There are five key factors that universities should consider ahead of the start of the new academic year, say Simon Williams and Gavin Yamey
One year ago, when universities in the United States re-opened for the fall semester, the outcome was disastrous. At that time, the US had about 55,000 new daily cases and there was “no federal covid-19 control plan or coordinated vision for safely reopening universities.”  In the United Kingdom, like the US, chaotic re-openings sparked outbreaks that plunged “entire flats and halls of residence into lockdown.” [2,3]
With universities on both sides of the Atlantic about to reopen, institutions of higher education are “once again confronting the challenges posed by SARS-CoV-2 in their planning for safe operations during the approaching academic year.”  The challenges are heightened by the Delta variant, which is estimated to be twice as transmissible as the original coronavirus strain, and which is now dominant in both the US and UK. 
It remains critically important to protect students from covid-19. While it’s true that covid-19 rarely kills young adults, they certainly can become ill and can also develop long term symptoms; studies suggest that about 10% of infected people at any age can develop long covid.  Infected students can infect older, vulnerable adults on campus, including teachers and university maintenance and service staff. There is also evidence that campus outbreaks can drive infection in the communities around the university. 
So, what steps can universities take to make autumn re-openings safer? We believe there are five key considerations.
First and foremost is the level of vaccination coverage. A new modelling study finds that colleges that achieve vaccine coverage of over 90% may safely return to normalcy.  In other words, say the authors, “campus activities can be fully resumed while holding cumulative cases below 5% of the population without the need for routine, asymptomatic testing.”  It will be difficult to reach such high coverage rates unless colleges have a mandate, and indeed many US colleges and universities require all students, staff, and faculty to be vaccinated before returning this fall.  If vaccination coverage is below 90%, colleges will have to rely on measures such as regular testing, masking, and distancing to keep campuses safe.
In England, at the time of writing this, students will not be required to show proof of vaccination.  The government is trying out various incentive schemes as well as vaccine passports in nightclubs to boost the number of young people getting vaccinated. [10,11]
The reasons for vaccine hesitancy (or vaccine delay) are complex, but include a lack of urgency to get vaccinated due to a reduced perception of individual risk and the inconvenience of making appointments.  Universities can increase uptake by offering vaccinations on site. Planning ahead, discussions for booster jabs are underway (in the UK vulnerable groups are due to be offered them from September), and health service and vaccine providers can work with universities to facilitate and increase uptake of booster jabs on campuses. 
Second, universities on both sides of the Atlantic are considering delaying or phasing in their autumn re-openings or incorporating a blended learning approach. Universities should consider a phased return so as to avoid a mass migration of all their students over a matter of weeks (the UK for example has about two million higher education students).
Third, wherever possible, universities, governments, and other relevant stakeholders and funders should invest in ensuring adequate ventilation across campuses, including in classrooms and accommodations. Between now and the start of the academic year is sufficient time for substantial investment in HEPA filters and CO2 monitors to ensure adequate ventilation across university buildings. 
This investment will provide benefits not just in the short-term related to covid-19, but also in the longer term for covid-19 and other respiratory diseases (including “freshers flu,” a group of illnesses caused by various viruses).  In the initial weeks of term, the incorporation of outdoor classrooms and social spaces should be encouraged where possible.
Fourth, effective contact tracing, combined with effective on-campus testing, isolation, and support is key to minimizing any impacts of transmission on and beyond campuses. Additional resources to ensure adequate support for self-isolation—to encourage adherence and mitigate any negative impacts of self-isolation—should be made available. 
Finally, masks still have a role to play in certain circumstances. In the US, the Center for Disease Control recently changed its guidance so that everyone—not just the unvaccinated—should wear a mask indoors in places with high levels of transmission.  Their new guidance was based on data suggesting that if a vaccinated person becomes infected, the cycle threshold value—an indication of how much virus a person is carrying—may be the same as in an unvaccinated infected person.  Some US universities, such as Duke University, are mandating indoor masking along with vaccination. 
Public opinion in the UK and US remains favorable towards maintaining facemasks, particularly in crowded settings. [20,21] Social distancing in large classrooms should be retained in certain circumstances (e.g. where local community rates are high). Where this is not possible, and where large group classrooms (e.g. lectures) are deemed pedagogically important, masks should be required as a precautionary measure for the initial phase after reopening.
Simon Williams is senior lecturer in people and organisation in the School of Management in Swansea University, and adjunct assistant professor in the Department of Medical Social Sciences in the Feinberg School of Medicine at Northwestern University, Chicago. Twitter @drsimonwilliams
Gavin Yamey, professor of global health and public policy, Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, NC, USA. Twitter @GYamey
Competing interests: GY is a signatory to the People’s Vaccine campaign and is a funding member of Amnesty International, one of the members of the People’s Vaccine Alliance. He was a member of the COVID-19 Vaccine Development Taskforce, hosted by the World Bank, and participated as an academic unpaid adviser in the consultation process that led to the launch of COVAX. He has received grant funding from the WHO, Gavi, the Vaccine Alliance, and the Bill & Melinda Gates Foundation. SW has no competing interests to report.
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