3 Questions: What to expect from Covid-19 this fall

“On campus, approximately 8,000 people have tested positive this past year,” says MIT Medical Director Cecilia Stuopis. “Yet we have had few, if any, hospitalizations, as fully vaccinated and boosted individuals have an exceptionally low risk of hospitalization and death from the disease.”

Cecilia Stuopis, Shawn Ferullo, and Ian A. Waitz discuss where things stand; explain the rationale behind the Institute’s testing and policies; and provide insights about what to expect this fall.

David Tytell | MIT Medical

August 4, 2022

As MIT prepares for the fall — its fifth full semester since the onset of the Covid-19 pandemic — the Institute is continuing to evolve from its initial stance of strong institutional responsibility for managing Covid to an approach rooted in individual responsibility.

Throughout the pandemic, MIT has taken an “always be prepared to pivot” approach, encouraging flexibility to ensure academic and research continuity and to provide ongoing support for community members impacted directly or indirectly by Covid.

In this 3Q, we hear from three people who have played active roles in assessing, monitoring, and helping the MIT community meet its mission throughout the pandemic: Cecilia Stuopis, director of MIT Medical; Shawn Ferullo, associate medical director and chief of student health at MIT Medical; and Ian A. Waitz, vice chancellor for undergraduate and graduate education. They offer reflections on the evolving and current state of the Covid pandemic and its impact on the broader campus community.

Q: What is the latest concerning Covid in our surrounding community? 

Stuopis: The pandemic and the response to it is always changing, but at this stage, it seems clear that we are moving toward an endemic phase — in fits and starts. As we shared back in February, the first place we look to understand the level of Covid in our surrounding area is wastewater. These data provide the most unbiased, accurate measurement of disease levels directly impacting MIT and its surrounding community.

For now, things are holding steady — with national hospitalization levels remaining relatively low. Many of us at MIT and throughout the country have either had Covid-19, or have friends and family members who contracted the illness. Omicron variants continue to be prevalent and are about as communicable as measles, so at this point, there are no safe bubbles, no matter how much we test or try to control access.

In better news, thanks in large part to vaccines and pharmaceuticals, we are in a much different place than we were even a year ago. On campus, approximately 8,000 people have tested positive this past year. Yet we have had few, if any, hospitalizations, as fully vaccinated and boosted individuals have an exceptionally low risk of hospitalization and death from the disease. Many who do test positive are now eligible to receive Paxlovid — available at any retail pharmacy — which helps to mitigate symptoms for most people who take it. And, perhaps most gratifying and encouraging, the youngest members of our community can finally be vaccinated as well.

Covid is far from over, but we are moving to a place where, as a society and as individuals, we are learning how to live with the disease. I don’t mean this to sound glib. Too many of us — myself included — have lost loved ones to this terrible pandemic. But we are progressing to a point where Covid is more closely resembling the flu than the terrifying disease it was back in early 2020.

Q: How and why has the Institute decided to change how we manage Covid testing on campus? 

Ferullo: First and foremost, the use of how and when we test, like with our peers, has evolved as the pandemic has evolved. Social distancing, PCR testing, and masking were once our only tools. Now they are just three tools among many, including vaccines and boosters, the wide availability of at-home testing, and pharmaceutical treatments. We have, however, always needed to be on our toes.

For example, when Omicron arrived this past January, we quickly realized that because the variant was so transmissible, surveillance testing and contact tracing could not prevent infection of our community members the way it did throughout 2020 and 2021. We adapted our testing approach accordingly, first moving to a reduction in surveillance testing, then moving to optional testing, and then finally, shifting to testing for symptomatic individuals only. As with every policy change, we monitored the overall levels of Covid on campus to see what, if anything, we needed to modify, and checked in with our peers and local community health officials.

Fortunately, we are pleased to report that we have continued to successfully mitigate the impact of the disease. While it’s true that many of us have contracted Covid, the risk to vaccinated individuals remains minimal. We also have to be realistic. Much of this country (and the world) have “moved on” from the once-required masking, distancing, and other measures. We cannot expect MIT to exist within a bubble, as we are part of a dynamic community that values in-person activities on and off campus. This is especially true because, throughout the pandemic, the vast majority of cases have come from off-campus interactions. Thus, imposing restrictions on campus, with no restrictions off campus, has little effect on the level of infection in our MIT community.

Barring any unforeseen changes such as new, more dangerous variants, we have every reason to believe that the Institute will fully operate in the fall with in-person classes, clubs, athletics, and other activities. It will be the closest to normal MIT has been since early 2020. That said, if things turn in a difficult direction, we know how to pivot, turn back the various knobs and switches, and be as ready as we can be.

Q: What is the latest on protocols and policies?

Waitz: Over the last six months, we and the MIT community have successfully pivoted from an institutional management of health — with 35,000 PCR tests per week conducted in a required surveillance program and required masking at the start of the spring semester — to personal/individual health management, with fewer than 100 tests per week conducted by MIT Medical. Moreover, the majority of positive cases are being identified through at-home testing. Likewise, individuals have used their judgment — with the support of their primary care physician, where appropriate — to make choices about masking.

The approach has worked. Even with Omicron and the large number of individuals who tested positive, we conducted a full semester of classes, in-person final exams, a multi-day Commencement, and alumni activities where we had more than 10,000 visitors on campus. All the while, we continued to encourage those who are concerned about their health, or that of close relations, to wear well-fitting masks when in crowded indoor spaces. I also want to applaud our residential life teams, our faculty and instructors, and others who have given those who needed to recover from illness the flexibility and space to do so.

I should reinforce Dr. Ferullo’s earlier point that surveillance testing is no longer a viable way to prevent disease spread in our community. And as Dr. Stuopis remarked earlier, Omicron’s BA.4 and BA.5 variants are now estimated to be as communicable as measles. For testing to have an effect, we would need everyone to test every day with complete compliance. And even that would likely not be enough. It is more effective to use testing in a targeted way: If you have symptoms, put on a mask and test — either using an at-home test or through Covid Pass after attesting to symptoms.

Putting that all together, while I know many are looking for specific signs of what might trigger policy changes, it’s hard to provide a hard number or name a specific event that would result in new or additional restrictions. However, for context, during the past semester, the wastewater MWRA data peaked at about 1,300 RNA copies/mL (seven-day average), with a few days close to 2,000 RNA copies/mL. If things continue in that range or lower, and the severity of the disease does not increase significantly, we are likely to continue to operate under the status quo — fully in-person, without required masking, and MIT-provided testing for symptomatic individuals only. For reference, the main Omicron wave that came through in January 2022 was at 10 times that level in the wastewater. So, it is certainly possible that more restrictions are in our future, but we are all hoping that is not the case.

As always, we remain in close consultation with state and local public health officials, and we are fortunate to have our colleagues at MIT Medical to help guide us as we navigate these difficult times. We continue to thank the entire MIT community for their patience, perseverance, and resiliency. We are all excited for the 2022-23 academic year. And we are confident that we can — and will — pivot, as needed, as we do our best to balance all the many factors that may arise.

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