Updated Guidance on COVID-19 Management on Campus

Note: the section on masks was revised March 2, 2022, to reflect updated CDC guidance.

Dear ACHA Members and Colleagues:

We recognize that, over the winter break, most of you have invested significant time developing plans to address the current COVID-19 outbreaks in advance of students’ return. We know how challenging this process is given conflicting messages; evolving guidelines; and expectations from campus leaders, students, faculty, and staff. Simply stated, it’s not easy to be serving as a campus public health leader right now. We thank you for your continued commitment to the health and safety of your campuses.

Many of you have reached out to ACHA asking for clarification on the revised CDC isolation/quarantine guidance, released December 27, 2021, in which CDC shortened the recommended time for isolation. While this request for clarification may seem straightforward, it is, in fact, challenging. As you know, IHEs vary in many ways, and recommendations must be responsive to the unique characteristics of campus life including but not limited to state and local restrictions; size and density of the living, dining, and learning environments; resources available, etc.

To better understand our members’ needs, the COVID-19 Task Force conducted listening sessions to hear specific concerns regarding testing, test management, isolation and quarantine, and masking. What we heard runs the full range of responses as schools use the scientific information available to tailor a reasonable response that meets their unique conditions. Many schools have decided to continue using the congregate setting standards while others have shifted to CDC’s five-day isolation/five-day masking plan. What has become clear is that there is no one-size-fits-all plan to address the current situation. With these factors in mind, ACHA provides guidance here in addition to its Updated COVID-19 Considerations for Institutions of Higher Education, released on December 6, 2021.

Updated Key Considerations

Public Health Partnerships

Now more than ever, IHEs must work in partnership with their local, state, territorial, or tribal jurisdictions regarding guidance and requirements on policies and protocols related to management strategies for COVID-19, such as isolation/quarantine, contact tracing, testing, and others that require an understanding of campus resources, demographics, vaccination rates, case rates, prevailing variants, as well as community conditions and local health considerations. This guidance should be relayed to campus decision-makers.

Vaccinations and Boosters

These are a critical component of the strategy to reduce the severity of illness, protect high-risk populations, decrease the strain on health care resources, and reduce the risk of emerging variants. ACHA recommends that IHEs require COVID-19 vaccination for all on-campus college students. ACHA also recommends that all eligible students, faculty, and staff receive COVID-19 booster doses.

Campuses without vaccine requirements should continue to identify and implement strategies to increase vaccine and booster uptake. Campuses should update policies and recommendations to align with the new CDC guidance for individuals who have received some or all of their vaccinations with a WHO-approved vaccine.

Note: CDC has updated its vaccine guidance with the following terms:

Up to date means a person has received all recommended COVID-19 vaccines, including any booster dose(s) when eligible.

Fully vaccinated means a person has received their primary series of COVID-19 vaccines.

Testing

When possible, testing should include a multi-pronged approach that includes pre-arrival, on-arrival, and surveillance testing. However, due to the pervasive nature of Omicron and limited resources, some of these testing strategies may not be feasible for some schools. Minimally, students who are symptomatic should be tested, regardless of vaccination status, with the testing of close contacts as the next priority. Use of PCR and FDA-approved rapid antigen tests are both acceptable when used for their prescribed purposes.

Masks

In light of a change in CDC guidance related to mask wearing and a nationwide decline in cases, IHEs may elect to repeal their mask requirements. Should pandemic circumstances change or local conditions arise that require the re-institution of mask requirements, IHEs should distribute and promote the use of N95, KN95, or ASTM-rated surgical masks. These masks offer the best protection against transmission. Masks should cover both the nose and mouth and fit tightly to assure the best protection. With the highly transmissible nature of the Omicron variant, campuses should reinforce the importance of wearing face coverings in a way that produces a good fit with no air gaps. If resources are limited, double masking as described in CDC guidance is the next best option.

Contact Tracing

Due to the high transmissiblity of Omicron, contact tracing by college health staff may no longer be feasible. Encouraging students to inform their close contacts and advising the close contacts to contact health services with questions/instructions may be a more realistic strategy under the current circumstances. Use of technology such as emails, text messages, Bluetooth, or GPS proximity tracing and exposure notification may decrease the phone call burden for staff.

Isolation

Schools can implement five-day (per CDC general guidance) or ten-day (CDC congregate setting guidance) protocols for isolation. If schools are using the five-day isolation protocol outlined by CDC, ACHA recommends students test out of isolation using a rapid antigen test. Isolation can be discontinued at least five days after symptom onset with a negative test. If the test is positive, additional testing on day seven or eight can be performed with a negative test ending isolation prior to 10 days. Serial testing allows students to return to class as soon as possible. If colleges cannot test or choose not to do testing as a condition for release, students should leave isolation only if they are asymptomatic or have symptom resolution, which includes having been fever-free for 24 hours without the use of antipyretics. The term “asymptomatic” does not always mean “not contagious.” Therefore, any individuals leaving isolation prior to day 10 should be provided with and instructed on the appropriate use of a well-fitted N95, KN95, or surgical mask, which should be worn at all times in public indoor settings and crowded outdoor settings where distancing is not feasible. If the individual cannot comply with the mask guidance as outlined, continuance of 10 days of isolation should be strongly considered.

If isolation space is limited, consider the following:

• Students who live near campus and have their own transportation can isolate at home.
• Students who are positive can be cohorted into identified rooms/locations for the isolation period.
• Students can isolate in place only after the roommate(s) are thoroughly informed of the risks of infection of sharing a household with an individual who is COVID-19 positive and are given options for alternative housing, if available. This option should not be offered if the roommate of the positive student is immunocompromised or in another high-risk group.

In some cases, students who are in isolation might need to access communal restrooms that are also used by students who have not tested positive. In these settings, it is important to minimize simultaneous use by multiple students and to maximize ventilation, distancing, and masking, with the understanding that masks will need to be removed for showering and oral hygiene.

Residential campuses that elect to follow guidance for congregate settings should follow CDC’s Isolation in High-Risk Congregate Settings guidance.

Quarantine

IHE-sponsored quarantine space may be limited and case management of high numbers of quarantined individuals will be challenging. In general, all individuals who are exposed (i.e., close contacts of infected persons) should monitor for symptoms and wear a well-fitted N95, KN95, or surgical mask for 10 days. If an individual develops symptoms at any time, they should isolate immediately and get tested.

Residential campuses that elect to follow guidance for congregate settings should follow CDC’s Isolation in High-Risk Congregate Settings guidance. Under this protocol, all exposed individuals quarantine for 10 days regardless of vaccination or booster status.

Specific strategies for dealing with a shortened quarantine should take vaccination status and individual risk factors into account.

Close contacts who are up to date on COVID-19 vaccination can forego quarantine altogether if they are asymptomatic; therefore, maximizing vaccine uptake is ideal. Those who are up to date on COVID-19 vaccination should be instructed on proper mask-wearing and to monitor for symptoms 10 days from the time of exposure. They should seek testing on day five or at any time before or after if they develop symptoms.

Close contacts who are not up to date on COVID-19 vaccination should quarantine for at least five full days. An individual could leave quarantine after day five if asymptomatic and with a negative NAAT or rapid antigen test performed on day five. The individual should be instructed on symptom monitoring and the proper use of a well-fitted N95, KN95, or surgical mask that should be worn for 10 days after their initial close contact. If the individual cannot adhere to the mask recommendations, continuing the 10 days of quarantine should be strongly considered.

Individuals who have had COVID-19 in the past 90 days do not need to quarantine or get tested for SARS CoV-2 if they were in close contact with an infected individual unless they develop symptoms.

Ventilation

Strategies to adequately ventilate and filter air in indoor spaces should be implemented to the extent it is feasible and possible. When possible, opening a window in a room a few inches can be useful. The addition of portable HEPA filters can be helpful, especially in spaces that lack mechanical ventilation.

Students at High Risk

Students with comorbidities that place them at higher risk for serious disease should consult with campus health services or their private health care provider regarding the best strategies for reducing their risk and avail themselves of accommodations offered by the IHE. Referrals to and collaboration with campus partners in student affairs, academic affairs, and disability services will afford students an opportunity to address their specific needs.

Please refer to ACHA guidance issued December 6, 2021, for more detailed information and avail yourselves of the ongoing conversations among peers online on ACHA Connect.

Thank you for taking the initiative to create your plans and for continuing to keep our campus communities safe.

Sincerely,

The ACHA Board of Directors and the ACHA COVID-19 Task Force