Using the Hazard Analysis of Critical Control Points (HACCP) framework, researchers assessed the risk and mitigation strategies for universities with students returning to campus. The methodology allowed a rapid response to curb disease transmission with continuing education.
The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has disrupted the entire world. Apart from its impact on public health, it has also caused great socio-economic harm, disrupting education, employment, and global GDP.
Although people under 25 years are probably the least affected by the virus medically, they will face the most significant long-term burden caused by the efforts to control the pandemic, including disrupted education, reduced employment opportunities, and living with low-quality public services.
Early closure of schools and universities helped reduce transmission in different countries. However, full-time home-based study, especially in the 18-24 age group of university students, led to increased loneliness and logistical problems, such as the availability of quiet spaces to study at home, reliable internet connection, and access to a computer.
Many key sectors employ newly trained university graduates. Interrupting university education will increase shortages of qualified workers in professions such as healthcare, social services, and education. Therefore, ensuring continued college and university education is essential.
Although some courses can be continued and delivered in an online format, many require lab work using resources that are not available at home, fieldwork, and in-person practical training.
Framework for risk assessment and mitigation
To understand the points of virus transmission when university students study and work in a university and ways to mitigate this risk, researchers from the University of East Anglia used the Hazard Analysis of Critical Control Points (HACCP) framework and applied it to the activities of university students. This allowed the researchers to evaluate the possibilities of mitigating virus transmission risk during usual university activities while helping students continue their education. They published their results on the medRxiv* preprint server.
The authors assessed the virus transmission risks for students returning to UK universities in three steps. The HACCP team created various interaction scenarios on campus. Hazards were defined as processes that would provide opportunities for high risk of virus transmission and were categorized as high, medium, and low risk. For the high-risk hazards, the team determined a suitable opportunity to eliminate or control the risk.
The main risks were associated with shared social spaces, such as sports changing rooms and study facilities. For housing, everybody living in student accommodation was considered to come from the same household. Therefore, the use of masks and social distancing was not regarded as necessary unless someone showed symptoms or was tested positive. All other activities were considered medium or low risk.
Framework allowed reduced number of cases on campus
The researchers identified 23 high-risk critical control points (CCPs) or opportunities to adopt measures to contain transmission risk. Physical distancing from others is particularly useful, as are high ventilation rates, outdoor settings, and good hand hygiene practices. How these principles are applied depends on the particular setting.
At the researchers’ university, the COVID-19 response focused on communications, social distancing, and testing and monitoring. The university sent regular communications about safety measures and student responsibilities during the pandemic. There was increased security and monitoring of students to prevent large social gatherings. Hand sanitizers and signs were provided to visually remind students of the COVID-19 risk. Teaching rooms were used between 10-20% of that of normal capacity to ensure physical distancing.
At the beginning of the autumn term, all university community members were encouraged to get tested using a scheme introduced by the university in partnership with the Earlham Institute. Students who tested positive and their households were quarantined for 10 days. The cases were monitored daily, and trends were reviewed to adjust the response as necessary.
After the students arrived back on campus, there was a peak of 69 positive cases after three weeks. The positive cases fell to less than 25 after six weeks. By 9 December 2020, there were only two positive cases, suggesting measures to reduce transmission were successful.
During the beginning of an emerging infectious disease, “the use of a response tool such as the HACCP framework allows for the rapid identification of risks and hazardous behaviors,” write the authors.
Detailed epidemiological studies can provide adequate risk reduction strategies, but they can take a long time to be completed. The HACCP method, in contrast, can be implemented quickly using different sources of information and stakeholders. Therefore, such rapid response techniques can prove useful in reducing the harm from future disease outbreaks.
*Important Notice
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.