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IU public health experts respond to the increase in COVID-19 cases in communal living

One of the goals of IU’s strategy to manage COVID-19 is monitoring individual groups across our campuses so that we can make local decisions and effectively manage those areas experiencing significant spread of disease. Despite this dedicated effort, the Greek community is experiencing unmitigated spread of the virus. 

This spread poses a risk to uninfected individuals in the Greek community, students outside of the Greek community, as well as faculty and staff at Indiana University Bloomington. The spread has become so severe that our mitigation testing strategies, contact tracing efforts, and review of outbreak trends may be unable to contain transmission.

As we started the academic year, pre-arrival and on-arrival testing maximized our probability of starting with a “clean slate” in our sororities and fraternities. In theory, we should have seen minimal cases introduced into Greek life after this process. Within two weeks of matriculation, however, a substantial percentage of the Greek community was ultimately placed in isolation for positive cases or quarantine due to close contact with a positive case.

We responded appropriately and have mobilized additional resources to attempt to mitigate further spread, yet we found we are unable to remove people from the population fast enough to prevent the transmission of the virus in this communally housed setting.

Many factors are contributing to the upswing of cases in fraternities and sororities at IU Bloomington.  The sheer infectivity of the virus, coupled with a high percentage of asymptomatic spread, makes it difficult to identify people as soon as they become infected and move them to isolation. As cases increase, tracing contacts in a timely manner becomes challenging. In fact, contact tracing can only successfully mitigate infections if the rate in a population is at a controllable level. When transmissions are as common as they are right now in the houses, contact tracing cannot remove people fast enough to achieve the desired outcome. In other words, we simply cannot bail water out of the boat as fast as it is rising.  

The structures of the Greek houses make it difficult to prevent transmission. Shared spaces, including bathrooms, lead to high-density contacts without barriers to spread when quarantine and isolation cannot happen in an alternative location. Even though a few houses do not currently have cases of COVID-19, we feel that the “incubator” effect of these settings will eventually create fertile ground for even broader spread, eventually spilling over into our non-Greek communities.

We have considered alternative paths pursued by our peer institutions, such as quarantining an entire house together. We feel the risk of this outweighs the benefit, because the infected fraction will eventually transmit to the non-infected fraction due to the close quarters. Decisions on how to reopen a house add additional complexity. For instance, if a house goes on quarantine together, any subsequent students testing positive in this period would reset the quarantine period, leading to serial stacking of 14-day intervals that could go on for months. The multiple intervals of quarantine might not end until everyone is either infected with the virus or immune. During these intervals, those who elected to be off campus for their quarantine would be unable to return to the house, given the high probability for viral transmissions in this communal quarantine setting. 

Indeed, the only completely effective way to ensure transmissions do not occur in a house-wide quarantine would be for everyone to have their own room and their own bathroom, and not come in contact with any other housemate for the entire 14 days (or more) of required quarantine. This does not seem possible at any house.

Given the current constraints of adequate control in communal housing, temporarily closing Greek houses should highly be considered to prevent worsening rates in both the Greek and non-Greek population. 

We do not offer this recommendation lightly. Our mission remains to keep the IU community as safe as possible, and our current assessment of the data supports this major shift in countermeasures. 

We will continue to remain vigilant and adjust processes to focus on delivering safe education to Indiana University Bloomington and all IU campuses as the pandemic continues to evolve.

Dr. Cole Beeler
Director of Symptomatic Testing
Assistant professor of infectious diseases, IU School of Medicine
Medical director of infection prevention, IU Health University Hospital

Dr. Aaron Carroll
Director of Mitigation Testing
Professor of pediatrics and health outcomes research leader, IU School of Medicine

Dr. Adrian Gardner
Director of Contact Tracing
Associate dean for global health, IU School of Medicine
Director of the IU Center for Global Health

IU’s Medical Response Team of experts was established to inform the university’s efforts to keep our campuses safe during the COVID-19 pandemic. Led by top doctors at the IU School of Medicine, the team meets daily to continually assess how the virus is spreading, the effectiveness of our efforts at controlling it, and allocation of resources. They use their medical expertise and a variety of ongoing metrics to shape decisions regarding campus operations in a way that prioritizes health and safety.