What Hospitals Can Learn from Return-to-School Failures

Conversations around return to school have been ongoing for weeks and even months now. The risks and safety of returning to school have been weighing heavily on everyone around the country and as we see schools attempt to open and then have to close, the lessons are a stark reminder of what we’re truly facing.

Last week, the University of North Carolina (UNC) Chapel Hill was forced to pivot to online learning after 177 students tested positive and another 349 were forced to quarantine following exposure, after they began their first week of in-person classes. “Among 100 major public universities—two per state—an analysis from Davidson College found that 23 have plans to teach primarily in person or offer a “hybrid” of face-to-face and online. Those with in-person plans, the analysis found, include the universities of Alabama, Georgia, Iowa and Kentucky.”

Saskia v. Popescu, PhD, MPH, MA, CIC

Many universities that have pushed for in-person semesters have implemented measures that they feel are enough—screening testing prior to classes, socially distanced classrooms, and mask mandates. Even universities like Notre Dame are finding clusters as they return to the first week of school. With 12,000 students returning to mostly in-person courses, it’s not surprising that 58 cases were already confirmed.

The truth though, is that we know these environments are particularly challenging. Congregate living environments, like skilled nursing facilities, are prime environments for the spread of respiratory infections. COVID-19 has shown a propensity for these settings and considering that colleges are not particularly trained or nuanced in infection prevention efforts, it’s not surprising that clusters are occurring.

Especially if we consider that thousands of students from a variety of locations are returning to an environment that has been widely panned as not ready for reopening. Fundamentally applying the level of infection prevention efforts for universities isn’t something that can be simply switched on—it requires considerable resources, training, education, and process development. A lesson we all too often learn when it comes to emergent situations. From exposure reviews and contact tracing to cleaning and ventilation, these are things that universities have not really had to consider at this level.

While healthcare facilities are not universities, there is a lesson to be learned about the rush to “return to normalcy.” As community transmission decreases in some areas, there is an increasing desire allow visitors again, allow for larger meetings, etc. The challenge though is ultimately what we want versus what needs to be done for staff and patient safety. Knowing the needs of patients, how can we safely allow visitors again? When will universal masking not be required?

A piece to this is that there is no hard rule. These are conversations that require considerable collaboration and plans to scale up and scale down. What are the thresholds for utilizing certain interventions? For example, the CDC recommends eye protection in areas that are experiencing moderate to substantial community transmission, but it becomes optional for those healthcare facilities in areas with minimal to no community transmission.

Learning from the lessons of those universities having to pivot to online courses, we should be sure to not make hasty decisions based off what we want to do versus what we need to do. Plans should be sustainable and have clear indicators for when we can relax and then also restrict.