the vaccine where available during sports physicals. The AAP has also updated their sports physical forms to include language on COVID-19 vaccination.

The strategy could make a major difference, with about 60% to 70% of children and adolescents taking part in organized sports across the country, the AAP notes.

Malani said COVID-19's impact on college sports was disappointing in 2020 but struck a more positive tone for this school year, given the higher vaccination rates.

"I am one of many people who is thankful the fall will look more typical in terms of sporting events," she said.

Taking Action

Encouraging more young people to get vaccinated and offering accessible ways to get the vaccine in local communities is part of the Back to School Week of Action sponsored by the US Department of Health & Human Services (HHS) and partner organizations.

HHS plans to engage school districts, students, teachers, national organizations, local government leaders, businesses, social media influencers, celebrities, and thousands of volunteers nationwide in the effort, which runs August 7-15. Plans include more than 200 vaccination events that focus on K-12 and college students.

"Right now, vaccine requirements are a bit patchy," Malani said. She said most universities and colleges have policies that either strongly encourage or require vaccination.

Very little remains certain as the pandemic continues to change, "but I can say that campuses that are highly vaccinated will be in the best position to avoid major disruptions this fall," she said.

Welcoming international students — which number 7000, about 15% of the student body the University of Michigan — presents another challenge.

"It's complicated because vaccination is not available everywhere in the world. We're advising students to get a vaccine wherever they are if they can get it," Malani said.

Nationwide Mandate Unlikely

"It would be difficult to have a federal mandate, probably not impossible, but politically difficult," Malani said in response to a reporter question about having federal vaccine requirements.

"I would support employers and schools taking a close look at what they can do to push the envelope on this," she continued. "We need to do something besides saying, 'Go get vaccinated.'"

Malani herself is the parent of college-age students.

"When I think about sending them to campus, there are a number of risks on my mind about their safety, their well-being, and their academics," she said. "The return to face-to-face learning is not zero risk, returning to campus is not zero risk."

But, she noted, "We can do all we can to keep that risk low."

Damian McNamara is a staff journalist based in Miami. He covers a wide range of medical specialties, including infectious diseases, gastroenterology, and critical care. Follow Damian on Twitter: @MedReporter.

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