Ryan Malosh, University of Michigan and Nina Masters, University of Michigan Medical School

Scientists have learned a few things over the past six months as the COVID-19 pandemic has continued. We’ve learned that the virus that causes COVID-19 transmits particularly well when a group of people are together in a small, poorly ventilated area. We’ve learned that young people are just as susceptible as older people to infection. We’ve learned that if there is widespread community transmission, the virus will find its way to the very places we don’t want it go.

So, it’s not surprising to us, researchers who study diseases that can be prevented by vaccines, that with schools and colleges reopening, the virus is spreading.

These are places designed around the idea of bringing lots of people to one place. Many of them bring people together from all over the world. They are perfect places for disease to spread.

How we got here

Back in March, colleges and universities closed down like everything else except essential businesses. They sent students home. There was a rough transition to online instruction. Students weren’t happy, faculty weren’t happy. And so, they started to come up with plans on how to reopen for in-person instruction for the fall semester.

Many places installed plexi-glass barriers in classrooms, considered mask mandates and worked out physical distancing in lecture halls. Most people realized that professors who taught large classes should plan for remote learning.

University administrators and public health experts started making these plans in the spring. Back then, we scientists and public health researchers all operated under the assumption that community spread would be under some sort of control by fall. We all thought that the country would increase testing capacity, and we have. Then, once new cases dropped to a low level, we could institute contact tracing, the way other countries had.

But that part hasn’t happened. And so now these same colleges and universities are facing huge increases in cases, including at the University of North Carolina, Notre Dame and the University of Alabama. Many universities that have opted to return to in-person classes are also having a surge in cases. These outbreaks will inevitably spread to the wider communities in which the campuses are located.

It seems that for many of these institutions, the priority was on financial concerns, which involved a return to a normal fall semester to the greatest extent possible. They then developed plans that they thought would make this possible. Faculty at many institutions and at least one ethics committee have argued that the priority should have been the safety of students, faculty and the surrounding communities.

While schools across the country have different priorities, enrollments, campus size, and student demographics, many schools share one thing in common: making no real contingency plans around reopening amid COVID-19, other than going remote if governors mandated it.

The schools that did spend the summer figuring out how to deliver high quality education remotely, or how to safely provide housing and access to services for the most vulnerable students, are less likely to have their fall semester disrupted. However, the College Crisis Initiative’s data dashboard found that only 7% of 1,442 four-year schools surveyed were planning on a fully online fall semester.

The challenge ahead

And so, the inevitable has come to pass. Now, many college campuses will struggle to control their outbreaks, because there are a lot of unique challenges inherent to COVID-19 in this population.

Colleges are not nursing homes or prisons. Some are trying to limit contact with the broader community.

But in general, students are not kept under lock and key. They have visitors from other schools. They go back and forth to their parents’ homes. And, yes, they go to parties. To us, blaming students for wanting a normal-ish college experience when the schools themselves have set the tone for trying hard to return to normal isn’t fair.

It’s also true that not all of the contact students have is as irresponsible as some have suggested. Many students hold jobs in the communities that surround the school. And most of these jobs aren’t typically the work-from-home type of job. In our undergraduate careers we both worked at jobs that had high contact rates with the community. And often, when your job is waiting tables at a local pizza place or manning a library desk, most of your colleagues are students as well. All of these factors will make contact tracing very hard.

Public health experts also expect a relatively high proportion of college-aged students to be either completely asymptomatic or to only have very mild symptoms. Without universal testing, these students won’t know they’re sick. They may not isolate if they have mild symptoms. But they will still be able to spread the virus to others. Symptom and temperature screenings may not recognize these individuals as those who need to stay away from campus buildings.

A different kind of campus test

Which brings us to testing. Some places are doing universal testing of students, multiple times per week. But, given the state of testing in the U.S., that is not a realistic possibility for most schools.

Let’s look at our university as an example. The University of Michigan has an undergraduate population of 30,000 students. Let’s assume that two-thirds of them came back to campus. That means 40,000 tests per week just for University of Michigan undergraduate students. Right now the entire state of Michigan is doing a little more than 200,000 diagnostic tests per week. Some schools have developed their own tests to handle this huge increase in capacity. But many university labs are involved in testing for large health systems and the rest of the state too. In these places it becomes very difficult for 1 in 5 tests available in an entire state to be dedicated to the students at a single university.

A scale-up of rapid, at-home antigen tests could be one approach to make testing on this scale feasible. These types of tests have the advantage of detecting highly infectious individuals – making them a good screening tool – but many are not approved by the Food and Drug Administration because they aren’t as sensitive as the standard PCR-based diagnostic test.

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If transmission on campus continues to happen mostly outside of the classroom, simply going remote will not solve the problem. Keeping students on campus will be risky. Many students will be attempting to navigate social distancing guidelines without a traditional social support network.

As much as possible, we believe students need to be able to safely return to their homes. But this can’t be done haphazardly. Bringing them to campus was a predictable risk – so is sending them home. As colleges inevitably move back to online instruction, plans must be put in place to minimize the risk of seeding epidemics. Dismissing all students, some of whom are infectious, back to their home communities risks spreading the virus further across the country, a bad outcome for all.

The unique epidemiology of COVID-19 in young adults, along with the contact patterns on college campuses and the inability to effectively screen through symptom reports or diagnostic testing, have left college campuses with few options for safely operating with in-person classes. We know that few wanted an all-remote fall semester, but it’s becoming clear that was probably our best bet.

Ryan Malosh, Assistant Research Scientist, University of Michigan and Nina Masters, Doctoral candidate, epidemiology, University of Michigan Medical School

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Zoë McLaren, University of Maryland, Baltimore County

On Aug. 26, the Food and Drug Administration granted an Emergency Use Authorization to a new rapid antigen test for COVID-19 called the BinaxNOW test.

I study public health policy to combat infectious disease epidemics. Testing is one of the most powerful tools available to fight the spread of COVID-19. The new test is inexpensive, rapid and easy to use. It will massively scale up access to testing, but hurdles remain in achieving widespread, frequent COVID-19 testing.

What type of test is BinaxNOW?

The credit-card-sized test is an antigen test that detects a specific viral protein from SARS-CoV-2. It costs US$5 and doesn’t require a lab or a machine for processing.

Performing the test is simple. A health care worker or technician would use a swab to collect a sample from less than 1 inch inside the nostril. They would then combine the sample with a few drops of chemicals inside the test card. Within 15 minutes, the test strip would show a positive or negative result. The test is also paired with an app that produces a digital code that can be scanned to show proof of a recent negative COVID-19 test.

What does the Emergency Use Authorization allow for?

The BinaxNOW test is currently only authorized for patients who have had COVID-19 symptoms for seven days or less, which is when virus levels in the body are likely to be high. It must be prescribed by a physician and performed by a trained technician or other health care worker.

The PCR test for COVID-19 is currently widely used and considered the gold standard, but requires patient samples to be sent to a lab and can take days to provide results. The new antigen test is designed to be a cheap and quick alternative to PCR testing for diagnostic purposes in a medical setting. It would add critical capacity to an overstretched testing system.

The emergency use authorization provides preliminary authorization for doctors to prescribe the antigen test while the full FDA approval process is ongoing. The authorization could be revoked if the test is not as accurate or reliable as expected.

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How accurate is this test?

Abbott, the health technology company that produces the test, reports that when patients had symptoms the test was in agreement with PCR testing for 97.1% for COVID-19 positive cases and 98.5% for COVID-19 negative cases. This is high enough for diagnostic settings where accuracy is critical.

However, the true accuracy could be lower because the performance testing group was only 102 people and the accuracy hasn’t been validated by the FDA as part of the full approval process. There will inevitably be some false negatives and false positives with the BinaxNOW test since accuracy isn’t 100%, but the FDA will monitor the data to make sure the test meets the reported accuracy.

Can this test be used for widespread screening?

The BinaxNOW test is cheap, rapid, able to be mass-produced and easy to use outside a lab. This makes it a promising candidate for widespread screening. However, the test is currently only authorized for people with COVID-19 symptoms.

This is an obstacle because an estimated 40% of all COVID-19 cases are asymptomatic and these people likely don’t know that they’re contagious. To maximize the effectiveness of any COVID-19 screening program, it is important to test people whether they have symptoms or not.

Health care providers are able to prescribe the BinaxNOW test for asymptomatic patients for off-label use, but health officials don’t yet know how accurate the test is when performed on asymptomatic people.

Is this test a game-changer?

The massive expansion of testing access made possible by the BinaxNOW test will almost surely outweigh the downsides of a small number of inaccurate results. Abbott plans to manufacture 50 million tests per month starting in October. This will quickly exceed the 76 million COVID-19 tests the U.S. has performed over the last six months.

Widespread, frequent testing is effective at slowing the spread of the coronavirus. The new testing capacity made possible by the authorization of this rapid antigen test represents a major advance in bringing the pandemic under control.

Zoë McLaren, Associate Professor of Public Policy, University of Maryland, Baltimore County

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Kathryn Crawford, Middlebury

Nearly a year before the novel coronavirus emerged, Dr. Leonardo Trasande published “Sicker, Fatter, Poorer,” a book about connections between environmental pollutants and many of the most common chronic illnesses. The book describes decades of scientific research showing how endocrine-disrupting chemicals, present in our daily lives and now found in nearly all people, interfere with natural hormones in our bodies. The title sums up the consequences: Chemicals in the environment are making people sicker, fatter and poorer.

As we learn more about the novel coronavirus and COVID-19, research is revealing ugly realities about social and environmental effects on health – including how the same chronic illnesses associated with exposure to endocrine-disrupting compounds also increase your risk of developing severe COVID-19.

In the U.S. and abroad, the chronic disease epidemic that was already underway at the start of 2020 meant the population entered into the coronavirus pandemic in a state of reduced health. Evidence is now emerging for the role that environmental quality plays in people’s susceptibility to COVID-19 and their risk of dying from it.

Why endocrine disruptors are a problem

Endocrine-disrupting compounds, or EDCs, are a broad group of chemicals that can interfere with natural hormones in people’s bodies in ways that harm human health. They include perfluoroalkyl and polyfluoroalkyl substances, better known as PFAS, flame retardants, plasticizers, pesticides, antimicrobial products and fragrances, among others.

These chemicals are pervasive in modern life. They are found in a wide range of consumer goods, food packaging, personal care products, cosmetics, industrial processes and agricultural settings. EDCs then make their way into our air, water, soil and food.

Research has shown that people who are exposed to EDCs are more likely than others to develop metabolic disorders, such as obesity, Type 2 diabetes and high cholesterol, and they tend to have poorer cardiovascular health.

EDCs can also interfere with normal immune system function, which plays a critical role in fighting off infection. Poor immune function also contributes to pulmonary problems such as asthma and chronic obstructive pulmonary disease; autoimmune diseases like rheumatoid arthritis and Crohn’s disease; and metabolic disorders. Many EDCs are also associated with different cancers.

EDCs can mimic human hormones

EDCs affect human health by mimicking our natural hormones.

Hormones are chemical signals that our cells use to communicate with one another. You might be familiar with reproductive hormones – testosterone and estrogen – which help distinguish male and female physiology and reproduction. Yet, hormones are responsible for maintaining virtually all essential bodily functions, including metabolism and healthy blood pressure, blood sugar and inflammation.

The chemical shape or structure of EDCs resembles hormones in ways that cause the body to misinterpret an EDC for a natural signal from a hormone.

Because the human body is very sensitive to hormones, only small amounts of hormones are required to convey their intended signal. Therefore, very small exposures to EDCs can have dramatic, adverse affects on people’s health.

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Environmental quality and COVID-19

Researchers are only just beginning to paint a picture about how environmental quality contributes to COVID-19 susceptibility, and there is much we still don’t know. However, scientists suspect that EDCs can play a role based on clear scientific evidence that EDCs increase people’s risk of developing chronic disease that put people at greater risk from COVID-19.

Public health organizations such as the U.S. Centers for Disease Control and Prevention and the World Heath Organization officially recognize underlying health conditions – including obesity, diabetes, hypertension, cardiovascular disease, immunosuppression, chronic respiratory disease and cancer – as risk factors for critical illness and mortality from COVID-19.

Scientific evidence shows that EDC exposure increases people’s risk of developing all of these conditions. Scientists are thinking about these connections, and research efforts are underway to answer more questions about how EDCs may be influencing the pandemic.

Air pollution and other environmental risks

In addition to EDCs, other environmental conditions are also likely playing a role in the COVID-19 pandemic. For example, multiple studies have reported increased risk of COVID-19 illness and deaths. The findings are consistent with those reported in China following the SARS outbreak in 2002-2003.

Recent evidence also shows that COVID-19 infection can lead to lingering health conditions, including heart damage. Environmental conditions such as heat waves are particularly dangerous for individuals with heart disease or heart damage. In places like California that are currently experiencing wildfires and heat waves, we can clearly see how multiple environmental conditions can combine to further increase risk of deaths associated with COVID-19.

In the U.S., regulations such as the Clean Water Act and Clean Air Act have improved environmental quality and human health since the 1970s. However, the Trump administration has been trying to weaken them.

In the past three and a half years, about 35 environmental rules and regulations pertaining to air quality or toxic substances like EDCs were either rolled back or are in the process of being removed, despite unambiguous evidence showing how poor environmental quality harms human health. Allowing more pollution threatens to exacerbate the trend toward a sicker, fatter and poorer America at a time when people’s overall health is necessary for our collective resilience to COVID-19 and future global health challenges.

Kathryn Crawford, Assistant Professor of Environmental Health, Middlebury

This article is republished from The Conversation under a Creative Commons license. Read the original article.