One of the more frustrating aspects of the ongoing “debate” about the role of universities and students in the second wave of coronavirus is the lack of clear evidence pointing one way or another. Cause? Effect? Yes, but does it correlate?
Understanding whether, for example universities might have amplified or seeded infection in September and October should be an important determinant in the plans that universities and both local and national government are putting in place for January. But we don’t appear to know for sure.
In the Lancet a group of 79 researchers, public health professionals, and healthcare workers are calling for a sustainable public health strategy. They say that universities should move to online teaching where possible, with students supported to return home safely with government support and guidance – because universities have been a “major hub” of community transmission. But that assertion is never evidenced.
Meanwhile that issue about where positive Pillar 2 tests were being allocated to if a student studying away from hadn’t yet switched GP has been fixed, with some interesting results. The TL;DR is that the initial “university area” peaks were higher than originally projected – but not loads higher. And the issue hasn’t had an impact in recent weeks – suggesting the hypothesis that it was a peak based on outbreak reporting and consequent mass testing still holds. DK has had a detailed look elsewhere on the site.
Illusion never changed into something real
I’ve long been really torn on the “in person teaching” imbroglio, but one aspect of it that I’ve been reflecting on is what I’ve been thinking of as the overall balance of restrictions. What I mean by that is that at any point (and indeed in any tier) national and local governments pick a basket of measures (restrictions) to control the virus. You don’t totally close society, you can’t have a free-for-all either, and the things you choose inevitably throw up contradictions.
That mid-point that you pick – between absolute freedom and absolute lockdown – doesn’t have to be about “herd immunity”. Mental health and individual freedom does matter, as does economic activity. None of them should be regarded as absolutes, and we can have a debate about how important they all are, but they all matter.
The thing for me is that even if you choose to not restrict something (ie students moving to university towns and cities for in-person teaching) and even if you do so for good reasons (giving the benefit of the doubt to governments and universities about the supposed educational, social and mental health benefits of doing so) you’re still using up some of what we might see as an infection “budget”. And when you do it, it means you can’t free up some other things – like non-essential retail, or outdoor education centres, or coach trips, or bowling alleys… and so on.
The point is that as a result of the choice we’ve made to “keep universities open” (and yes, I know, they never closed, I mean for blended learning and student migration) other people are suffering – both economically and with their mental health. Freedom to operate higher education the way we are means restrictions imposed elsewhere.
And I worry that some of those harms that others are taking weren’t worth it for the supposed freedoms we’ve afforded to students this term. I think on balance I might have picked a different “thing” to exempt. And yes, I know my argument turns in on itself given I committed to taking economic impacts into account. I’m just saying.
Above all what I’m saying is that any area of society, aspect of our lives, service or industry could have the “sorry but we have to control the virus so it’s off” or the “we’re letting this happen because of its importance to the economy, mental health, personal freedoms” argument attached to it. Either argument works insofar as either argument works, if you see what I mean. I just think history may look unkindly on this set of choices, which inescapably look driven by a particular kind of economics – particularly when we seem barely to have spent a penny (in England) on supporting students, but have ensured that their fees and wider economic activity rolls in.
Our conversation has run dry
The thing about the DfE taskforce minutes that emerged recently is the overall sense that this pandemic has been pretty cheap for DfE. You just keep piling the expectations onto the tuition fee income to alleviate everything, wave about the £256m magic money twig and hope for the best. And because the subsidies in the student loan system only kick in when you’re approaching retirement while remaining economically unsuccessful, (home undergraduate) students aren’t especially grateful – in fact they feel exploited. Postgrads, upfront payers and international students, even more so.
But as well as the “decision” to “keep universities open”, we should look carefully at the mitigations and conditions that scientific advice placed on that freedom in a given basket of measures at a given time. SAGE, for example, didn’t initially advise a shift to online teaching for this term, and contrary to reports never actually advised that residential students should not be allowed home for Christmas. In each case the advice was conditional – universities can operate if the mitigations are put in place.
Anyone that’s ever carried out a risk assessment will know that it’s the risk mitigation steps that matter. And there will be plenty of people that have been in the position of eventually having to cancel, postpone or refuse something because the risk mitigation steps weren’t affordable, deliverable or practicable. There are a number of moments in the taskforce minutes, for example, where sector types remind the zoom room that testing needs to be ramped up – but you don’t get the sense that anyone ever asked the question “if the government doesn’t deliver, should we be going ahead”.
Crucially, over the summer SAGE said that:
Higher education and national plans should flexibly and proactively consider how to mitigate associated risks, including through testing, quarantine/isolation, staggering term end dates or other measures.
So with the new year on my mind I’ve looked back at some of that SAGE advice on universities to identify some of these mitigations it said needed to be in place for universities to “reopen” (again, government framing not mind) to see how well we did – and ask what might still need to be done in January.
So I guess the fortune teller’s right
First of all, there was clear advice that any restrictions on social activity implemented because of outbreaks should be thought about, mitigated for and planned for:
Local response plans should… take account of potential negative impacts on mental health and wellbeing and impacts on social activities as well as the delivery of education. This should include when and how changes to course delivery modes will be implemented, and how any restrictions on social activities will be implemented.
It would probably be fair to say that delivery here was variable – and the results of our polling in October suggest that even if mitigations were in place, they didn’t have the desired effect. Universities and both local national governments need to redouble efforts here in the new year – if we are bringing students back, we can’t have them this lonely all term again.
Mental health obviously featured prominently:
Higher education providers should be prepared to provide greater, evidence-based support for wellbeing and mental health.
It’s hard to pinpoint what’s been going on on the ground – for example, some have faced a spike in demand for appointment based services and some have seen a collapse. What’s fairly clear is that providers “further behind” on the sort of “whole institution” approaches embodied in the Student Minds University Mental Health Charter look like they have struggled the most to anticipate needs and flex delivery as appropriate.
What is clear is that the kind of funding put in in Wales in year on this agenda will help – whereas doing what we’ve done in England (funding a website with a subcontract for a type of nightline) probably won’t really work.
Next, information and triggers:
There should be clear plans for communication and encouraging adherence if an outbreak occurs. If cases, or rumours of cases, occur on campus or in residences, it may produce a divisive and anxious atmosphere for both staff and students, and the wider community. This would be intensified by having no clear signal of how many cases would represent a dangerous situation for the community.
It took a long time for universities to work up clarity over case numbers, and DfE isn’t giving out the data on cases that OfS is collecting for it. Nor are we seeing student cases in the context of testing. An important work in progress and plenty of room for improvement.
Have students been getting a test?
A national plan for [higher education] testing and isolation must be developed that can be adapted and implemented locally. Current evidence from the general community suggests that uptake of testing among people who have cough, fever or anosmia is low. Estimates range from 12% to 35%. Staff and students must be encouraged and supported to obtain a test.
This will require them to … be assured that any perceived negative consequences to requesting a test will be dealt with, without hassle. If staff or students feel that the result of a test may have a negative impact on their studies, pay, workload, peers or colleagues, this will be a disincentive to request a test or to reveal their symptoms. [They will also need to] be able to effectively isolate”
We don’t really know whether students have been getting tests at a rate any higher or lower than the general population. And there are clear dangers in either case. If it’s the former students look like a bigger problem than they really are, which may explain late September. If it’s the latter, it’s the reverse – which may in turn explain late October.
What is almost certain is that students will have been perceiving considerably negative impacts arising from self-isolation if a test is positive – if you tell people that face to face teaching is important for mental health, the only way you’ll meet people and rarer than usual, you’ll inevitably cause them to be concerned about missing out on it.
And support for students to self-isolate (food, compensation for lost part time work) has been astonishingly patchy – and worse the further we move out of university-run halls. There has been precious little investment here and no real national plan or standard.
What help could mass testing have been?
One-off testing immediately prior to the end of term may support decisions for individual students in terms of isolating when returning home. Testing mid-term is more likely to be useful to inform national-level decisions with information on the potential impact of end of term migration, although it would be an inefficient surveillance approach.
We’ve obviously run with the former to “get students home”. Ironically we’re doing that to solve a problem whose size and shape we don’t know, precisely because we didn’t get to the latter fast enough.
Enhanced testing in response to clusters may be an appropriate strategy when contact tracing is challenging or there is concern over wider transmission. This could for example include testing a whole accommodation block, course year group or department.
The good news is that this does seem to have been implemented in some locations on some campuses. The bad news is that it has by no means been universal – and may be distorting our understanding of the outbreaks we saw in September and October.
And then there’s so called Covid hotels:
If possible, Universities should consider providing dedicated accommodation facilities to enable students who test positive to effectively isolate if they require it. This will enable students to isolate away from others they share accommodation with to minimise the risk of an outbreak, as well as discouraging students returning home when sick which risks importing cases into a new geographical area.”
This has only happened in a tiny handful of universities – fairly surprising given there was a lot of this in May. Generally halls (both university run and private) look too full to pull this off next term – so why aren’t we utilising local hotel capacity?
On student housing, SAGE’s sub committee on behaviours (the Scientific Pandemic Influenza Group on Behaviours) said that overcrowding within homes is a driver of infection, specifically picking out houses of multiple occupation (HMOs), where the risks intensify according to the number of people co-habiting and the age profile (older groups having greater vulnerability, but younger adults potentially having greater exposure).
As well as the transmission issues, SPI-B worried that isolation could result in
Increased exposure to damp and/or poor ventilation and increased risk of cardiovascular disease and respiratory disease… mitigations and isolation may be difficult to enforce mutually within these settings as there are no culturally agreed forms of mutual obligation linked to kinship.
Shared responsibility for maintaining the health of the group may not be present. Distrust and conflict may develop if one member of the household is suspected to have or is confirmed to have Covid-19. And since there is no agreed upon “social script” for these households, it is important to provide clear guidance on Covid-safe practices targeted to shared rented accommodation.”
As far as we’re aware, nothing at all has emerged from MCHLG or DfE on students in HMOs or indeed people in HMOs at all. Not a peep.
You’re a little late
I’ve said it before and I’ll say it again – if you reduce the capacity of campuses by 70 per cent so that people stay apart, but keep your student housing at 100 per cent (and the decision on campuses then means people spend more time in that student housing) it’s not hard to guess what happens next both in terms of mental health and epidemiology.
SAGE thought that the key to the problem in hotel-style halls was segments/bubbles:
Rather than quarantining an entire halls of residence, use of segments may also mean that certain flats can be quarantined instead, minimising wider
disruption. This is particularly important when considering numbers in quarantine – if there were no controls or segmentation in place, relatively few infections could result in the majority of a university needing to be isolated.
It’s pretty clear that halls were the big problem in September and October, and the collapse of “household!” plans within hotel-style halls a major part of that. But has anyone seen any revised guidance on how that could work in January?
Ventilation and face coverings were also in there – the former continues to develop in government guidance and the latter eventually became a part of DfE advice. Access was also a key issue:
Alongside any adjustments to enable in-person provision, it is important that access to online learning is also considered, both in terms of accessibility of materials for different students and in their ability to engage effectively including whether they have appropriate equipment, working spaces and internet connections.
Given it was always clear that even with some in-person teaching, there would be online teaching and so we’ve needed to fix digital divide issues for students and academics, the fact that we didn’t universally fix that divide by September is pretty shocking. Three cheers for the efforts from many universities here, but we’ve not fixed it for everyone. Surely as a society we should hurl some money at fixing it for January?
Once “teaching” was Covid-secure, didn’t we need to worry about informal contacts?
Contacts off-campus are also relevant, and care needs to be taken not to inadvertently increase risk by driving staff and students into riskier environments. For example, closure of canteens or student bars (rather than improving their COVID-security) will be counterproductive if this simply makes students congregate in cafes or bars that are less COVID-secure.
Sadly too often we seem to have done the opposite here. See for example the DfE guidance on catering during the England November lockdown, or the wholly counterproductive advice over student societies.
I’m all out of faith, this is how I feel
So lots of lessons to learn, and still much to do to put in place the mitigations that SAGE says were necessary. As has been the case throughout the pandemic, they’d all be easier to implement with some national coordination, financial support and cushions/safety nets that free up students and universities to be creative and exercise choice.
Given the choice, I’d still rather that we weren’t wasting campus capacity on teaching. I’m still not at all sure that what we’re doing is more important than my local library, nail bar or bowling alley being open (or indeed escaping bankruptcy). And I wish we could give students the chance to complete the year without forcing those in residential mode to move again in the new year.
But if, for whatever reason, we must insist on coming back in the new year, surely the least governments can do is work with the sector to coordinate and fund universities to follow the advice we were given to make it less risky?