Control of COVID-19 transmission on an urban university campus during a second wave of the pandemic

ImportanceThe coronavirus disease 2019 (COVID-19) pandemic has severely disrupted United States educational institutions. Given potential adverse financial psychosocial effects of campus closures, many institutions developed strategies to reopen campuses in the fall despite the ongoing threat of COVID-19. Many however opted to have limited campus re-opening in order to minimize potential risk of spread of SARS-CoV-2. ObjectiveTo analyze how Boston University (BU) fully reopened its campus in the fall of 2020 and controlled COVID-19 transmission despite worsening transmission in the city of Boston. DesignMulti-faceted intervention case study. SettingLarge urban university campus. InterventionsThe BU response included a high-throughput SARS-CoV-2 PCR testing facility with capacity to delivery results in less than 24 hours; routine asymptomatic screening for COVID-19; daily health attestations; compliance monitoring and feedback; robust contact tracing, quarantine and isolation in on campus facilities; face mask use; enhanced hand hygiene; social distancing recommendations; de-densification of classrooms and public places; and enhancement of all building air systems. Main Outcomes and MeasuresBetween August and December 2020, BU conducted >500,000 COVID-19 tests and identified 719 individuals with COVID-19: 496 (69.0%) students, 11 (1.5%) faculty, and 212 (29.5%) staff. Overall, about 1.8% of the BU community tested positive. Of 837 close contacts traced, 86 (10.3%) tested positive for COVID-19. BU contact tracers identified a source of transmission for 51.5% of cases with 55.7% identifying a source outside of BU. Among infected faculty and staff with a known source of infection, the majority reported a transmission source outside of BU (100% for faculty and 79.8% for staff). A BU source was identified by 59.2% of undergraduate students and 39.8% of graduate students; notably no transmission was traced to a classroom setting. Conclusions and RelevanceBU was successful in containing COVID-19 transmission on campus while minimizing off campus acquisition of COVID-19 from the greater Boston area. A coordinated strategy of testing, contact tracing, isolation and quarantine, with robust management and oversight, can control COVID-19 transmission, even in an urban university setting. Key PointsO_ST_ABSQuestionC_ST_ABSCan a multi-faceted approach lead to control of COVID-19 transmission and spread on an urban campus? FindingsDespite a second wave of SARS-CoV-2 in the greater Boston area, Boston University was able to minimize outbreaks by means of active surveillance of campus populations, isolation of infected individuals, early, effective contact tracing and quarantine, regular communication, excellent data systems, and strong leadership. Most transmission appeared to occur off campus and there was no evidence of classroom transmission. MeaningUsing the main axioms of infection control including frequent testing, vigorous contact tracing, and rapid isolation and quarantine, and a strong leadership structure to ensure nimble decision-making and rapid adaption to emerging data, controlling the transmission and spread of SARS-CoV-2 on an urban campus was feasible despite worsening local transmission during the course of the semester.