I have been teaching my students online since October and do I miss teaching IRL. This new study concludes based on computer models that the combined effectiveness of three COVID-prevention strategies on college campuses — mask-wearing, social distancing, and routine testing — are as effective in preventing coronavirus infections as the Pfizer and Moderna vaccines. I do think this study can stir quite some discussion.

Abstract of the study:

The research, published in Annals of Internal Medicine, has immediate significance as college semesters are poised to start again — and as the distribution of approved vaccines lags behind goals.

The study found that a combination of just two common measures — distancing and mandatory masks — prevents 87% of campus COVID-19 infections and costs only $170 per infection prevented.

Adding routine lab-based testing to the mix would prevent 92% to 96% of COVID infections. Still, the cost per infection prevented increases substantially, to $2,000 to $17,000 each, depending on test frequency.

As the infection rate continues to rise during the winter, the findings are especially meaningful for institutions of higher learning aiming to strike a balance between in-person and remote instruction, while managing costs to promote safety and reduce transmissions.

“While some measures are highly effective, implementing them is entirely up to each college’s financial situation, which may have already become strained because of the pandemic,” said Pooyan Kazemian, co-senior author of the study and an assistant professor of operations at the Weatherhead School of Management at Case Western Reserve.

“It is clear that two common non-medical strategies are very effective and inexpensive — and allow for some in-person instruction,” said Kazemian. “While it’s true routine testing of the asymptomatic helps catch some infections early and reduce transmissions, they also pose the highest financial and operational burden, even if performed every 14 days.”

Among the study’s other findings:

• About three of every four students — and nearly one in six faculty — would become infected over the semester in the absence of all mitigation efforts.
• Minimal social distancing policies would only reduce infections by 16% in students.
• While closing the campus and switching to online-only education would reduce infections by 63% among students, it would be less effective than opening the campus and implementing a mask-wearing and social distancing policy, which would reduce infections by 87% among students.

The study

Researchers examined 24 combinations of four common preventive strategies — social distancing, mask-wearing, testing and isolation — and calculated their effectiveness and cost per infection prevented.

The team took into account interactions between three groups: students, faculty, and the surrounding community (including staff), and used a computer simulation model Kazemian and his colleagues developed — known as Clinical and Economic Analysis of COVID-19 interventions, or CEACOV — that simulated a semester of a mid-sized college (5,000 students and 1,000 faculty).

“While states have started offering COVID-19 vaccine to healthcare workers, first responders, and long-term care facilities, it is unlikely that most students and university faculty and staff will be offered a vaccine until late in the spring semester,” said Kazemian. “Therefore, commitment to mask-wearing and extensive social distancing, including canceling large gatherings and reducing class sizes with a hybrid education system, remains the primary strategy for minimizing infections and keeping the campus open during the spring semester.”

Abstract of the study:

Background:
Colleges in the United States are determining how to operate safely amid the coronavirus disease 2019 (COVID-19) pandemic.

Objective:
To examine the clinical outcomes, cost, and cost-effectiveness of COVID-19 mitigation strategies on college campuses.

Design:
The Clinical and Economic Analysis of COVID-19 interventions (CEACOV) model, a dynamic microsimulation model, was used to examine alternative mitigation strategies. The CEACOV model tracks infections accrued by students and faculty, accounting for community transmissions.

Data Sources:
Data from published literature were used to obtain parameters related to COVID-19 and contact-hours.

Target Population:
Undergraduate students and faculty at U.S. colleges.

Time Horizon:
One semester (105 days).

Perspective:
Modified societal.

Intervention:
COVID-19 mitigation strategies, including social distancing, masks, and routine laboratory screening.

Outcome Measures:
Infections among students and faculty per 5000 students and per 1000 faculty, isolation days, tests, costs, cost per infection prevented, and cost per quality-adjusted life-year (QALY).

Results of Base-Case Analysis:
Among students, mitigation strategies reduced COVID-19 cases from 3746 with no mitigation to 493 with extensive social distancing and masks, and further to 151 when laboratory testing was added among asymptomatic persons every 3 days. Among faculty, these values were 164, 28, and 25 cases, respectively. Costs ranged from about $0.4 million for minimal social distancing to about $0.9 million to $2.1 million for strategies involving laboratory testing ($10 per test), depending on testing frequency. Extensive social distancing with masks cost $170 per infection prevented ($49 200 per QALY) compared with masks alone. Adding routine laboratory testing increased cost per infection prevented to between $2010 and $17 210 (cost per QALY gained, $811 400 to $2 804 600).

Results of Sensitivity Analysis:
Results were most sensitive to test costs.

Limitation:
Data are from multiple sources.

Conclusion:
Extensive social distancing with a mandatory mask-wearing policy can prevent most COVID-19 cases on college campuses and is very cost-effective. Routine laboratory testing would prevent 96% of infections and require low-cost tests to be economically attractive.