It has been nearly a year since severe acute respiratory syndrome coronavirus disease 2 (SARS-CoV-2) – the causative pathogen of coronavirus disease 2019 (COVID-19) – was first detected in Wuhan, China. As the virus continues to claim lives and disrupt economic activity across the globe, infection control measures remain essential.
During the pandemic's peak in March 2020, many schools and universities were closed to help reduce viral transmission risk. By September, however, many countries had lifted lockdown measures, and in-person classes had resumed for the new academic year. In many cases, universities invited students to return to campus but set out strict social distancing regulations and conducted much of their undergraduate teaching online. Given the high number of cases observed in student halls of residence in the UK over the last few months, much speculation has occurred as to whether students represent reservoirs for viral transmission to the rest of the population.
This is because of the high contact lifestyle students are thought to engage in, the close-quarters nature of their shared accommodations, and the fact that many young people are asymptomatic when infected with SARS-CoV-2, and so detecting and preventing spread among them can be difficult.
However, a team of UK-based researchers at the University of Bristol and the University of Exeter found that university students report fewer daily contacts amid the coronavirus pandemic. This said, most of these contacts were those not affiliated with the university, indicating potential transmission to other people other than students and staff.
The team revealed that 8% of the students surveyed reported over 20 daily contacts, increasing the likelihood of catching COVID-19 and infecting others. Over one-third of the reported contacts involved touch.
The study, published on the pre-print medRxiv* server, aimed to provide insight into students' behavior from the start of the 2020/2021 academic year.
The researchers used the COroNavirus QUESTionnaire (CONQUEST), an ongoing survey on contacts, behavior, and potential SARS-CoV-2 symptoms for staff and students at UoB. The survey has been live since June 23, 2020.
The study participants completed an initial questionnaire, which included questions on background demographics. They were provided with an option to fill out a shorter version of the questionnaire on symptoms, contacts, and whether they were infected with COVID-19.
The team focused on the survey data from September to November 2020. The questioned tackled information about demographics, previous day contacts, information about symptoms in the last week, whether the students had been self-isolating, and COVID-19 status.
The students were asked about their contacts, other contacts, and group contacts. The individual contacts were those they spoke to in-person one-on-one, including household and support members. Other contacts were other people they spoke to in person to in the same setting. Lastly, group contacts include large groups of people in the same setting, such as tutorials, lectures, religious services, sports teams, and large gatherings.
What the study found
The study findings revealed that of the 740 students who completed the survey, 35% had symptoms in the previous week, 7% had cardinal symptoms, and 14% had been isolating in the week before the survey.
Of the students with symptoms, only 7% sought medical attention, and 12% thought they had COVID-19. About 20 students had tested positive more than two weeks before the survey, and 42 students had tested positive in the two weeks before the survey, with cardinal COVID-19 symptoms in the last seven days.
The most common symptoms among those who tested positive in the last two weeks before the survey included a runny nose, sneezing, loss of sense of smell, a headache, unusual fatigue, loss of taste, and a sore throat. Meanwhile, 36% of the students reported having a fever and 35% said they had a persistent cough, which are both considered cardinal symptoms of COVID-19.
The team also found that about half of those with COVID-19 cardinal signs had been isolating in that week compared to those without symptoms. Also, 99% of those who tested positive for COVID-19 in the last two weeks had been isolating within the last week.
"Just over half of those who reported cardinal symptoms self-isolated, indicating that some students that should have been isolating had not been doing so," the researchers said.
"Students that had been isolating in the prior week had fewer contacts than those that had not been isolating, with a higher percentage of contacts among those isolating being contacts within their home than for those not isolating," the researchers added.
The team also found that the mean number of contacts reported the previous day was about two. The researchers found that students in their fourth year of study had higher numbers of contacts than those in their first year, despite living in households with fewer members.
This may be due to students in the higher year levels having more social networks than freshmen students. Students in larger households tended to have more contacts than those with just two to three household members.
Those who tested positive within the two weeks before the survey had fewer contacts than those who had not tested positive. This suggests that many of the students attempted to adhere to the COVID-19 guidelines.
The findings also showed that the students in this period had fewer daily contacts than the same survey in 2009, showing that they had been adhering to infection control guidelines to prevent infection.
"We show that while the majority of students report low numbers of contacts on the previous day, there is a sizeable minority that reports large numbers of contacts, highlighting the heterogeneity of transmission and role that individuals with large numbers of daily contacts (potential "super spreaders") could be having on the spread of disease," the researcher concluded.
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
- Nixon, E., Trickey, A., Christensen, H., Finn, A., Thomas, A. et al. (2020). Contacts and behaviours of university students during the COVID-19 pandemic at the start of the 2020/21 academic year. medRxiv. https://doi.org/10.1101/2020.12.09.20246421, https://www.medrxiv.org/content/10.1101/2020.12.09.20246421v1