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Harvard’s Coronavirus Response Is Supported by History and Public Health

By Lucas E. Buyon, Sina Famenini, and Jake R. Petrini
Lucas E. Buyon is a Ph.D. student at the Graduate School of Arts and Sciences. Sina Famenini is an MPH45 candidate at the Harvard School of Public Health. Jake R. Petrini is an MPH candidate at the Harvard School of Public Health.

On March 10, 2020, Harvard University decided to transition all classes online for the remainder of the spring semester and asked all undergraduate students to move off-campus in less than one week due to concerns over the outbreak of novel coronavirus, or COVID-19. There is little doubt that this decision has a great impact on students — from moving expenses and airline flights, to the cancellation of social gatherings and provocative speakers, to the possibility of leaving Harvard without an official in-person graduation ceremony. Students have responded with a mix of emotions — from frustration and confusion to elation and uncertainty about when they will see each other again. Some have raised rightful concerns over the safety and support for first-generation and low-income students. Others in the community have questioned the decision and mocked the administration for being too cautious and overstating the threat.

Amid this uncertainty, and fair criticism, Harvard’s overall response is supported by history and public health practice.

Consider the 1918 influenza pandemic and the deliberate choices made by two cities — Philadelphia, Pa. and St. Louis, Mo. Philadelphia allowed public gatherings while St. Louis chose to ban all public gatherings. As a result, there were dramatic differences in the mortality rate per day between the cities: St. Louis had a peak weekly death rate of 31 per 100,000 persons, while Philadelphia’s was 257 per 100,000 persons.

St. Louis’s non-pharmaceutical interventions made the difference. NPIs are a class of public health interventions that do not involve a biomedical or pharmaceutical component, but also serve to help slow the spread of an infectious disease. School closures, shifting classes online, and banning public gatherings are all forms of NPI that fulfill two crisis management goals. First, they eliminate high-risk opportunities for mass infection. Second, they enforce the public health concept of “social distancing,” which intends to keep individual community members from engaging in activities that require close contact with one another for a sustained period of time.

While the 1918 flu and COVID-19 are caused by different viruses, a rapid increase in cases of COVID-19, which is scalable with surge capacity, will similarly burden the healthcare system. Harvard School of Public Health Professor Marc Lipsitch’s study on the 1918 influenza pandemic found that NPIs can have a dramatic effect on public health and that the mortality rate rapidly spikes when NPIs are removed. His findings underscore the importance of maintaining NPIs throughout an epidemic.

The goal of NPIs is to slow and eventually stop disease transmission, which is measured by its effective reproductive number, “R.” R is the average number of people who will get infected by an already infected person. A disease with an R of 2 means that each case will infect on average 2 people, and an R of 1 means each case will infect on average 1 person. R is not a static number, so reducing a disease’s R to be less than 1 is critical to stopping the spread. Therefore, the enforcement of NPIs is particularly important to help reduce R and diminish the likelihood of person-to-person transmission.

NPIs reduce the density of people in a space, which significantly diminishes the likelihood of spread of an infection. Schools bring large groups of people together — a closure limits the opportunities for mass spread because one person has fewer interactions with groups of people. The decision to transition to classes online is an impactful public health intervention — it directly limits the propensity for the spread of this novel infection before it has a chance to establish a foothold at Harvard.

Without school closure, it is likely that when the first COVID-19 case is detected in the Harvard community, the virus will have likely started circulating in the population and spreading without anyone’s knowledge — risking thousands of individuals. By reducing population density — in this case, by de-densifying student housing and ending in-person lectures — Harvard can prevent an outbreak from spiraling out of control. Given the growing number of cases in Boston, the majority of which stem from a Biogen conference where 1 undetected case has led to 70 cases in a matter of days, this decision is a wise public health choice.

We recognize that the news of moving out of dormitories on such short notice cannot be easy. In particular, we realize that this situation places hardships on students who may not have a safe home to go back to or struggle to return home due to finances and travel restrictions. We urge the University to support these students as it goes forward with its plan to move classes online and to take actions as peer institutions have done to support these students by allowing them to remain on campus in de-densified dorms, or paying students who rely on on-campus jobs through the end of the semester. The University’s objective — to keep students safe — should include their financial and psychological well-being. But ultimately, we commend the University for taking decisive and appropriate public health actions toward reducing the spread of COVID-19.

Lucas E. Buyon is a Ph.D. student at the Graduate School of Arts and Sciences. Sina Famenini is an MPH45 candidate at the Harvard School of Public Health. Jake R. Petrini is an MPH candidate at the Harvard School of Public Health.

The writers are members of the Harvard Chan Student Association Executive Board: Lucas Buyon is President, Jake Petrini is a Vice President of Academic Affairs, and Sina Famenini is Vice President of Student Advocacy.

A list of the members of the Harvard Chan Student Association Executive Board is available here.

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