COVID-19 Isolation and Quarantine Experience for Residential Students at a Large Four-Year Public University

Abstract

Rapid identification and management of students with COVID-19 symptoms, exposure, or disease are critical to halting disease spread and protecting public health. We describe the interdisciplinary isolation and quarantine program of a large, public university, the University of Virginia, Charlottesville. The program provided students with wraparound services, including medical, mental health, academic, and other support services during their isolation or quarantine stay. The program successfully accommodated 844 cases during the fall 2020 semester, thereby decreasing exposure to the rest of the university and the local community. (Am J Public Health. 2021;111(10):1772–1775. https://doi.org/10.2105/AJPH.2021.306424)

For highly infectious reportable diseases, such as COVID-19, rapid identification and management of infected students and their close contacts are critical to halting disease spread and protecting public health. As institutions of higher education prepared to operate during the COVID-19 pandemic, previous isolation and quarantine plans for small outbreaks, such as mumps, required deployment on a much grander scale to effectively mitigate COVID-19.^1–3

INTERVENTION

A broad, interdisciplinary university isolation and quarantine team was created to serve students requiring isolation or quarantine because of COVID-19 symptoms, exposure, or disease. The team’s steering committee worked collaboratively to develop a comprehensive program that provided students with wraparound services during their isolation and quarantine stay, including medical, pharmacy, mental health, food, and social support.

PLACE AND TIME

The program was implemented during the fall (September–December) 2020 academic semester at the University of Virginia in Charlottesville.

PERSON

All students living and learning on campus who were exposed to or had COVID-19 disease or symptoms were served by this program. The isolation and quarantine team consisted of representatives from across the university, including student affairs, student health and wellness (SHW), dining, facilities management, student housing, real estate and leasing services, major events, development, and information technology services. Beyond a steering committee of 15, the number of staff who carried out isolation and quarantine operations varied across the semester. On average, direct one to one advice and medical support for students in isolation and quarantine was provided by four full-time equivalent nurses and two full-time equivalent student affairs professionals (drawn from a rotating pool of approximately 50) who were trained and supervised by a SHW physician and student affairs dean, respectively.

PURPOSE

In a university setting, where students live in congregate settings and interact with many peers, prompt isolation and quarantine of affected students is essential to reduce the risk of transmission among students, faculty, staff, and community members.^4,5

IMPLEMENTATION

The isolation and quarantine team identified housing spaces among university-owned properties (i.e., dormitories, apartments) and private hotels in the local community. This inventory of nearly 1500 beds was prepared, maintained, and continuously refined through collaborations between the isolation and quarantine team and local vendors. Three dormitories were specifically identified for isolation housing, which allowed students to walk from their usual on-campus residence. Quarantine housing was available at both on- and off-campus locations; transportation was provided via a contracted vendor. Quarantine spaces consisted of a single room and single bathroom, and isolation spaces were suite-style, with five or six double-occupancy rooms and a shared bathroom.

To organize and centralize the complex sets of data necessary to execute this system, information technology services staff created a build-out to the student affairs’ incident tracking database (SafeGrounds) to capture all housing and student assignment details (e.g., isolation and quarantine dates, locations, meal needs, and any special circumstances). In addition, information technology services created a bridge between SafeGrounds and the SHW electronic medical records system to allow one-way secure transmission of templated data pertinent to isolation and quarantine.

SHW staff or the local health department identified students who met Centers for Disease Control and Prevention (CDC) criteria for isolation and quarantine. SHW staff then documented COVID-19 status (i.e., isolation, quarantine, or patient under investigation), with start and end dates in a template in the electronic medical records (Medicat), which electronically transmitted to SafeGrounds. COVID-19 status updates (e.g., a change from patient under investigation to isolation) were communicated via the same mechanism.

Upon notification, student affairs staff assigned students to the appropriate living space (Figure 1). Once students were assigned a living space, they remained in that space regardless of a status change. Students in isolation and quarantine housing received personalized wraparound support from university staff under the leadership of the isolation and quarantine team (Figure A [available as a supplement to the online version of this article at http://www.ajph.org]).

FIGURE 1—

Simplified Process Flow Map Used by the Isolation and Quarantine Team to Manage University of Virginia, Charlottesville Students With COVID-19 Symptoms, Exposure, or Disease: Fall 2020 Semester

Note. PUI = patient under investigation.

Each student was assigned a medical and general support care team. The general support team ensured that all individual needs were met, including dietary, transportation, medication delivery, mental health, and virtual academic and social engagement. The medical team assessed isolation and quarantine students at regular intervals via telephone call or electronic medical record secure message and escalated to further medical evaluation as needed.

All students were contacted at entry, midpoint, and before discharge, and symptomatic students were contacted more frequently. The medical team ensured that testing occurred at the recommended time and location. Testing was performed via polymerase chain reaction and analyzed in the university academic medical center laboratory. Testing for asymptomatic students was performed at a designated university site, free of charge, with samples collected via staff-proctored, self-collected midturbinate nasal swab. Testing for symptomatic students was collected by trained clinical staff at SHW via nasopharyngeal swab and billed to patient insurance. Once students met the CDC criteria for discharge,⁶ they returned to their regular housing (Figure B [available as a supplement to the online version of this article at http://www.ajph.org]).

EVALUATION

During the fall 2020 semester, approximately 4700 students (92.6% undergraduate and 7.4% graduate; 55.5% White; and 54.1% female) were living in on-campus housing. The isolation and quarantine housing accommodated 844 students, including those classified as isolation (n = 119), patient under investigation (n = 298), and quarantine (n = 427). These cases occurred in 799 unique students living on campus; 761 of them entered isolation and quarantine housing one time and 38 students entered two to three times throughout the semester.

Students with isolation and quarantine stays were predominantly undergraduates (99.5%), White (66.5%), and female (53.6%). Undergraduate and White students living on campus were more likely to have isolation and quarantine stays (99.5% vs 92.6%; P < .01 and 66.5% vs 55.5%; P < .01, respectively) compared with the total student population living on campus.

At the peak of the surge, the team accommodated 62 students in isolation and quarantine housing in one day (Figure 2). Approximately 26% of the 298 patient under investigation students and 15% of the 427 quarantine students subsequently tested positive during their time in isolation and quarantine. We excluded students who went home to isolate or quarantine from the data, as follow-up testing or result data were not consistently available. No student required hospitalization for worsening medical or mental health status.

FIGURE 2—

Daily Count of University of Virginia, Charlottesville Students Entering On-Campus Isolation and for COVID-19 Quarantine Housing During the Fall 2020 Semester

ADVERSE EFFECTS

Any person in isolation or quarantine, whether at an institution of higher education or in the community, can experience feelings of social isolation, loss of productivity, and possible financial loss.⁷ Wraparound support services provided to students in university isolation and quarantine housing allowed early identification and mitigation of these potential negative impacts by connecting students with the appropriate resource.

Students did not receive any charge for housing or services received during their isolation and quarantine stay, and most coursework could be completed remotely. During the early weeks of the program, many students expressed a desire to go outside for exercise and fresh air while in isolation and quarantine housing. With guidance from public health officials, the isolation and quarantine team developed a plan to safely accommodate outdoor excursions for students in quarantine.

SUSTAINABILITY

The isolation and quarantine program will continue throughout the pandemic as an essential component of the university COVID-19 mitigation strategy. Although the scale of the isolation and quarantine program will eventually contract as the pandemic subsides, this model of pan-university collaboration to meet the needs of students in isolation or quarantine remains relevant for the future. It provides a framework that can be rapidly activated to serve students with other highly infectious diseases, such as mumps or varicella.

PUBLIC HEALTH SIGNIFICANCE

Isolation and quarantine for affected individuals is an essential COVID-19 control measure. By safely housing and caring for nearly a fifth of university students who lived on campus during the fall semester, exposures were decreased to the rest of the university and the local community. In addition, students were able to remain local during their isolation and quarantine period, thus decreasing transmissions to their families and home communities. Students staying in isolation and quarantine spaces were able to readily access medical, mental health, academic, and other support services, which may not have been available in other areas, thus decreasing public health burden.