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Multiple COVID-19 Clusters on a University Campus — North Carolina, August 2020

Our take —

This study describes a COVID-19 outbreak at a large North Carolina university in August 2020, following broad re-opening of its campus. Within two weeks of re-opening, there were 670 lab-confirmed COVID-19 cases detected from specimens collected from students, faculty, and staff, including a large cluster of 106 cases from a university-affiliated apartment complex. However, this number is likely an underestimate, as there was no universal testing and some cases may have been reported to facilities outside the university. The main drivers of the outbreak were student gatherings and close living settings, highlighting the need for comprehensive measures, including increased testing and reduced density in community housing and student gatherings. Universities with on-site learning may consider counseling their communities on harm reduction options to support students’ needs to socialize, while also helping to foster options to reduce risks as early data suggest that socializing will occur.

Study design

Prospective Cohort

Study population and setting

This study described a COVID-19 outbreak at a large US university following broad re-opening of its campus. On August 3, 2020, a North Carolina university opened its campus to students for the first time since transitioning to remote learning in March 2020. Students returned to campus from August 3-9, and in-person classes commenced on August 10. In accordance with CDC guidelines, prevention strategies such as reducing density in classrooms and dining halls were taken. However, there were no re-opening testing or quarantine requirements before or after on-campus arrival. Students were required to sign an acknowledgment of guidelines and community standards regarding daily symptom checks, mask use in classrooms and all indoor common spaces, physical distancing, and no group gatherings of >10 persons indoors or >25 persons outdoors. Residence halls opened at 60-85% of usual capacity, with two dorms reserved for isolation and quarantine; students at increased risk for severe illness from COVID-19 could request a single room. A total of 19,690 undergraduate students registered for the Fall 2020 semester, of which 29% (5,800) lived on-campus as of August 10.

Summary of Main Findings

From August 3 to 25, 2020, there were 670 lab-confirmed COVID-19 cases detected from specimens collected among students, faculty and staff. Median age of cases was 19 years (range: 17-50 years); 293 (43%) were men, and gender was missing for 47(7%) of cases. No COVID-19 hospitalizations, deaths, or multisystem inflammatory syndrome cases were recorded by August 25. By August 19, when 334 cases had been reported, the university transitioned to online classes, and offered testing at the student health clinic and university hospital testing center for those living in residence halls with case clusters. A cluster was defined as ≥5 epidemiologically linked cases within 14 days of the earliest illness onset. Students living on-campus were required to go home and instructed to self-quarantine for 14 days. Those who applied for and received a hardship waiver were allowed to remain on-campus. In total, 18 clusters were identified from August 3 to 25, representing 30% of all cases (5 in residence halls, 5 among members of a fraternity or sorority, 1 in an off-campus apartment complex, and 4 among athletic teams). Clusters ranged in size from 5 to 106 patients, the largest being in the off-campus housing. The main drivers of the outbreak were student gatherings and close living settings.

Study Strengths

To be considered a COVID-19 case, individuals needed laboratory confirmation. Therefore, there is a high degree of certainty that the cases reported in this study were truly cases (versus relying on individuals to self-report COVID-like symptoms).

Limitations

The number of true cases is likely underestimated due to lack of universal testing at the university, and some cases being reported to health facilities outside of the university (e.g., in students’ home states). Information on cases among staff and faculty were limited, and likely underestimated. In addition, data were not available on how well students adhered to the COVID-19 prevention community standards and university guidelines which they were required to sign. Clinical follow-up was limited, thus potential longer-term complications remain unknown.

Value added

This study described the rapid rise in COVID-19 cases at a North Carolina university within 2 weeks of re-opening to students in August 2020. Prior to this study, little had been reported on outbreaks of COVID-19 at US universities.

This review was posted on: 23 October 2020