How COVID-19 Spread on a North Carolina Campus in the First Weeks of Fall 2020

Colleges and universities are hard places to stop SARS-CoV-2, the virus that causes COVID-19: students live close together, and socializing and gatherings are hard to limit. Before August 2020 there was little data on outbreaks there. This report describes what happened when a North Carolina university — called university A — reopened its campus that month.

The reopening

University A moved mostly to remote learning in March 2020 and broadly reopened on August 3. Students moved into residence halls August 3–9, and in-person classes started August 10. In line with CDC guidance at the time, it:

• spread move-in appointments over a week;
• thinned out classrooms for distancing, cut dining hall capacity and added takeout;
• had students sign an acknowledgment of community standards and guidelines recommending daily symptom checks, masks in all indoor common spaces and classrooms, 6 feet of distance indoors and out, and gatherings of no more than 10 people indoors and 25 outdoors — about 95% signed, though there were no data on whether they complied;
• opened residence halls at 60%–85% capacity, mostly in double rooms, with two dorms kept for isolation and quarantine, and let students at higher risk of severe illness request single rooms.

It did not test students on arrival or quarantine them before or after they came. Fall undergraduate enrollment was 19,690, and about 5,800 (29%) lived on campus as of August 10.

What happened

From August 3 to 25, 670 laboratory-confirmed cases were identified among students, faculty and staff.

• The median patient age was 19 (range 17–50), and 96% (643) were under 22, used as a stand-in for undergraduates. Of those, 230 (36%) lived on campus, at least 51 (8%) belonged to a fraternity or sorority, and 51 (8%) were student athletes.
• 18 clusters — five or more linked cases within 14 days — were found: eight in residence halls, five among fraternity and sorority members, four among athletic teams and one in off-campus apartments. They held 201 (30%) of the cases and ranged from five to 106 people; the largest was tied to a university-affiliated apartment complex.
• As of August 25 no one had been hospitalized or died, and there were no cases of multisystem inflammatory syndrome; one student was kept in an emergency department for extended observation.

Confirmed COVID-19 cases at university A by earliest date of illness identification, August 2020. CDC.

The response

On August 19, with 334 cases (50%) reported to the local health department, all classes moved online and the university began thinning out campus housing. Testing was recommended for everyone in residence halls with clusters and offered to all students. Students in campus housing had to go home unless granted a hardship waiver, and those leaving were told to self-quarantine for 14 days. Off-campus testing sites served the community and targeted student apartment complexes with multiple cases.

Lessons

Student gatherings and shared living, on and off campus, likely drove the rapid spread. The authors call for stronger, campus-specific measures:

• enforcing mask requirements;
• reducing the density of campus housing;
• testing more for SARS-CoV-2;
• discouraging student gatherings.

Limits

The case count is likely an undercount — some cases went to students' home health departments, some students didn't identify themselves as students or use the campus clinic, and not everyone was tested. Fraternity and sorority involvement is likely underestimated, since some students may not have disclosed membership and non-members may have attended unofficial rush events and parties. Little was known about off-campus housing, gatherings, mask use, longer-term complications, or the part faculty and staff played.

Sources

Based on Wilson E, Donovan CV, Campbell M, et al., "Multiple COVID-19 Clusters on a University Campus — North Carolina, August 2020," MMWR Vol. 69, No. 39, CDC; a work of the United States government in the public domain.