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ACHA Issues New Guidance on Protecting Vulnerable Populations Amid COVID-19 Pandemic

Along with careful and ambitious plans to reopen for the fall semester amid a pandemic have come pledges from campus leaders to keep all of their students safe. But new guidance from the American College Health Association (ACHA) urges college officials to also protect, support and engage those who are most vulnerable in the campus population as they respond to the COVID-19 pandemic and its consequences.

Dr. Jean ChinDr. Jean Chin

In its Supporting Vulnerable Campus Populations During the COVID-19 Pandemic guidelines, ACHA names African American/Black, Asian American, first generation/low income, international, Latinx, LGBTQ+, Native American, and undocumented students, as well as students with disabilities as groups that have not only experienced the pandemic’s disproportionate impact, but the economic fallout, racism and health disparities that have been at the intersection of the public health crisis. This list, authors point out, is not exhaustive, and students may fall into multiple categories.

“We know from history that our most vulnerable citizens — marginalized, low income, underserved, and people of color — are the same people who suffer the most during a global health crisis. That holds true on college campuses as well,” says Dr. Devin Jopp, ACHA’s CEO. Among them are students attending historically Black colleges and universities. Many are often “uninsured or underinsured and rely on the care and services provided by student health centers and campus counseling centers, and during the pandemic, face “a unique set of challenges,” authors said.

Dr. Jean Chin, an associate clinical professor of medicine at Augusta University/University of Georgia Medical Partnership, sits on the ACHA’s COVID-19 Task Force and is an author of the guidelines. Diverse spoke with Chin about the new guidance, mitigating a campus outbreak and whether a successful fall semester during a pandemic is possible.

DIVERSE: What have been your thoughts as you’ve tracked and watched the recent round of campus openings and sudden shifts to sending students home and going all virtual?

CHIN: I believe that many colleges moved forward to open even knowing the rate of community transmission was high. UNC Chapel Hill was a prime example of that. Community transmission was high, the Orange County [North Carolina] health officials asked to delay opening because of case rates. UNC Chapel Hill listened but opted to go a different way. If there was a clear national strategy with adherence to clear metrics, there would be less of a patchwork approach. Students are going to have lapses in behavior. That student behavior, the wild card in all the plans, will be the driving force of openings and then closings.

I also go back to the lack of a national strategy to manage this pandemic which has been unchecked for the better part of 9 months. The lack of a testing strategy, mask policies, PPE [personal protective equipment], testing supply distribution, and the fortitude to adhere to a phased reopening of the country has led to piecemeal approaches to reopening and closing of bars, restaurants, businesses, schools, and [higher ed institutions].

We are all pandemic weary and want some normalcy. We want a normal fall with its vibrant campus life, sports, tailgating, rush, and all those opportunities to meet new people who will become your new best friends or your life partner. We want those rich academic opportunities to rub elbows with renowned researchers, professors, lecturers, and entrepreneurs who could open future employment or professional doors. We want to teach clinical skills and see patients again without the face shields, the gloves, the N-95s, the Plexiglas, the video screens, and the other barriers that certainly protect us but decrease rich, interpersonal interactions.

With all these desires for normalcy, it shouldn’t be too terribly surprising that there have been lapses in judgment and behavior. I give credit to those leaders who have made the very difficult call to walk back an opening decision, particularly knowing the myriad stakeholders and pressures they had to balance. Some would argue they should have never opened in the first place, but you know the saying about hindsight.

DIVERSE: In the process of these recent campus shifts, some campus leaders are blaming students. Did you see this scenario coming? Could you have written the script?

CHIN: Yes, and no. My script would have multiple final scenes based on student adherence to public health recommendations and the level of community transmission in the surrounding community. Student behavior was always the wild card. Even the most detailed meticulous planning would unravel with the unholy trinity of mass gatherings, no masks, and no physical distancing. Add alcohol to the mix, and it is like gas on a fire.

DIVERSE: Why was new guidance for campuses enrolling vulnerable populations needed?

CHIN: To be clear, the task force had intended to include the vulnerable populations piece in the original reopening guidelines that were published on May 7. However, as the list of vulnerable populations that we wanted to include continued to expand, we decided this topic needed its own standalone document. Also, we didn’t want to hold the release of the reopening guidelines for the additional two or more weeks that it would have taken to cover these topics. That said, though we all have been impacted by this pandemic, [the] underrepresented, marginalized, and students of color have been disproportionately affected by the disease, the economic downturn, and the move to online learning. We needed to draw attention to the additional resources and supports these unique populations needed to continue their education during this pandemic.

DIVERSE: When it comes to students of color, were there essential elements missing from the discussion and planning that colleges and universities did to reopen their campuses?

CHIN: Campus plans lacked recommendations customized for these vulnerable groups. Recommendations to involve students in creating, editing, or vetting prevention messages; recommendations to develop culturally competent networks of care and services with empathy and understanding of these students’ unique perspectives, challenges, and needs. In the midst of emergency preparedness and planning, the health and safety of the whole is a priority. These considerations are reminders of the needs of the diverse parts of the whole that campuses serve, particularly those who are disproportionately affected by this pandemic.

This [ACHA] newest set of guidelines provides recommendations on how to assist and support those vulnerable students, i.e. the people utilizing the facilities and the campus as opposed to recommendations for the overall campus itself.

DIVERSE: What impact do you hope that the new ACHA guidance for vulnerable populations will have on campuses, their leaders and ultimately students as the new academic year begins?

CHIN: The entire [ACHA] task force hopes that this guidance provides campus leaders a call to action to recognize, protect and support the most vulnerable members of our campuses so they can achieve their academic goals. These guidelines also have actionable insights for campus consideration.

DIVERSE: From a medical and COVID testing standpoint, what would a successful fall semester look like on college campuses when and if they can finish as scheduled?

CHIN: Medically speaking, success on campuses would include a universal influenza vaccination, robust telemedicine and telemental health processes are implemented to meet student needs and protect the health and safety of the health care workers and staff responsible for delivering those services; face coverings and physical distancing are universally adhered to. And, as far as testing is concerned, ideally all campuses would have access to inexpensive, accurate tests with rapid turnaround times (less than 24-48 hours). However, testing is only one tool in the toolbox. We must also have contact tracing in place and sufficient isolation/quarantine space, universal masking requirements, physical distancing, appropriate cleaning and disinfection protocols.

Students will get infected with COVID-19. Success in this arena means planning for testing, isolation/quarantine that adequately removes the student from the mainstream and breaks the chain of transmission early. Success also means the student in quarantine or isolation has adequate support, including meals, medical/mental health care, educational assistance, etc.

A successful fall semester would look different on each campus. Broadly speaking, success means campuses executed their plan whether that plan was a hybrid, in-person, or [a] fully remote plan, anticipated all the bumps in the road, and implemented their contingency plans successfully, even if one of their contingencies was to change course completely. Successful planning starts with who is invited to the table and that plan includes communicating frequently and transparently. Ideally, there would be no reports of mass student gatherings without masks and without physical distancing. But if there are any failures in the plan or planning, leadership assumes responsibility and conversely will share and celebrate any successes with students, faculty, and staff.

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