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Medisina at Politika by Dr. Rey Pagtakhan  

College life in the age of COVID-19

by Dr. Rey D. Pagtakhan

Colleges and universities have re-opened for the 2020 fall semester in the shadow of the COVID-19 pandemic. The new and highly contagious viral respiratory disease has created uncertainties and risks to learning. Controlling the spread of COVID-19 for the safety of students, staff and the community while providing a rich college life are the twin challenges.

The United Nations August 2020 policy brief, Education during COVID-19 and beyond, stated, “The COVID-19 pandemic has created the largest disruption of education systems in history, affecting nearly 1.6 billion learners in… all continents… When education systems collapse, peace, prosperous and productive societies cannot be sustained.”

Planning for the resumption of classes has included heavy emphasis on health safety. The new disease has caused enormous illness and loss of human lives – and livelihoods – and inflicted serious disruptions to the national economy, including the financing of education.

Magnitude of the toll on human life

As of September 12, 2020, Johns Hopkins University has reported 32,585,798 cases of COVID-19 worldwide including with 919,081 deaths. Canada has 138,164 cases and 9,220 deaths. The Philippines: 257,863 cases and 3,325 deaths. The United States has 6,482,523 cases and 193,676 deaths.

Reflected in these numbers are the more than 7.8 million patients and 83 thousand deaths added anew worldwide in the half-month since my prior commentary. Of whom over 10 thousand were diagnosed in Canada, 48 thousand in the Philippines, and more half a million (568,610) in the USA, with the average number of daily deaths calculated at seven, 65 and 792, respectively.

Risk of infection spread in college environment

College settings have become new hotspots for COVID-19. Could returning students become key messengers of disease spread as they gather for social events?

“Five students at the University of Western Ontario have tested positive for COVID-19 less than a week after the start of classes,” reported the Globe and Mail as this commentary went to the press, “prompting the local health authority in Ontario to declare an outbreak.” This is the first major outbreak linked to a Canadian university since the fall semester opened. Large gatherings of Queen’s University students partying in disregard of physical distancing rules had been observed. Students in Atlantic Canada have also been charged for failing to self-isolate over the Labour Day weekend.

Dozens of universities in the United States have experienced similar outbreaks linked to parties or to students living together in residences. While the level of community spread has been much lower in Canada than in the U.S., bringing students together has raised alarm from public health officials.

College and university campuses are not in a bubble. They are a community within the surrounding greater community of residents and businesses. Inside the classrooms and outside on campus and nearby off-campus settings, the venues provide ideal locations for the virus to spread from one infected individual to several other contacts with speed and unknowingly from asymptomatic students. The collective daylong activities provide the intensity of in-person interactions within compacted periods of time.

The virus has several travel routes and entry points: embedded in large and small droplets in saliva, mucus and phlegm from an infected person during coughing, sneezing, talking, and singing that then enter via the nose and mouth (most frequently) and the eyes of a contact by inhalation, or transferred through handshakes, hugging, kissing, or by touching of contaminated surfaces and then one’s face. Hence the need for face masks, physical distancing, hand hygiene, cough etiquette, alternative greetings, not touching one’s face with unwashed hands, and disinfection of frequented surfaces.

The thirst for independence and socialization among young adults combined with a sense of invincibility and sensitivity to peer influence are worthy of consideration. Students spend more time indoors at college and gather with more people. While being outdoors is safer, it does not equate to protection if physical distancing is not or cannot be exercised and wearing a facemask is deemed a social burden during mass gatherings.

The teaching and support staff includes older adults. The over-60 age group is particularly vulnerable to the infection, especially if there is an underlying health handicap.

Not to be overlooked are the families of students and staff, to whom and from whom visits and contacts are expected.

Such is the college environment – a potential petri dish for the rapid spread of COVID-19.

The Canadian situation

Canada’s colleges and universities have transformed campuses to comply with the recommendations of public health officials. They have confronted the following challenges: to move all or most programs via virtual learning platforms; make technology investments for course delivery online; budget for lost revenues from non-academic activities, events, and residences and from loss of international students unable to attend in person.

Across the country, 54 per cent of colleges and universities have chosen to deliver programs online, 40 per cent have adopted a hybrid model, and about 4 per cent are offering courses in-person in communities where the prevalence of infection has been low and where class sizes are small with facilities able to accommodate social distancing.

Challenges and solutions

Getting 100 per cent of students to comply with all the safety guidelines is one of the challenges of COVID-19 that cannot be fully solved. Nonetheless, a CNN panel of contributors has polled specialists in infectious disease, teaching, counselling, and business for their insights on some of the challenges and feasible solutions. Let me distil from them some pointers:

  • The greatest challenge is a combination of testing and controlling the spread of COVID-19 in an environment conducive to transmission of the virus.
  • Colleges could keep faculty and staff safe by limiting class sizes and enabling physical distancing. Work that can be done remotely should be done so.
  • Acknowledge with candour that bringing people to campus from across the country or the world cannot possibly be done without witnessing large outbreaks.
  • The only model that will be effective is one that tests large numbers of students – those who live on and off campus – regularly and getting results quickly, coupled with effective contact tracing.
  • Constant use of facemasks, physical distancing and regular had washing.
  • There is significant risk to nearby communities. If bars and restaurants are open near a university, students will be there. Business owners should recognize this, protect their employees and encourage good behaviour from everyone. As a resident, adjust one’s schedule and behaviour accordingly.
  • College students should certainly be alerted when safe and effective vaccines become available. In the meantime, they should seek medical attention promptly, if they feel unwell.
  • Acknowledge that international students play an important role in our universities and colleges and governments should make rules for their admission clear, coherent and timely.
  • Acknowledge that telling students to abstain completely from social interactions or threatening them with suspension does not work. Colleges, families, and health experts can reach this group to help them understand and follow the rules by treating these students like adults and communicating with them the dangers of COVID-19 and how it is spread, and informing them how to can protect themselves.

Why some students break COVID-19 rules

Collegiate rites of passage to adulthood encourage youth to take risks. Restrictions to behaviour could only lead to rebellion. Fraternity and sorority recruitment at the start of the semester involve mass gatherings and parties, notwithstanding the rules against them in the age of COVID-19.

Note, however, that risky behaviours may be a function of their normal physiological and emotional development, not a conscious breach of prescribed public health rules. This much we have learned from developmental psychologists. CNN News has shared the opinions of three experts in the field – assistant professor and developmental psychologist Hannah Schacter at Wayne State University, senior director for Counselling & Psychological Services at Pennsylvania State University Ben Locke, and the director of Alvord, Baker & Associates, Mary Karapetian Alvord, who counsels young adults. All three have made the following observations:

  • many of the exciting firsts college promises – freedom, independence and friendships – lead students to act in ways that can expose them or others to the virus because the brain region during this age period that is most sensitive to social rewards has developed ahead of the part responsible for consequence-driven decision-making;
  • they know the negative consequences of risky behaviour but are unable to regulate and control the impulses that answer to the social reward of the moment;
  • new friendships and peer approval influence outweigh the potential risks of restricted conduct;
  • their eagerness to connect overtakes their fear of the virus;
  • they depend on social connections to build their identities;
  • they may have internalized earlier medical advice given publicly that children and teens are not part of the high risk group;
  • conflicting messages of wearing of masks from public leaders;
  • they have been overwhelmed by anxiety and depression; and
  • they have difficulty processing the full impact of the pandemic.

These three experts recommend the following approach:

  • Colleges and universities need to share with the students the responsibility of keeping those on campus safe; shifting blame onto students could stir up rebellion.
  • Encourage students to appreciate the mutual benefit and the sacrifice and motivate everyone’s buy-in to take care of each other.
  • Handle them with empathy and acknowledge the sacrifices they have already made to help control humanity’s crisis. Summon the best in them.

Dr. Rey Pagtakhan graduated from the University of the Philippines and trained at St. Louis Children’s Hospital of Washington University School of Medicine and at Winnipeg Children’s Hospital of the University of Manitoba (UM) Faculty of Medicine. He earned a Master of Science in Perinatal Physiology, with his thesis Initiation of Respiration, from the UM Faculty of Graduate Studies and Research. A retired lung specialist, professor of pediatrics, and Fellow of the American College of Chest Physicians, he was a former school trustee, MP, and cabinet minister. In June 2003, he presented on “The Global Threat of Infectious Diseases” at the G-8 Science Ministers/Advisors Meeting held in Berlin.

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