Association of University Reopening Policies with New Confirmed COVID-19 Cases in the United States

Abstract

Importance

Reopening of universities in the U.S. has been controversial in the setting of the coronavirus disease 2019 (COVID-19) pandemic.

Objective

To investigate (1) the association between new COVID-19 cases since September 1 ^st with the number of students returning to campus in each county across the U.S. and (2) how different reopening policies at universities correlated with new COVID-19 cases.

Design

Observational cohort study using publicly available data sources. Multivariable regression models estimated both effects of university reopening and different reopening policies.

Settings and Participants

Populations in U.S. counties reporting new confirmed COVID-19 cases from August 1 ^st to October 22 ^nd .

Exposures

(1) total enrollment of students under the in-person or hybrid policies per county population and (2) proportion of online and hybrid enrollment within each county.

Main Outcomes and Measures

Mean number of daily new confirmed COVID-19 cases per 10,000 county population from September 1 ^st to October 22 ^nd .

Results

For 2,893 counties included in the study, mean number of daily confirmed cases per 10,000 county population rose from 1.51 from August 1 ^st to August 31 ^st to 1.98 from September 1 ^st to October 22 ^nd . Mean number of students returning to universities was 2.1% (95% CI, 1.8% to 2.3%) of the county population. The number of students returning to campus had an increased association (β = 2.006, P < 0.001) with new confirmed COVID-19 cases within the local county region where the institution resided. For 1,069 U.S. counties with universities, the mean proportion of online enrollment within each county was 40.1% (95% CI, 37.4% to 42.8%), with most students enrolling in-person or hybrid mode. In comparison to holding classes in-person, reopening universities online (β = -0.329, P < 0.001) or in a hybrid mode (β = -0.272, P = 0.012) had a decreased association with new confirmed COVID-19 cases.

Conclusions and Relevance

A higher number of students returning to campus in U.S. counties was associated with an increase in new confirmed COVID-19 cases; reopening online or partially online was associated with slower spread of the virus, in comparison to in-person reopening.

Key Points

Question

Are students returning to universities and specific reopening policies associated with new confirmed coronavirus cases in United States?

Findings

In this cohort study of 2,893 U.S. counties, the number of students returning to campus was significantly associated with a higher number of new confirmed COVID-19 cases. In 1,069 U.S. counties with universities, online or hybrid reopening was significantly associated with a lower risk of new cases compared with in-person reopening.

Meaning

An increased risk of coronavirus infection was seen in surrounding regions after universities reopened last fall, and this effect was largest in those holding in-person classes.

SciScore for 10.1101/2020.12.11.20247353: (What is this?)

Please note, not all rigor criteria are appropriate for all manuscripts.

Table 1: Rigor

NIH rigor criteria are not applicable to paper type.

Table 2: Resources

No key resources detected.

Results from OddPub: Thank you for sharing your code.

Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:

These findings should be interpreted in the context of the following limitations. First, we studied the effects of university reopening policies using observational data with multivariable adjustment. The choice of control variables may not be a comprehensive list, and residual confounding from other sources of variability in county-level rates of COVID-19 cases is possible. However, we did adjust for several key factors, and our results were stable over sensitivity analyses. Second, the actual reopening dates may vary among universities, ranging from late August to mid-September. In our analysis, the calculation of outcome variable, which is based on the cutoff date September 1st, could be viewed as approximation of confirmed rates after university reopening. Not only does the start vary across different campuses, but even when students arrive back on campus it can be difficult to ascertain directly their time of contact with others. Finally, testing capacity and the accuracy of reported numbers of tests and cases might have varied across counties or over time as the COVID-19 pandemic developed. This issue could have also introduced some noise to the measurement we used of new confirmed COVID-19 cases. In conclusion, we found a higher number of new confirmed COVID-19 cases in U.S. counties after students returned to universities and colleges during the fall of 2020. Among U.S. counties with universities and colleges, reopening with in-person classes was associated with a hig...

Results from TrialIdentifier: No clinical trial numbers were referenced.

Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

Results from JetFighter: We did not find any issues relating to colormaps.

Results from rtransparent:

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