As virus cases mount, who’s overseeing Virginia universities?

As colleges and universities across Virginia reopen their campuses to students — leading, in some cases, to surging cases of COVID-19 — many have done so with plans that weren’t vetted by the Virginia Department of Health or even, in some cases, their local health departments.

Dr. Laurie Forlano, VDH’s deputy commissioner for population health, told the Mercury that the agency’s central office in Richmond did not review college reopening plans prior to students’ arrival for the fall semester. “The local health departments, I’d say that is where that consultation and collaboration happened,” she added in an interview last week.

But how involved health officials were in those plans has varied considerably, largely depending on the region.

A regulatory void

Dr. Danny Avula, director of the Richmond and Henrico Health Departments, and Dr. Benjamin Schwartz, director of epidemiology and population health for the Fairfax County Health Department, said that staff did review reopening plans for each of the schools in their districts. In Charlottesville, health officials have communicated with school leaders and coordinated a contact tracing simulation with the University of Virginia in July, but did not review a copy of its reopening plan, according to Ryan McKay, the senior policy analyst for the Thomas Jefferson Health District.

Liberty University, which made headlines in late March for reopening its campus during the early days of the COVID-19 pandemic, also didn’t receive a local review. The Central Virginia Health District “is not performing individual review of reopening plans nor performing inspections prior to students’ arrival,” population health manager Lindsey Lockewood wrote in an email on Wednesday.

“CVHD’s role is to serve as a resource for those who need guidance applying the reopening requirements to the unique characteristics of their particular school,” she added. 

It’s left a regulatory void as many of Virginia’s four-year colleges and universities bring thousands of students back to local communities. By June, state officials had determined that colleges and universities would be allowed to reopen their campuses in the fall as long as hospitalizations were stable and there were “positive trends in public health data” (though daily cases have nearly doubled since June and the state’s percentage of positive COVID-19 tests — at 7.7 percent as of Thursday — is a full percentage point higher than it was at the end of that month). 

But officials also reassured Virginians there would be high standards for resuming in-person academics. Gov. Ralph Northam, who has issued strict restrictions for restaurants, entertainment venues, social gatherings and other aspects of everyday life throughout the pandemic, issued nine pages of guidance for higher education that described VDH and local health departments as “close partners” to colleges and universities. At a news conference on June 11, Peter Blake, director of the State Council of Higher Education for Virginia, announced that nearly 100 institutions would be tasked with submitting detailed reopening plans to the organization for review.

“Institutional plans will not only address the safety of the students, but also the health of the faculty and staff, many of whom are from vulnerable populations” Blake said. “The plans will also consider the needs of the communities that are home to our institutions.”

‘At no point are we … involved in regulating” 

SCHEV did review every reopening plan, according to spokeswoman Laura Osberger. But in a preface above its online database, SCHEV emphasizes that “certification by SCHEV does not constitute ‘approval’ of a plan” — only that it meets 26 criteria set out in the governor’s guidance. Those guidelines set broad requirements that schools develop “strategies to decrease the risk” of on-campus housing, for example, and create a plan for “campus outbreak management,” with no details on what should be included in those measures. 

“We did not say, ‘This is a good plan, this is a bad plan,’” Osberger added. “It’s not an endorsement.” Nor does SCHEV — described as a “coordinating body” for Virginia higher education — have regulatory authority over the state’s colleges and universities. Osberger stressed that the organization could not close a campus over outbreaks of COVID-19 or even enforce mitigation measures to curb the spread of the virus.

“If we get a complaint that such-and-such university isn’t following its plan, we would look at the plan, reach out to the institution, and say, ‘We’ve had this complaint, make sure you’re addressing it,’” she added. “But we haven’t had any of those.”

Local health departments likewise said they have no regulatory authority over colleges and universities when it comes to closing down campuses or mandating new policies in response to outbreaks. Avula contrasted the guidelines for higher education with Northam’s statewide mask mandate, which specifically gives VDH — including local departments around the state — the authority to enforce the order. In response, the agency’s central office requested $6 million for additional inspectors, and local departments began shifting staff or hiring new workers to look into complaints, Avula said.

VDH wasn’t given the same explicit authority to oversee or respond to actions on campus. “At no point are we, at the local health department level, involved in regulating,” Avula said. “Certainly we try to provide the best guidance that we can, but it’s never been VDH’s role to approve plans — just to provide suggestions and guidance and encourage everyone to minimize transmission as much as they can.”

At times, that’s given colleges and universities the freedom to make decisions contrary to state health guidance, with some actions drawing scrutiny from faculty and students. Interim recommendations issued by VDH in July, for example, discouraged campus-wide testing before reopening — guidance that Forlano said was largely based on limited testing resources and concerns that negative test results could provide a false sense of security. “Most tests are a point in time, so testing a student today is what that student’s status is today,” Forlano said.

That didn’t stop multiple universities from requiring a negative test result from students before they returned to campus, or coordinating pre-entry testing through third-party vendors. George Mason University, Virginia Commonwealth University, and William & Mary all contracted with Kallaco, a startup first incorporated in April, to provide at-home testing kits to thousands of students. The company processed the tests through Opteo, a laboratory based in New Orleans, which uses a PCR test that hasn’t been validated by the U.S. Food and Drug Administration for self-collected samples. In mid-August, the FDA also warned that the kit carried a risk of false results.

In an interview last week, Kallaco CEO John Spivey said Opteo had taken steps to ensure the test was valid for self-collected samples and made adjustments to mitigate the risk of false results. Opteo did not respond to a request for comment, and the lab is not currently authorized by the FDA as having validated its own COVID-19 test — something Spivey attributed to the agency’s long turnaround times for approving lab-developed tests. 

After faculty from George Mason and VCU raised concerns with Kallaco’s testing process, George Mason changed its collection protocols so that anyone collecting their own samples had to be supervised by a medical professional. Dr. Ali Andalibi, the associate dean of research for George Mason’s College of Science, concluded the school’s “initial screening process was not ideal,” according to a statement from university President Gregory Washington, but “concluded that the results we attained were reliable.”

Initially, Opteo also wasn’t forwarding its results to VDH, something required by state and federal regulations. VDH confirmed Wednesday that Opteo had begun submitting its results to the department, but in an email on Thursday afternoon — in response to detailed questions aimed at confirming whether Opteo was equipped to adequately process self-collected samples from students — Forlano said the Mercury would need to reach out to specific universities for more information on the tests. Universities have referred those questions to Kallaco. The U.S. Food and Drug Administration referred the Mercury, after several back-and-forth emails, to the U.S. Department of Health and Human Services, which did not respond to multiple calls and emails for comment.

Forlano said the agency also sent a questionnaire out to colleges and universities last Thursday — after the Mercury asked if other schools had used labs other than established national providers such as Quest and LabCorp — to determine what laboratories were being used for testing. Randolph-Macon College, Virginia State University and Hampden-Sydney College also listed Kallaco or Opteo as their testing providers, according to Forlano, but it’s still unclear if any other small laboratories are processing tests from Virginia universities.

‘Those conditions seemed absurd’ 

Beyond the technical concerns over pre-entry testing at some schools, students have raised questions over how widely testing overall is being conducted. One VCU student, who asked that her name not be used due to concerns that the university would penalize her for speaking out, told the Mercury that she contacted university health services after her roommate was exposed to the virus. Her roommate’s results — which eventually came back positive — were still pending at the time she called, and the student said she was told she wasn’t eligible for testing because she was asymptomatic and hadn’t had contact with a laboratory-confirmed case.

“With a virus that often shows up asymptomatic and could be spread from a stranger in a grocery store, those conditions seemed absurd to me if they want to keep down infection rates at all,” the student wrote in an email. Since Aug. 23, VCU has reported a total of 191 COVID-19 cases among students and employees and converted its Honors College building into an isolation ward after a cluster of COVID-19 infections among student athletes.

“While I wouldn’t be able to address an individual student’s situation or experience, I can share that VCU conducted entry testing for our residential students, tests students with symptoms and conducts prevalence testing on students faculty and staff,” university spokesman Michael Porter said Wednesday, adding that “Student Health refers students for testing if they are symptomatic or have been in contact with a positive patient.”

Any student can independently seek testing at an outside clinic or a community testing event. But many pointed out that it can require students to shoulder an added out-of-pocket cost, or discourage those without symptoms from getting tested. Wait times still vary across Virginia and by location. CVS Pharmacy, for instance, is now estimating a two- to three-day turnaround for tests, but some Virginians are still reporting waiting more than a week for results to come back — a lag Northam has previously described as “unacceptable.”

Procedures vary widely

Testing procedures also vary widely from school to school. James Madison University, which shifted to online learning on Tuesday after hundreds of students tested positive for COVID-19 almost immediately after returning to campus, didn’t require pre-entry testing at all. Some schools refer students to outside providers, while other students can have samples collected at their university health centers. 

Processing methods vary, too. Schwartz said samples from students at George Mason are processed by the county’s public health laboratory, ensuring results within a day or two. JMU’s reopening plan called for samples to be sent to LabCorp. There’s also varying levels of support for the local health departments that ultimately handle the investigation and contact tracing for cases on campus. Avula said VCU hired its own contact tracers, who track and upload cases into the same software program as public health employees. UVA agreed to fund seven new contact tracing positions at the Thomas Jefferson Health District, which McKay said would be filled over the next four to six weeks. Classes at UVA are scheduled to begin on Tuesday.

But at James Madison, contact tracing was left to the local health department. “We hired an occupational health nurse, and that person handles the faculty and staff side,” university spokeswoman Caitlyn Read said in a phone interview on Wednesday. “Now, if an employee wants to go get a test and they’re symptomatic, or they have questions about COVID-19, they can contact this individual. So, we did put resources into helping our faculty and staff.”

By Wednesday, JMU was reporting 627 total cases of COVID-19 on campus. Only five were among school employees.

Some students at James Madison said the school simply lacked the resources to enforce safety measures among thousands of students both on- and off-campus. Read said the majority of cases were linked to off-campus social gatherings that violated the school’s COVID-19 student agreement. But in the less than a week that campus remained open, multiple students shared photos and videos showing dozens of students sitting in lecture halls or gathered in dining facilities. Around 45 percent of classes had an in-person learning component, according to Read.

In the chairs, yes. In the corners of the ballroom where we had to all huddle up and sit on the ground because all the seats were taken, no. pic.twitter.com/DmyWJ3Rv9Y

— Jacob (@Jugger) September 1, 2020

One senior resident adviser also told the Mercury that RAs were charged with enforcing mask wearing and visitor restrictions in residence halls, which immediately presented challenges due to a lack of follow-through by school officials. “Essentially, all we could do was tell people to stop and then document it,” she said. Reports were sent to the dorm’s hall director and then area director, who was responsible for disciplining students or sending the complaint higher up in the administration. But the student said she never saw a violation addressed by the university.

Read said repeated violations could result in a hearing before the university’s Office of Student Accountability. She also added that students were only on campus for five days before the decision to transition back to remote learning. “We have received dozens of reports, and we’re working through them, but it’s the kind of thing that takes time because there are also very complicated issues of individuals’ rights,” she said.

More concerning to the RA was that the university’s health center, where students went for testing, was closed over the weekend, requiring students who were exposed to the virus or who came down with symptoms to electively quarantine until it reopened again. She also said it quickly became clear that there were no consequences for not updating JMU’s daily health screening app — ostensibly a mandatory requirement for students and faculty. 

Another administrative employee said the LiveSafe app — which was originally used by JMU and several other Virginia colleges and universities as a campus safety platform before it began offering daily symptom screening — does not send out a notification if users forget to update it. None of his supervisors ever asked for proof that he had filled it out. 

“There’s lots of days where I forgot to do it, and no one ever followed up,” he added. Read said the app was downloaded around 20,000 times (JMU’s student population is around 22,000, she added), but that it would have been impossible to follow up with every user, every day.

“Again, enforcement here is challenging,” she continued. “We were not keeping track of who was not using this thing, to be totally transparent. There is no way we can feasibly do that, given everything we’re trying to work through.”

‘I certainly have the opportunity to intervene’

There are other large state universities with more than 100 cases of COVID-19 on campus, including UVA — with 174 since Aug. 17 — and Virginia Tech, which recorded a total of 178 positive results as of Aug. 30, the latest available data on its dashboard as of Thursday. At Virginia Tech, an increasing number of cases are among football players. But for now, none have seen outbreaks as extensive as JMU’s, which threatened to overwhelm the school’s designated quarantine and isolation units.

But students, staff and community leaders in some college towns have raised numerous concerns with bringing students back to campus. Charlottesville Mayor Nikuyah Walker called UVA’s reopening plan “a recipe for disaster” in July. The university’s student newspaper, The Cavalier Daily, pointed out in a recent editorial that the school’s more than 100 cases at the time occurred before the majority of students returned for the fall semester. 

Before JMU closed down campus, its student newspaper, The Breeze, reported that the university had denied a Freedom of Information Act request for cases broken down by whether they occurred on- or off-campus. Multiple local health departments told the Mercury they were also unlikely to inform an entire residence hall if a student living there tested positive, or share if a positive case had been linked to other exposures in communal spaces such as bars and restaurants. Schwartz, the Fairfax director of epidemiology and population health, referred a reporter to the university when asked for confirmation on the number of positive cases at George Mason. 

With little regulatory authority given to local health departments, Avula said any decision to shut down a campus or impose new safety guidelines would have to come from the state’s health commissioner, Dr. Norman Oliver, or the governor himself. That’s largely left schools to self-regulate. At a news conference on Tuesday, Northam said he was watching health metrics on campus and could step in if universities weren’t following their reopening plans.

“We expect our colleges and universities to continue to follow their plans and also to work with the local health districts,” he added. “As long as that is continuing to happen, then I think we can proceed, but if it’s not, I certainly have the opportunity to intervene.”

So far, that hasn’t happened. JMU, the first — and so far the only — university to close down its campus, announced in an email to students on Tuesday that it made the decision “after consultation with the Virginia Department of Health.” Ultimately, the university made the final call, according to state officials.

“As is the case with institutions across Virginia, JMU was in close consultation with VDH,” agency spokeswoman Marian Hunter wrote in a Wednesday email. “However, they made the decision on their own.” 

“Ultimately, these decisions are made at the institution level with support from VDH,” she added.