To return to campus, every one of us experienced a common pain: a cotton swab shoved up our noses. At least, I hope we all have this in common by now. I initially hadn’t planned to return to campus, but decided otherwise after agreeing to serve as a teaching assistant for an in-person class — ironically, Concepts and Methods in Infectious Disease Epidemiology — at the last minute. Although my pre-pandemic research focused on influenza and rotavirus, I, like many other infectious disease epidemiologists, now spend some time working on the COVID-19 response.

Let me be clear: we are resuming in-person instruction without the minimum necessary conditions to ensure everyone’s safety. Low rates of community transmission are key to reopening safely, yet just days ago the White House specifically warned that Georgia is still experiencing “widespread and expanding community viral spread.” Emory’s health-promotion measures are certainly less cavalier than what students are experiencing at many other institutions around the country. But are they enough? No — and the additional measures may lull us into a false sense of security. 

Although we were all screened (i.e. tested even without the presence of symptoms) for SARS-CoV-2 infection before the semester began, Emory’s public health protocols do not include regular and frequent campus-wide screening. We have a testing strategy, but not a regular screening strategy. The latter is crucial because it allows for the identification of contagious individuals who do not have symptoms; between 35% and 70% of COVID-19 transmission is estimated to be symptomless. Emory’s own infectious disease epidemiologists included this transmission process as a foundational piece of a model developed to estimate how many COVID-19 cases, hospitalizations and deaths might occur at Emory under different return-to-campus scenarios. 

The projected impact of different screening strategies alone is striking. Based on the model’s projections, were the entire student body to return to campus, wear masks and practice social distancing, 3,056 students and 1,046 faculty and staff would be expected to become COVID-19 cases in the fall semester without routine screening. Monthly screening would reduce cases by 30% and 29%, respectively, and weekly screening would reduce cases by 81% and 65%. Start-of-semester-only screening was deliberately not modeled because “screening on return would have limited effect” on case prevention. While routine screening does not eliminate our risk completely, it certainly makes us substantially safer.

It’s worth noting that reduced class sizes, reductions in the actual number of students returning to campus and other risk-mitigation measures which Emory has implemented were not explicitly modeled. Nonetheless, while these measures may make us feel safer, they reduce risk only incrementally. Temperature checks may catch high fevers, but are unreliable for specific COVID-19 detection. Directional signs prevent brief contact with others, but how long we spend near someone matters more. Sanitizing surfaces kills germs, but we can’t really touch our faces if we’re already wearing masks properly. None of these measures actually protect uninfected people against aerosolized viruses expelled when contagious individuals breathe or talk. An aerosol can pass through masks and linger in the classroom air. But because we feel safer, it can be tempting to stand or sit closer to people, or wear our masks a little less often. Maybe we think a small, maskless gathering of only Emory students is safe enough.

We already have a preview of what awaits, should we succumb. Four clusters of COVID-19 cases have already been identified at the University of North Carolina at Chapel Hill less than a week after they began classes. Chapel Hill has now shifted entirely online for their undergraduate students. On a drive through Emory Village on Sunday evening, I saw throngs of maskless students milling about. My heart ached with worry for each of them. Yes, we were all tested before school started. That test only tells you if you are infected at that very moment in time. The test means nothing if you get exposed afterwards: at the grocery store, on a walk, in a class or somewhere else. Holding each other accountable for our collective health matters. 

In public health, perfect is the enemy of good. But there’s a difference between a good plan and a good-looking plan. It may feel unbearable to go without hugs and handshakes, or stifling to have distanced lunches and attend masked classes. I miss the comfort of normalcy, too, but please, stay alert for yourself and for others. Have those hard conversations if you see or know someone engaging in high-risk activities. This is not the in-person semester we wanted, but it’s the one we have — and how long we will have it is up to us.

Avnika Amin (17PH, 22G) is from Columbia, South Carolina.

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Avnika B. Amin (17PH, 22G) is a fourth-year epidemiology doctoral candidate and received her master’s degree in epidemiology from Emory University. Her dissertation work focuses on potential causes, methodologic issues and epidemiologic biases influencing heterogeneity in rotavirus vaccine effectiveness. Amin’s research centers on the development and evaluation of vaccines, their role in infectious disease transmission dynamics and interventions to address and prevent vaccine hesitancy.