It is important for each visitor and member of our community to recognize that even though the university will take precautions to reduce the risks of COVID-19 on campus, individuals can never be completely shielded from all risk of illness caused by the virus, and everyone in our campus community shares the responsibility for the health of the community.
There are several exceptions to the face covering requirement when indoors on campus:
Furman considered this and other options for mandatory screening. Our decision not to require all students to pre-screen for the SARS-CoV-2 virus comes after multiple detailed discussions with local and national infectious disease experts, as well as Furman’s own epidemiologists, scientists and clinical staff. We are also following the guidance of the Centers for Disease Control and Prevention (CDC), South Carolina Department of Health and Environmental Control (SC-DHEC), and our on-campus health provider, Prisma Health. For example, from the CDC document Interim Considerations for Institutions of Higher Education Administrators for SARS-CoV-2 Testing, “Testing of all students, faculty and staff for COVID-19 before allowing campus entry (entry testing) has not been systematically studied. It is unknown if entry testing in IHEs provides any additional reduction in person-to-person transmission of the virus beyond what would be expected with implementation of other infection preventive measures (e.g., social distancing, cloth face covering, hand washing, enhanced cleaning and disinfection). Therefore, CDC does not recommend entry testing of all returning students, faculty, and staff.”
Beyond the written guidance, however, it may be helpful to consider why we believe such tests may have potentially limited value in improving potential health risks versus other measures. Most importantly, the turnaround time for a pre-entry screen can largely mitigate its predictive value for a student returning to campus. The processing time for results can range from 2-6 days after arrival of the sample at the lab. In order to make sure students have their results back in time to return to campus (and given differences in lab turnaround times based on different scenarios nationwide), this would require a 10-day window minimum from sample collection to returning to school, assuming an asymptomatic test was universally available to all students.
Consider the following implications: (1) The test is only valid on the day the specimen is collected, so any potential exposure that occurs after that time may result in an undetected infection that is unknown to the student; (2) COVID tests can produce false negative results in asymptomatic individuals early in the infection phase, because the viral load has not developed sufficiently to give a positive indication (i.e. an asymptomatic individual may in fact be infected when tested, but consider themselves “safe,” because the test did provide a positive indication); (3) the CDC-recommended protocol for an asymptomatic individual who tests positive for COVID-19 to return to work is 10 days after the positive test. This means that for a student who remains asymptomatic, they would ordinarily return to class in 10 days (i.e., the length of time passed from when most students would have collected their sample to their scheduled return to campus). On the other hand, students who do develop symptoms prior to returning to Furman are required to obtain a COVID-19 test, and are not permitted return to campus if the test is positive until approved by the Student Health Center. In the end, pre-entry screening is limited by providing a single outcome at a single point in time, and if conducted at home, this can significantly precede the campus arrival date. Thus, while having limited impacts on actual disease transmission, it also promotes a false sense of security (e.g., “I tested negative, and my friends tested negative, so it’s ok to come into close contact”) that can be very counterproductive.
What we know to work based on clear scientific evidence are measures such as de-densification (spreading people out on campus through phasedreturn), practicing physical distancing (6 feet or greater), wearing a face covering at all times indoors when around other people, reducing close contacts as much as possible (defined as 6 feet or less for 15 minutes or more) and restricting the overall number of individuals in our social circles. Furman’s phased return plan is centered around adapting the physical environment and providing education, training and the opportunity for commitment (Paladin Promise) to advance these most critical behaviors for members of the entire campus community. Our success – and that of all other institutions of higher learning this fall – will be much more impacted by individual behaviors and the operational planning to allow students to adopt those scientifically-guided practices than any efforts tied to random screening.
With that said, our community should be encouraged to note that Furman will require testing and quarantine as appropriate of all students who are symptomatic, as well as all close contacts of those students as recommended by the CDC and SC DHEC. Moreover, we are conducting on-campus asymptomatic testing of smaller subpopulations of students who may spend significant amounts of time together on a daily basis (e.g. athletic teams), and can also respond to make this testing available as appropriate to specific areas or groups on campus in the event a higher rate of transmission is observed.
Our staff epidemiologists have identified the recent scientific articles (below) that specifically speak to the recognized value of de-densification in reducing risk. According to Inside Higher Education (see https://www.insidehighered.com/news/2020/07/21/universities-invite-some-not-all-students-back-campus), Furman is by no means alone in making difficult decisions that involve a reduction of student density. The specific decision to delay by a period of four weeks from first-year student arrival until sophomores and juniors arrive on campus will ensure adequate testing capacity, validate contact tracing, and provide for essential isolation and quarantine space to address any unforeseen outbreaks. It will allow us to measure and evaluate increases in baseline infection, respond accordingly, and ensure the safest outcomes, both for the students on campus and for those joining us in September.
Evidence for social distancing slowing incidence of COVID
Evidence for stay at home orders slowing incidence of COVID
Multiple control strategies in Wuhan (including phasing of work)
There are quite a number of factors or indicators that Furman will use in assessing the health of the campus and overall community. Excepting an order from a governmental body (e.g., SC State Governor’s Office) or an inability to care for students or employees on campus or in our local health community (e.g., quarantine/isolation space or ready access to hospital resources), no single factor in isolation will be used to make such a decision. Factors that our clinical professionals and epidemiologists are monitoring daily include new cases in Greenville and surrounding counties, local and state trends in new infections, infection rate per 100,000 and associated trends, % positivity rate for daily testing (lower is better), and hospital bed availability (see https://www.scdhec.gov/infectious-diseases/viruses/coronavirus-disease-2019-covid-19 for daily reports). In addition, factors on our own campus including the number of new cases daily and over a 2-week period, % positivity, trends in increasing/decreasing cases, the number of students in isolation (symptomatic or testing positive), students in quarantine, and adherence to university protocols will be used to evaluate campus health and our capacity to reduce restrictions or make specific recommendations to mitigate viral spread.
Furman’s contact tracing protocol will notify individuals who had close contact within 6 feet for more than 15 minutes with anyone testing positive for COVID-19, within 48 hours prior to the time of the initial onset of their symptoms.
This is why students will be strongly encouraged to minimize the number of individuals whom they have this type of contact with on a daily basis. Students are also encouraged to keep a daily contact log which will expedite the contact tracing process if necessary.
Students who meet the criteria for an exposure (close contact within 6 feet for more than 15 minutes with anyone testing positive for COVID-19, within 48 hours prior to the time of the initial onset of their symptoms) will be quarantined for 14 days from the time of most recent exposure.
Students unable to go home to quarantine will be moved into campus housing space that has been allocated for quarantine. Students in quarantine will be required to have no contact with other individuals for a period of 14 days from the time of last exposure to the person with COVID-19. The quarantine space will have a private bathroom. The Earle Student Health Center will virtually check on students in quarantine on a daily basis. Meals will be delivered to the space by Dining Services, and students will participate in their courses remotely, regardless of it the course is an online or in-person course.
Furman strongly recommends that any student required to quarantine obtain a test for COVID-19 before returning to class and activities. This can be ordered through the Earle Student Health Center (if in South Carolina), or obtained by an independent provider (typically obtained 5-7 days post initial exposure, or at the first indication of symptoms). While the test will not reduce or lengthen the period of quarantine for an asymptomatic individual, it can serve as a very valuable indicator to the family or campus community of whether an active infection is present.
Students who quarantine at home may return to campus after the 14-day quarantine.
Before the quarantined student returns to their housing assignment, the space will be cleaned and disinfected by the university.
Students who are symptomatic for COVID-19 should shelter in place in their campus housing space and must contact the Earle Student Health Center immediately. They should not go to class or the dining hall. The Earle Student Health Center is accessible by phone 24 hours a day to provide guidance, and as appropriate, a medical order for a COVID test with a local Prisma provider. Symptomatic students will be asked to shelter in place in their individual residence (meals delivered and course access provided online) until laboratory results are returned, typically 24-48 hours.
Students who test positive for COVID-19 and unable to go home to isolate will be moved into campus housing space that has been allocated for such. Per CDC guidance, students in isolation will be required to have no contact with other individuals for a period of 10 days from the time of symptom onset or the positive test sample was acquired, assuming the individual has no fever (< 100.4 F) without taking fever-reducing medications for the most recent 72 hour period and improving symptoms (also 72 hours). On-campus isolation space will have a private bathroom. The Earle Student Health Center will provide daily virtual checks on students in isolation. Meals will be delivered by Dining Services, and students may participate in their courses remotely, regardless of whether the course is an online or in-person course.
Students who isolate at home may return to campus following the protocol indicated above (10 days from the time of symptom onset or the positive test sample was acquired, assuming the individual has no fever (< 100.4 F) without taking fever-reducing medications for the most recent 72 hour period and improving symptoms (also 72 hours).
Before the isolated student returns to their housing assignment, the space will be cleaned and disinfected by the university.
Furman will follow the guidance of the Centers for Disease Control and Prevention (CDC), South Carolina Department of Health and Environmental Control (SC-DHEC) and Prisma Health (our on-campus health provider), all which are consistent. First, if identified as a close contact, the period of quarantine will be the accepted length of 14 days; a negative test will not shorten the period of quarantine since the viral load may not have achieved sufficient level to provide a positive indication. Secondly, while serological testing can be very useful in providing populations statistics, confidence in antibody tests as an indicator of disease immunity on an individual basis remains an issue of concern (i.e., it is not yet widely accepted by the scientific/medical community that a positive antibody titer indicates resistance to COVID-19 infection/transmission, as some antibody tests have been shown to have significant selectivity issues, and in other cases individuals with antibodies have been shown to be re-infected).
With this guidance in mind, were individuals to come into close contact with an individual testing positive for the COVID-19 virus (< 6 feet exposure for more than 15 minutes within 48 hours prior onset of their symptoms), Furman’s quarantine protocol would be for a 14-day period from the most recent time of exposure.
The university will closely monitor the evolving circumstances related to COVID-19, along with rapidly developing scientific knowledge and medical resources, to determine the appropriateness for adjustments and contingencies. For general questions about the fall semester, please email email@example.com.