There is one thing that health care professionals and public officials from both sides of the aisle can agree on: one of the most effective ways to control a pandemic is to contact trace those who test positive for the virus and quarantine those people for a set number of days to control the virus spread. But the public, which has been deeply divided by other aspects of public health strategy like wearing masks, for instance, is not as universally accepting of this tried and true protocol.  A microcosm of this division is illustrated by the reaction to all pandemic health strategy on college campuses around the country.

When colleges decided to open their campuses this fall, it set up a controlled experiment of a society living and interacting in a confined space. Each campus represented a small town or city. In an ideal world each would be a perfect sociology testing ground for best practices in strategies to deal with and control the virus infiltrating every part of America. Alas, we are not living in a perfect and uncomplicated world. While each state and municipality were struggling to come up with plans to reopen grade schools and businesses, colleges were in hyperdrive to welcome back students and faculty.

Very little has been reported about contact tracing on campus, in part because the emphasis in the news has been on featuring mask-less parties with no social distancing.  There have also been numerous stories about fraternities and sororities hosting parties in crowded living conditions or staging pop up parties at secret locations. Social gatherings have always been an expected part of campus life, and a segment of the college population seems unwilling or unable to postpone that experience to a time when COVID is under control.

Logistics

Like many members of society, college students guard their privacy. They don’t want to “rat out” their friends at a party that flouts school policy. Since many experience mild or no symptoms, they see COVID and contact tracing as an impediment to normalcy. As a result, campuses have the potential of becoming isolated super spreaders. As the return of college students to campuses has fueled as many as 3,000 COVID-19 cases a day, keeping track of them is a logistical nightmare for local health departments and colleges. Ironically, the planning colleges have done to make a safe classroom had paid off. Most of these COVID cases are occurring from social gatherings, large and small, not from classroom instruction.

There is an unmistakable tendency for college students to resist or impede contact tracing. As Kaiser explains, “Some students are putting down their home addresses instead of their college ones on their COVID testing forms – slowing the transfer of case data and hampering contact tracing across state and county lines.” This allows a lag time when the virus can spread freely. “Making matters worse, college-age people already tend to be hard to trace because they are unlikely to answer a phone call from an unknown number.” College students are as annoyed with SPAM calls as anyone else. And since they live on their cell phones, they simply ignore call numbers they don’t recognize.

Kaiser quotes the urgency of the problem. “With that virus, you really need to be able to identify that case and their contacts in 72 hours,” said Indiana University’s assistant director for public health, Graham McKeen. And if they aren’t exhibiting symptoms, they might not ever come forward on their own.

Further, some students, if they are exhibiting symptoms, simply leave campus and head back home, and this creates even more headaches for tracers. According to Kaiser, “The Centers for Disease Control and Prevention highlighted this issue in a recent study of an unnamed North Carolina university’s COVID outbreak, stating that the number of cases was likely an underestimate. ‘For example, some cases were reported to students’ home jurisdictions, some students did not identify themselves as students to the county health department, some students did not report to the student health clinic, and not all students were tested,’ it said.”

To complicate things further, schools sometimes lack an interconnected COVID tracking system, McKeen tells Kaiser, “It is very patchwork, and people operate very differently, and it also doesn’t translate during a pandemic.” Indiana University has had more than 2,900 cases across its campuses.

And unlike society, which has a lower and steadier ebb and flow of people, colleges get slammed with an influx of students at the start of every semester. The Columbia/Boone County Department of Public Health and Human Services saw a COVID spike at the University of Missouri soon after the semester began with the peak reaching more than 200 new cases per day.

In Massachusetts, Pat Bruchmann, chief public health nurse for the Worcester Division of Public Health, said she had noticed some students at the 11 colleges in her district were getting tested off campus or when they went home for the weekend. In response, her department now proactively looks for positive test results among people who are of typical college age. So far, she’s had 10 or so cases reassigned to her department from other areas because of address issues, Bruchmann said.

Conspiracy Theories

While contact tracing has become standard operating procedure to curb epidemics and pandemics, some segments of society, including college students, read between the lines and see dark implications beyond the virus for creating a database of information on citizens. According to AZCentral, Washington State had to issue a bulletin to its citizens in May that, no, people who give information to contact tracers won’t be imprisoned in “deep state FEMA camps” and cut off from society.

So, to clarify things, let’s explore what contact tracing is designed to do and how it is conducted. The AZCentral (a website for the “Arizona Republic” newspaper) published a release from Kaiser Health explaining the process of contact tracing.

When a person tests positive for certain communicable diseases, health care providers must report their contact information to public health departments. Contact tracers then try to reach out quickly, generally by phone, to find out the person’s address, and work with that person to narrow down where the infection may have occurred. The tracer also asks about the person’s symptoms to find out whether they need medical assistance and also as a way to figure out how long they’ve had the virus. Then the tracer asks the COVID positive person for a list of anyone they’ve come in close contact with from about 48 hours before they were symptomatic and places like restaurants, bars and hair salons to follow up with them. All of this information is provided to the tracer on a voluntary basis. Finally, Kaiser explains, “Close contacts are urged to quarantine for 14 days, check their temperature regularly and avoid contact with other household members, if possible.”

It sounds simple and innocent enough, but part of the problem might be the way it is conducted. And less human contact and more technology is not always the solution.

In the UK, a contact trace downloadable app was in development that might have seemed to be the perfect solution for colleges to use, but it has triggered fear and paranoia. The BBC reports that there is so much resistance to it that it has delayed its launch. Facebook is full of warnings that the app will access all your contacts without your permission, but this is not the case. It will only find people who were in close proximity to you for a significant period of time if you test positive. Then, that person will be contacted for possible quarantine instructions. Students, like other segments of the population worry about forced quarantining, involuntary treatments such as vaccines and, if they are married students with children, having their children taken from them and placed with social services.

In Wisconsin, there was false chatter online about the government installing surveillance cameras to catch and punish people who break the quarantine rules. In Appleton, Wisconsin, employees of the Washington Ozaukee Public Health Department had their employees threatened and followed when they were driving official vehicles. The department has since then removed the department’s logo from these vehicles out of concern for their employees’ safety.

Economy

And of course, there’s an economic factor to the anger and resistance by a segment of the community to contact tracing. People who have been furloughed or who own a restaurant or beauty salon or bar that is bleeding in debt with little hope for the cash infusion customers can bring are fed up and tired. They want this all to end. They have COVID fatigue and like standing on the ledge of a burning building, they rather leap than face the heat and flame any longer.

In another sense, they are like people stranded in a rowboat on the ocean. Quoting the poem “The Rime of the Ancient Mariner” by Samuel Taylor Coleridge, “Water, water, everywhere, but not a drop to drink.” There comes a time when the saltwater becomes tempting. It’s wet, it’s there and the mouth is so parched that the desire to drink it is irresistible. Out of desperation, you take the chance you won’t get sick and die.

College students are in that same boat. Masks and social distancing be damned. Contact tracing? No thanks. Maybe I won’t get sick, or if I do, it won’t be so bad. I’ll take my chances, keep quiet and ride this out my way.

And the virus is only too happy to go along for that ride.

SOURCES: AZCENTRAL, Kaiser Health News, BBC, Politico, CDC