by Katherine Deane
January – July 2021 – Expect to need to maintain non-pharmaceutical interventions – including social distancing, face masks, cleaning, and rapid tests. Exact interventions may vary with government guidance.
January 2021 – Rising levels of Covid-19 in the community after Christmas mixing may lead to further lockdown conditions.
February-April 2021 – End of Phase One vaccination program. Levels of Covid-19 in the community expected to be initially high, likely requiring some social restrictions to continue in the first few months.
April-July 2021 – End of vaccination of remainder of population. Covid-19 levels dropping across these months. Social restrictions likely to be reduced as the months progress.
Summer 2021 – End of pandemic in UK. Able to stop all non-pharmacological interventions. Staff recover and take holiday.
Autumn 2021 – Start of term with normal teaching program.
The current situation in UK universities
Most universities are providing limited face-to-face teaching using non-pharmaceutical interventions to prevent transmission such as social distancing and additional cleaning protocols. Some universities have implemented higher quality interventions such as the use of face masks indoors, and the availability of asymptomatic swab testing on campus. A few universities have gone to completely online provision. All of these interventions have helped reduce the risk of Covid-19 transmission in UK universities.
The initial exponential growth of Covid-19 cases at the start of term in many universities has slowed down. Some of this reduction has been due to non-pharmacological interventions and university specific restrictions on student activities. However the level of Covid-19 in the community has had significant impact on the levels in universities. So, claims for the efficacy of the Covid-19 safe workplace interventions are yet to be proven, particularly in the context of higher levels of community Covid-19 (Manchester University, 2020).
It is expected that the levels of Covid-19 in the community will continue to be high during winter months as the virus spreads more easily in indoor unventilated environments, and survives for longer in cooler temperatures (Huang, 2020).
Medical risks from Covid-19 are not equitably distributed. People at increased risk from Covid-19 are older, male, have other illnesses, or are from Black, Asian, or other minority ethnic populations (Williamson, 2020; ONS, 2020). It is recognised that young students are at low risk of having a poor acute reaction to being infected from Covid-19. But their risk of infection may be higher as students often live in overcrowded accommodation which substantially increases the risk of Covid-19 transmission (Williamson, 2020). Whilst a severe reaction to Covid-19 is rare, it’s not impossible, with a number of infected Manchester University students ending up in Intensive Care (Parker, 2020). Finally students are in contact with lecturers and support staff who represent a much wider range of ages and medical risks. They are also in contact with the local community and some students (e.g. those in health faculties) are in contact with patients, all of whom could be at higher risk from Covid-19 infection (SAGE, 2020).
A survey of staff at the University of East Anglia identified that about half of respondents were at greater risk from Covid-19 themselves, and/or were in households with people at greater risk or had caring responsibilities for people at greater risk (Figure 1: UCU UEA, 2020). This highlights how complex and interconnected modern society is. It is impossible to segregate those at greater risk from Covid-19 (SAGE, 2020; Griffin 2020).
Figure 1: Would you class yourself or those in your household as moderate or high risk from Covid-19? (UCU UEA 2020)
We now have a better understanding of Long Covid (ie symptoms for more than eight weeks) (Sudre et al, 2020). Long-COVID is characterised by symptoms of fatigue, headache, breathlessness and loss of sense of smell; but also evidence of organ damage (Dennis et al, 2020) and increased risk of neuropsychiatric complications as well (Butler et al, 2020). Long Covid occurs in one in 20 people infected with COVID-19 (Sudre et al, 2020). However it appears to be more common in younger age groups, and affects around 10% of 18-49 year olds who become unwell with COVID-19. It can be severe enough to prevent patients from returning to work or study, and can last for many months.
What happens next?
There is excellent news about a number of vaccines which have been shown to create good levels of immunity (Gallagher, 2020a; Gallagher, 2020b; Bosely 2020; Roth 2020). All the vaccines need two injections to be effective. The government plans a massive roll-out of vaccinations with GP practices (Kanani, 2020) supplemented with vaccination centres set up in conference centres, sports halls, community centres. The immunisation plans start in care home residents and staff at the start of December, with all high risk people and health and care staff immunised by the end of February 2021 (JCVI, 2020; Rapson, 2020). The vaccines would then be rolled out to everyone else with the aim to have the whole adult population of the UK vaccinated by April 2021. This would have massive impact as it would deliver herd immunity (estimated at 60-70% immunity) and stop the pandemic in its tracks. However a number of issues could lead to delays: vaccines need to be approved by the Medicines and Healthcare products Regulatory Agency (MHRA); some stocks of vaccines are already manufactured but more need to be created; vaccines need to be transported to the UK (which may be affected by Brexit); the -80oC cold storage of the Pfizer-BioNTech vaccine during the transport process is challenging and failures will lead to the vaccine being unusable; finding sufficient staff to deliver the vaccines will be hard when the NHS has 100,000 job vacancies; and concerns about vaccine safety may lead to hesitancy and lower than needed uptake. Overall, the estimate of a successful vaccination program being completed by April is the very best case scenario.
Other factors such as greater availability of rapid Covid-19 tests will reduce the frequency of people having to isolate for extended periods of time, so social restrictions are likely to be reduced as the year goes on. However the risk of being infected with Covid-19 will remain relatively high during the first quarter of 2021. Until the population have been fully vaccinated, the proposal of allowing Covid-19 to circulate unchecked in order for the population to develop herd immunity from infections has been refuted as impractical and unethical (Griffin, 2020) and could actually increase the infectivity and lethality of the virus (Spinney, 2020; Bonneaud, 2019). Therefore universities need to be cautious and pragmatic and understand that both the spring and summer terms will almost certainly still need non-pharmacological interventions in place in order to ensure the safety of students, staff and the surrounding communities.
Impact on teaching practice
The University and College Union’s national position is that all university courses should be offered remotely and online, unless they involve practical training or lab work (UCU, 2020), for both the spring and summer terms in all universities. However, few universities have adopted this position. If face-to-face teaching is to continue it should remain at current levels with social distancing, with inevitable consequences in terms of room capacity and the need for repetition of teaching sessions in order to reach entire student cohorts.
As vaccinations start to be rolled out, individual risk levels may reduce, but overall the university community remains at high risk from infection, and of transmitting that to the community they live in (SAGE, 2020; McIntyre, 2020). So whilst it is expected that Covid-19 levels will reduce substantially as we head towards the summer, care should still be taken to reduce transmission on campus.
In addition university management should recognise how tired and burnt out their staff are, with the substantial effort of keeping universities running mostly virtually, and trying to maintain the quality of teaching alongside their own concerns about their health and the health of their friends and families. Many will have suffered losses; many will have supported students dealing with losses. Staff will need time to recover, to take holidays that were not taken during the pandemic, and to decompress from this stressful period of over-work. Then they will be able to return to campus in the autumn of 2021 able to teach effectively.
Don’t just return to ‘normal’
Not all of the pandemic lessons have been negative. I am a disabled lecturer who uses a wheelchair and has an energy limiting disability. I have found virtual working a huge advantage. Other staff with disabilities, caring responsibilities, or just long journeys to work may find the greater flexibility to work more from home also helpful. This flexibility will allow easier management of responsibilities in work and the rest of life. Students with similar issues may find accessing a university level education easier if some or all of their course was delivered virtually. It will be a challenge for university finances, but the opportunity for greater equity of access to university level education is undeniable.
SRHE member Dr Katherine Deane is a wheelchair using Senior Lecturer in Health Sciences and Access Ambassador at the University of East Anglia. She is working to remove barriers to accessing life so people can express their brilliance. Post Covid-19 re-opening guidance with a focus on disabled visitors available here https://embed.org.uk/covid-19-reopening
Reference UCU UEA. 2020. A survey of UCU members’ opinions on the impact of Covid-19 on teaching and workload at UEA. University and College Union, University of East Anglia Branch. November 2020. Available from firstname.lastname@example.org on request