SARS-COV-2 INFECTION IN UK UNIVERSITY STUDENTS: LESSONS FROM SEPTEMBER-DECEMBER 2020 AND MODELLING INSIGHTS FOR FUTURE STUDENT RETURN

The UK Higher Education sector poses unique challenges for COVID-19 control. Multiple universities experienced outbreaks at the start of the 2020/2021 academic year, although the scale of outbreaks varied considerably. Here we present a synthesis of work on SARS-CoV-2 transmission in higher education settingsusing multiple approaches to assess the extent of university outbreaks, how much those outbreaks may have led to spillover in the community, and the expected effects of potential control measures. To base this securely in what we know from the pandemic so far, we have brought together data from multiple sources, including Public Health England, the Office for National Statistics, Higher Education Statistics Agency data and detailed data from individual universities.
First, we use observations from early in the 2020/2021 academic year to tease apart transmission between universities and the wider community, both at the start of term and during outbreaks in universities, and also consider risk factors for infection within universities in terms of accommodation structures. We found that the overall distribution of outbreaks in universities in late 2020 were consistent with the expected importation of infection from the students arriving from their home addresses. Considering outbreaks during term from one university, larger halls of residence posed higher risks for larger attack rates, and this was not mitigated by segmentation into smaller households. The dynamics of transmission from university outbreaks to wider communities is complex, and while sometimes spillover does occur, occasionally even large outbreaks do not give any detectable signal of spillover to the local population.
Secondly, we explored some of the proposed control measures for reopening and keeping open universities in the face of an ongoing pandemic, namely staggering the return of students at the start of term, and also virus testing strategies at the start and during term. From multiple approaches, we found the proposal of staggering the return of students to university residence is of somewhat limited value in terms of reducing transmission. At best, staggering may delay outbreaks to later in the term, while the cost may be considerable in terms of the time demanded of students to self-isolate while infections are detected in incoming cohorts. We show that student adherence to testing and self-isolation are likely to be much more important for reducing transmission during term time. Finally we explored asymptomatic testing strategies in the context of a more transmissible variant (as currently dominant in the UK) and found that extremely frequent testing (all students every 3 days)would be necessary to prevent a major outbreak.