Abstract
During early August 2020, county-level incidence of coronavirus disease 2019 (COVID-19) generally decreased across the United States, compared with incidence earlier in the summer (1); however, among young adults aged 18-22 years, incidence increased (2). Increases in incidence among adults aged ≥60 years, who might be more susceptible to severe COVID-19-related illness, have followed increases in younger adults (aged 20-39 years) by an average of 8.7 days (3). Institutions of higher education (colleges and universities) have been identified as settings where incidence among young adults increased during August (4,5). Understanding the extent to which these settings have affected county-level COVID-19 incidence can inform ongoing college and university operations and future planning. To evaluate the effect of large colleges or universities and school instructional format* (remote or in-person) on COVID-19 incidence, start dates and instructional formats for the fall 2020 semester were identified for all not-for-profit large U.S. colleges and universities (≥20,000 total enrolled students). Among counties with large colleges and universities (university counties) included in the analysis, remote-instruction university counties (22) experienced a 17.9% decline in mean COVID-19 incidence during the 21 days before through 21 days after the start of classes (from 17.9 to 14.7 cases per 100,000), and in-person instruction university counties (79) experienced a 56.2% increase in COVID-19 incidence, from 15.3 to 23.9 cases per 100,000. Counties without large colleges and universities (nonuniversity counties) (3,009) experienced a 5.9% decline in COVID-19 incidence, from 15.3 to 14.4 cases per 100,000. Similar findings were observed for percentage of positive test results and hotspot status (i.e., increasing among in-person-instruction university counties). In-person instruction at colleges and universities was associated with increased county-level COVID-19 incidence and percentage test positivity. Implementation of increased mitigation efforts at colleges and universities could minimize on-campus COVID-19 transmission.
Highlights
Morbidity and Mortality Weekly ReportOpening of Large Institutions of Higher Education and County-Level COVID-19 Incidence — United States, July 6–September 17, 2020
Broader generalizations based on the matched analysis might not be warranted because 11 university counties with in-person instruction were excluded from the matched analysis because no appropriate matches were available
COVID-19 incidence, hotspot occurrence, COVID-19related testing, and test positivity increased in university counties with in-person instruction
Summary
Opening of Large Institutions of Higher Education and County-Level COVID-19 Incidence — United States, July 6–September 17, 2020. County-level mean estimates of COVID-19 incidence,§ testing rates, percentage test positivity,¶ and hotspot status** were compared for university counties with remote-instruction, in-person–instruction, and nonuniversity counties during the 21 days before and after the start of classes. Difference-in-difference estimates used a regression model with the following specification: Yct = α + β1∙In Personct + β2∙Afterct + δIP∙Afterct∙In personct + θc + θs + θweek + θweekday + εct, where Yct is the outcome of interest (i.e., either COVID-19 incidence or percentage test positivity) for each county c and each unit of time t (days); In Personct is an indicator equal to 1 if the county has a college or university that started classes in an in-person format; Afterct is an indicator equal to 1 for all the days after the county’s assigned start date (i.e., an indicator equal to 1 for days 0 to 21, where day 0 is the start date); θc and θs are county- and statelevel fixed effects; θweek and θweekday are fixed effects for each calendar week and each weekday; and εct is the unobserved error term. COVID-19 testing, percentage positivity, incidence, and county hotspot status among counties with and without colleges and universities,* by instructional format on the first day of the fall 2020 semester — United States, 2020
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