The COVID-19 pandemic is a curse that also presents opportunities. The opportunity I’m discussing, how to reopen our Universities for on-campus classes, is a big one, one which affects over 2 million young Canadians who attend universities and colleges in Canada.
Some societies and individuals will take advantage of the opportunity this adversity presents to catalyse change, as we have done with the rapid implementation of video visits and e-health for our patients. Others will use it to accelerate political reform of daycare, senior care and to consider issues like the living wage. One’s enthusiasm for pandemic related changes will be based on a mixture of evidence, emotion and personal world views. I’ve been thinking about the opportunities this pandemic presents for university education. The first and most obvious thought is that universities should go online while students shelter safely at home. I think that is understandable, but misses the point and ignores a unique learning opportunity. A university education is mostly about the on campus experience, not simply the conveyance of facts that can certainly be garnered online. When I came to Queen’s for Medicine, anatomy professor Dr. Tony Travill looked our first year medicine class in the eye and told us to “go away and learn about life and, when you come back, I’ll teach you about medicine”. This was one of the many non-virtual experiences I had at Queen’s, not all of which were pleasant. Perhaps universities can respond to COVID-19 using their capacity for research and innovation. Can we devise innovative ways to run a safe campus to provide Canadian youth with a truly enjoyable and enriching educational experience while respecting good public health policy? A tall order to be sure; but the answer must be yes!
In this spirit, let me tell you about an exciting plan afoot in the Faculty of Health Sciences at Queen’s University under the leadership of Dr. Stephen Vanner, Deputy Head of Medicine, with partnership from our Schools of Medicine, Nursing and Rehabilitation Therapy and a team of 15 collaborators from across the university. The University is bringing health care professional students back and Dr. Vanner and team are seizing on the opportunity to understand the impact of this return on the students both physical and mental wellness and how COVID-19 testing, combined with these outcomes, can help inform the University and Canadians at large in future decision making. This team will use a program of nonpharmacological interventions, wellness surveys and repeated testing for COVID-19 (by PCR and serology). This exciting project, entitled “ COVID-19 testing of health professional students: Informing testing and public policy for Universities and Society” is the subject of a grant (under review) in the CIHR’s current COVID-19 grant competition.
As I mentioned in an earlier note, it is likely that our future will see repeated testing of the population (for the virus by PCR) combined with serology (to determine who has been infected previously, and is thus immune). Visit Nobel Laureate Paul Romer’s site and see the animation on his page which illustrates the predicted benefits of widespread testing. It is likely that with widespread and repeated testing only the sick will be quarantined while the healthy can circulate with relative confidence in a safe society.
Most Canadian Universities appear to be choosing to “go virtual” in the coming year. This will be unlikely to satisfy young learners who want an authentic, face to face experience on campus. This approach sounds safe and cautious, but is it? University age adults will be unlikely to stay sequestered in their parents’ homes for an entire year. It is likely that many will gradually become more adventurous as the first wave of COVID-19 wanes. They intuit that life involves risk but that the risk to them personally, as healthy young people, is relatively low. I would argue it may be safer (for them and for society) to have them attend redesigned universities than to stay on the sidelines at home. When I say safer, I am considering mental and economic well-being; not just physical health.
This is a great time for Canadian universities to re-envision the campus experience, allowing on-site learning to continue. Imagine a campus where all residence rooms are single rooms in which physical distancing is practiced. Imagine that those young people who can’t be accommodated in residence because of this are encouraged to rent in the community. Would they really be at higher risk to themselves or society than if they stayed home and undertook a virtual education? It seems unlikely they would be less willing to comply with physical distancing and testing on campus than left in their parents’ homes.
Certainly there is diversity of opinion. Most of this disagreement is not based on the facts (which are fairly clear): 1) COVID-19 is sticking around for some time; 2) there is not enough testing material to test everyone; and 3) the economy cannot tolerate an indefinite stay at home/shelter in place policy. If one is timid and risk averse one may favour a switch to virtual everything; if one is cavalier it’s easy to channel the USA and immediately open everything up. However, can Canadian universities have the best of both? Could we reorganize our universities to deliver an optimal balance between quality and safety? Perhaps students could attend a campus 2.0, with smaller classes, shifts of in-person classes alternating with on-line course, daily fever checks, and self-quarantine and a requirement to be tested and quarantine if febrile. I wonder whether students who want an in-person university experience might even be willing to co-pay for testing as an investment in their own health security? One way or the other, these young people will progressively become more mobile within society. Arguably, it would be better that they are at university, receiving education than that they remain frustrated at home, with the related financial and psychological consequences (and little evidence that their true risk of COVID-19 is reduced).
Is the idea of reopening universities crazy and reckless? I don’t think so but here is what others think. In Alberta, the University of Calgary is anticipating a mix of in-person and online classes. I like the approach of their president, Ed McCauley who is quoted as saying, “Priority for the 30 per cent of students allowed on campus will be given to small classes and labs, tutorials and seminars, along with other experiential learning opportunities. All other classes will remain online. Combining delivery methods means students who wish to have face-to-face opportunities can safely have them. Those who wish to stick with remote learning in these times can build their schedules accordingly".
Note that Mount Royal, experiencing the same COVID-19 epidemiology in the same city, is responding very differently.
I am not expecting this on-line predominant offering to be well received and I am not alone in my concerns. A recent CBC article noted, “A survey which polled more than 1,000 prospective and returning post-secondary students, found 30 per cent said they might change their plans about enrolling this fall (due to the financial impact of the pandemic and concerns over issues related to a perceived lower quality of remote learning vs in person class experience.”
In this article they also quote David Robinson, executive director of Canadian Association of University Teachers(CAUT) as saying, “Among those students who say they will still be able to afford their tuition fees and living costs, a large number — about 75 per cent — are worried that distance learning will create a poor learning experience,"
Our principal Patrick Deane is quoted as saying “We will be open, but how “normal” life at Queen’s will be will depend on the best advice available from public health authorities to ensure that students enjoy stable, safe and stimulating conditions for their studies. It is certainly our hope that students will be on campus, but we are also preparing for the possibility of remote delivery should physical distancing still be required and significant concentrations of people be prohibited.”
Here is our current COVID-19 epidemiology (see below). Kingston is in a bubble with a low incidence of COVID-19 (28.7 cases/100,000 population), positioning us ideally to carefully reopen the city and university (in my personal opinion). In contrast, Toronto has a rate almost 10 times higher (262.5 cases/100,000 population). This is a reminder that realities and response to the pandemic can and should vary by location.
Certainly some universities outside Canada, like Notre Dame University, are choosing to fully open in the fall. The Indiana State Department of Health reports 1,678 deaths (not cases) as of mid May 2020. Some of these schools are in locations with much higher disease prevalence than Queen’s. The leaders of these schools are not ignorant of the risks nor are their heads in the sand. They recognize the risk but choose to accept and mitigate it. The Notre Dame principal equivalent, Rev John Jenkins, compared reopening the campus to, “assembling a small city of people from many parts of the nation and the world, who may bring with them pathogens to which they have been exposed.” Here is a list of other schools that plan on opening this fall- it includes respected institutions, like Harvard University.
The decision to reopen for in-person classes should of course reflect local epidemiology. However, if the local prevalence is low, then with attention to nonpharmacological interventions (students in shifts, single occupancy rooms, smaller class room size and testing with quarantine of the sick) a return to something nearer normal is possible. Canadian society will need to accept that there will soon come a day when we collectively and individually need to balance risks and benefits of increased association. It is unlikely that there will be a COVID-19 vaccine in 1 year. It is also unlikely the disease will disappear, despite wishful thinking by some. Thus, society will need to balance the need for education of our young people and the restoration of commerce with a reduced, but non-zero, risk of localized COVID-19 outbreaks on campus. I hope that Canadian universities can build on the study that Dr. Vanner and colleagues are championing and get Canada’s university students back on campus in the fall.