Bryn Mawr Must Reevaluate Its Fall Plans

By a group of Bryn Mawr students (see below)

As fall semester approaches, a growing number of colleges and universities (now including three of the Seven Sisters and the University of Pennsylvania) have shifted to a virtual-only experience. Meanwhile, Bryn Mawr published its final COVID-19 guidelines and expectations on August 12. The plan, now reaffirmed, has remained largely unchanged throughout the summer—welcome back as many students, staff, and faculty as are willing, and accept that the SARS-CoV-2 virus is coming to campus, too.

Testing

Bryn Mawr’s reopening plan depends on a containment strategy built around self-reporting of symptoms and contact tracing. A Town Hall Q&A updated on August 20 states that Bryn Mawr is “not relying on testing to control the spread of the virus.”

Universal testing of all students is scheduled to occur only three times: after arrival, and at the ends of September and October. Bryn Mawr will not provide testing for faculty and staff. If faculty and staff are symptomatic, they are suggested to “contact their medical provider for advice on testing, treatment, etc.”

Outside of this, testing will be conducted on a discretionary basis. The only clearly outlined provisions are for tests in response to self-reported student symptoms, and even then, only when deemed necessary by the Health and Wellness Center. 

And according to a recent report from CNBC, some 40% of COVID-19 tests nationwide are now returning “too late to be clinically meaningful.” Harvard University’s professor of global health, Dr. Ashish Jha, asserts that “if tests take more than 48 hours, you [lose] the window for contact tracing… [and] beyond 72 hours, the test is close to useless.”

AFC Urgent Care, which will administer diagnostic tests for students upon arrival, estimates 2–3 days turnaround time under normal operation for their Havertown, PA location, and 3–5 days during high demand. AFC West Chester says that during high demand, results may take “upwards of 7–10 days.”  Bryn Mawr has alluded to adopting point-of-care testing machines with faster turnaround times, but as of August 19, they are still “working to obtain” this capacity. Until they are obtained—if they are obtained—AFC will be Bryn Mawr’s only source of testing. 

Testing is vital to any containment strategy. Several colleges have already adopted twice-a-week tests for every person who has access to any campus facility. This approach is necessary because there is a narrow window after infection during which the virus is most likely to be detected. 

According to infectious disease specialist Dr. Aileen Marty of Florida International University, in the early days after exposure, there may not be “enough virus in the upper respiratory system to be detectable.” MIT’s COVID-19 information website states that a diagnostic test has the highest chance of detecting infection during the period “approximately five to seven days after a probable exposure.” It specifically recommends against relying on a negative result from a diagnostic test taken “a day or two” after air travel, as it is unlikely to detect an infection that occured during travel.

Therefore, Bryn Mawr’s strategy for testing students as they arrive may not be sufficient. As of August 19, the Health and Safety page states that all residential students will be arriving between August 24 to August 30, and that at least two days will elapse between arrival and testing. According to Bryn Mawr’s SGA (Self-Government Association) meeting notes emailed to students on August 22, testing dates are scheduled for August 26, 28, 30, and 31. This may be too soon for the first round of universal testing to identify positive cases that develop from travel exposure. The next round of universal testing will not be conducted until the end of September.

Without fast, comprehensive, and sustained testing, Bryn Mawr will not be able to respond to positive cases promptly. The virus has a lengthy incubation period (up to 14 days from exposure to symptoms onset; 4–5 days being median), and presymptomatic individuals are also contagious. Furthermore, asymptomatic cases would not be identified at all when testing in response to symptoms. Testing demand has made resources scarce nationwide, and demand will only continue to surge with flu season and school reopenings around the corner. If spread were to occur (and administration already expects it will), response measures are unlikely to begin until it is already too late to easily contain outbreaks.

Symptom reporting

Instead of frequent testing, Bryn Mawr is relying on symptom monitoring. However, the ambiguity and ubiquity of many of the listed symptoms for COVID-19—“headache,” “sore throat,” “cough”—is likely to result in mild symptoms being ignored. Individual students and staff may be hesitant to constantly miss class or work. The Health and Wellness Center may be reluctant to order self-isolations at the sheer scale with which such symptoms normally occur. And, at least for staff and commuting students, when a new symptom such as coughing resolves by the next day, normal campus activity may be resumed.

Unfortunately, a significant portion of COVID-19 cases are caused by presymptomatic or asymptomatic transmission. And as Dr. Julia L. Marcus, infectious disease epidemiologist at Harvard Medical School, notes: “Young people especially may be asymptomatic. … Testing only based on symptoms is inadequate to prevent spread.” 

Infected individuals may be contagious 48 to 72 hours prior to developing symptoms, and the two days prior to symptoms emerging may be the most contagious period of all. By design, a strategy built on responding to symptoms will fail to catch cases before they contribute to spread.

Contact tracing

When spread begins to occur, Bryn Mawr will rely on contact tracing to contain it. Yet by the time contact tracing is initiated, a community member must have first noticed symptoms, then been tested, and then obtained a positive test result. The requisite contact history thus must extend at least two weeks (to account for the incubation period), plus test turnaround time. The amount of spread which might occur over this window could render contact tracing futile. Compounding this, almost nobody on campus will be considered a close contact, by definition.

A “close contact” is narrowly defined as being within six feet of someone for more than fifteen minutes. If the various rules are all correctly observed—small social circles, no family or non-Bi-Co romantic partners in residential spaces—few contacts would make the cut. Notably, classrooms and bus rides are excluded entirely (because they are said to meet social distancing requirements). It is unclear if students will even be informed if someone in their class or the same Blue Bus has tested positive.

There are two clear risks with this approach. First, no amount of distancing or masking seems to guarantee safety when occupying continually shared indoor space. In Arizona, three school teachers used the same classroom to conduct online classes for two hours a day. All safety, masking, distancing, and hygiene measures were observed. All three contracted the virus. One died.

Second, students, staff, and faculty are being asked to sign and abide by agreements that carry the penalty of significant sanctions for infractions. Although it is important that rules are followed and enforced, it is equally important to know when they are broken. If social interaction rules are not observed, even accidentally, the fear of possible repercussions or social stigma will only discourage full disclosure. The balancing act between the conflicting needs for complete transparency and for response to rule flouting will be difficult to maintain—and failure could be disastrous. 

The only way these tracing efforts are likely to be effective is if almost no spread occurs at all after the virus makes its way to campus. A combination of luck, masks, and distancing might accomplish this. If it does not, there appears to be little hope for successful mitigation.

Quarantine

According to a Return-to-Campus Agreement for faculty, staff, and graduate students, testing is not required even following the positive test result of a close contact. Instead, they are told that they may simply return to work “if a close contact’s symptoms resolve or if they receive a negative test or are cleared by a medical professional.” According to a letter to students sent on August 12, this agreement has already been signed by all staff.

By August 20, undergraduate students were required to sign an agreement stating that they “will participate in a screening quarantine for 14 days” following their arrival. The current (August 19) edition of the Campus Health and Safety Guide, however, states that the screening period is between move-in (August 24–30) and the start of classes (September 8). The college is already only loosely interpreting its own stated commitments. 

Long-term consequences

It is now well established that people of all age groups can suffer severe, lasting health consequences from COVID-19. Multisystem Inflammatory Syndrome in children, myocarditis (heart inflammation), long-term neurological damage, and myriad additional chronic symptoms have all been reported in patients who are otherwise considered recovered. The full range and extent of health consequences, short- and long-term, are only just beginning to be understood. What is well known is that they also include prolonged, costly hospital stays, acute health consequences, and death.

By reopening campus when a COVID-19 presence is acknowledged to be inevitable, Bryn Mawr is asking, and in some cases requiring, members of its community to bear these risks. By testing primarily in response to symptoms and not offering testing for staff, they are increasing the risks for all. 

Despite this, the administration is insisting that under their protocols there “should be little risk” for staff who have frequent contact with students, and are therefore refusing to offer hazard pay. It is extremely painful to see workers who are essential to campus operation treated in this manner.  

Bryn Mawr must be forthcoming about the health risks and the range of campus spread outcomes that are possible under its reopening plan. It must also be transparent and prompt in reporting the consequences which do occur.

Making sense of Bryn Mawr’s decisions

A number of the medical experts cited on Bryn Mawr’s Health and Safety website are part of institutions that have now moved to a virtual-only fall semester (Johns Hopkins, Jefferson, Penn). In pressing ahead with their reopening plan anyway, Bryn Mawr insists it is different. It cites its experience “managing a residential community” over the spring and summer—a community which was not only smaller than the projected fall attendance, but which also did not travel from all over the country during the pandemic to get there, and which did not feature the in-person classes that it will in the fall. It cites having a “capacity for testing” that nevertheless does not form the basis of their safety plan. And it cites favorable local area transmission statistics and patient care capacity—factors over which it has no control, and which its own reopening may end up overwhelming.

It is difficult to see how this situation has been assessed as low risk. It is difficult to understand why, if Bryn Mawr is confident in its ability to procure testing capacity, it has chosen to eschew testing in its containment strategy and declined to offer testing to staff. And it is difficult to reconcile the decision to take these risks with Bryn Mawr’s stated operating principle of putting everyone’s health and safety first.

These risks are not limited to students and other Bryn Mawr community members, but extend to the surrounding county and state, which will be affected by surges in demand for testing, contact tracing, and health care resources. The burden, as always, will fall disproportionately on those already most vulnerable and marginalized. This is a time for maximum prudence and maximum caution. We owe it not only to ourselves, but to everyone in all our communities.

Call to action

We are at a critical juncture in the national handling of the pandemic, and the decisions that institutions make now have enormous consequences. 

Numerous other institutions have already changed course. Smith College has set a particularly noteworthy example. It had previously embraced the much stronger twice-a-week testing standard, but decided even then that the risks were too high, citing troubling ongoing circumstances, the potential for rapid asymptomatic transmission, and the failed examples of other schools.

We urge Bryn Mawr to immediately, comprehensively, and transparently reevaluate its entire reopening plan under a single guiding principle: public health. All other considerations, wants, and needs must be secondary to averting this crisis.

Students, parents, and all members of the Bi-Co community—please join this call to action. Sign on to support this letter. Demand answers, accountability, and change from this administration. We must do more to avoid risking the health and lives of students, employees, and the surrounding community.

Decisive action now still has the chance to inspire other schools and institutions to follow suit. The lives saved will be nationwide, its impact immeasurable. We have one chance to get this right.

To sign: click here.

To view signatures: click here.

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Signed alphabetically:

Hilana El-Mekkoussi ‘21
Sophie Greer ‘23
Anna Hsu ‘22
Rebecca Li ‘22
Lila Sattler
Vanessa Shehu ‘22