COVID-19 Prevention at Institutions of Higher Education, United States, 2020 – 2021: Implementation of Nonpharmaceutical Interventions

Abstract

Background: In early 2020, following the start of the coronavirus disease 2019 (COVID-19) pandemic, institutions of higher education (IHEs) across the United States rapidly pivoted to distance learning to reduce risk of on-campus virus transmission. Objective: To explore IHE use of nonpharmaceutical interventions (NPIs) during the subsequent pandemic-affected academic year 2020—2021. Design: Cross-sectional study of data collected January — June 2021. Setting: US four-year, undergraduate IHEs. Patients (or Participants): All public (n=547) and a stratified random sample of private (n=300) IHEs. Measurements: From IHE websites, we documented NPIs, including changes to the calendar, learning environment, housing, common areas, and dining; COVID-19 testing; and facemask protocols, and performed weighted analysis to assess congruence with the US Centers for Disease Control and Prevention (CDC) guidance for IHEs. We used weighted multivariable linear regression to explore the association between IHE characteristics and the summated number of implemented NPIs. Results: Overall, 20% of IHEs implemented all surveyed CDC-recommended NPIs. The most frequently utilized were learning environment changes (91%), practiced as one or more of the following: distance or hybrid learning opportunities (98%), 6-feet spacing (60%), and reduced class sizes (51%). Additionally, 88% of IHEs specified facemask protocols, 78% physically modified common areas, and 67% offered COVID-19 testing. Among the 33% of IHEs offering ≥50% of courses in person, having <1,000 students was associated with having implemented fewer NPIs than IHEs with ≥1,000 students. Limitations: Data collected from publicly available sources may introduce observation biases but allow for large sample size. Conclusion: Only 1 in 5 IHEs implemented all surveyed CDC recommendations, while a majority implemented a subset. IHE size and location were associated with degree of NPI implementation. Additional research is needed to assess adherence to NPI implementation in IHE settings.