Delta variant raises concerns about a new, unpredictable phase of the pandemic
Despite a high vaccination rate and low number of cases within the Dartmouth community, some College and town COVID-19 policies are likely to remain in place in the fall to mitigate the spread of the virus.
Masking is required in most indoor spaces regardless of vaccination status.
This article is featured in the 2021 Freshman special issue.
At the beginning of summer term, Hanover’s suspension of its universal masking mandate, followed by Dartmouth’s removal of nearly all COVID-19 restrictions, seemed to usher in a return to normalcy after nearly a year and a half of strict public health measures. But the risk of increased cases of COVID-19 due to the Delta variant — a mutated, doubly contagious strain of the original Alpha variant — has triggered the reinstatement of an indoor mask mandate and hindered that return as the fall term draws near.
According to the Centers for Disease Control and Prevention, the delta variant accounted for over 99% of new COVID-19 infections nationwide by Aug. 28. In Grafton County — where Dartmouth is located — cases rose to a seven-day daily average of 20 on Sept. 1; the rate was as low as one per day in late July, the New York Times reported. The Times data also showed that the number of hospitalizations and deaths have remained low.
Rockefeller Center for Public Policy policy fellow Anne Sosin emphasized the new challenges posed by the Delta variant, especially in campus environments.
“Here we are with a very transmissible variant that’s upending our thinking about how to approach this phase of the pandemic,” Sosin said. “I think we’re just beginning to grapple with what this means … and it forces us to ask some really hard questions without great answers.”
Associate Dartmouth Hitchcock Medical Center epidemiologist and medicine professor Jose Mercado said that a “proactive” approach is needed to put an end to the pandemic, saying that widespread community vaccination and preventative measures like mask wearing are “steps one and two” of a multi-step solution.
At Dartmouth, former chair of the COVID-19 Task Force Lisa Adams wrote in an emailed statement that vaccination is the “most important defense in the pandemic,” but said that the College will also continue to use both PCR and antigen testing, along with isolation for infected individuals and contact tracing. She also wrote that in the case of exposure, the College will require quarantine and a test for unvaccinated individuals or masking and a test for the vaccinated.
Public Health Council of the Upper Valley director Alice Ely said that the COVID-19 vaccines are necessary to protect the community but noted that vaccinated individuals can still carry and spread the virus.
Currently, 66% of Grafton County is fully vaccinated, according to The New York Times; 90% of residents over 65 are fully vaccinated and 73% over 12 are. At Dartmouth, 89% of the total Dartmouth community and 94% of the on-campus community are fully immunized, according to the College’s COVID-19 Dashboard.
Despite high regional vaccination rates in the Upper Valley, associate Geisel epidemiologist Annie Hoen stressed the importance of preventing further spread of disease through a multi-layered mitigation approach.
“When we see transmission happening in spite of a large proportion of our population being vaccinated, and we see cases increasing both locally … and in the U.S. more broadly, that is an indication that we need more layers,” Hoen said. “...Epidemiologists are starting to converge on this notion that the vaccine is not going to get [disease transmission] under control on its own.”
Sosin, however, noted the difficulties in attempting to impose preventative measures on college campuses where students live in close proximity to one another.
“A layered mitigation approach is hard to implement in a setting where students are living, dining [and] attending classes in such close quarters,” Sosin said. “The ancestral strain of the virus is really difficult to control in a campus environment, and the Delta variant is twice as transmissible. Even with a mask mandate in place, it’s going to be very difficult to control.”
Sosin said that colleges must appropriately consider the goal and duration of their response in this next phase of the pandemic, noting that most experts have now come to the conclusion that the total elimination of COVID-19 is an unattainable and unrealistic goal.
“I’m not sure what we’re after at this point,” Sosin said. “We need to reframe our thinking, and we’re just beginning to do that, from pandemic thinking to endemic thinking. There’s a paradigm shift that will need to happen.”
In Sosin’s view, testing and indoor mask mandates should remain in place on campus until children under the age of 12 become eligible for the vaccine, given the many professors who have young children and the many points of contact between the College and the broader Hanover community.
Although most children recover from the short-term symptoms of COVID-19 — at rates much higher than that of older adults, for example — Ely noted the still-extant risk of long-term complications and ramifications of contracting the virus.
“While most children are pretty healthy and strong … we don’t always know which children have an underlying health condition,” Ely said. “A COVID infection could be very, very serious. [When I was] talking to a local primary care physician, she described seeing long-term problems with anxiety, mental health issues and other concerns popping up in kids that have recovered from COVID.”
According to Sosin, both the physical and mental health of the Dartmouth student body are important factors when determining sweeping policy changes. She said that a “human approach” is needed to support students and mitigate the effects of any restrictions.
“I think we need to be really mindful of what we’re putting in place and think about … how to support students,” Sosin said. “We need to ensure the health of our communities, but health is more than the absence of COVID, and this means supporting our students in every way possible, both physically and mentally.”
Adams wrote that both students’ physical and mental health are key considerations in all of the College’s COVID-19 response decisions, adding that the two are “inextricably linked.” Responding to a question about any upcoming College health policies, Adams wrote that testing modality and frequency are currently being discussed.
According to Adams, the College’s policy decisions rely on both regional and national level data.
“It is so difficult to make predictions, but we are watching the emerging data and federal [and] state guidance and listening to a range of constituents and trying to adapt it to our environment as a congregate setting with a high vaccination coverage rate in a rural setting,” Adams wrote. “Policies are constantly being reviewed and revised, and the goal is to be as nimble as possible with decision making.”
On Aug. 5, the College reimposed its indoor mask mandate after having previously removed all mandates at the start of the summer term. Hoen noted that the increase in cases at the College prior to the mask mandate signaled the “need to take some action.” According to the College’s COVID-19 dashboard, there are currently 13 active cases among students and faculty as of Sept. 1.
Sosin posited that although the College is responsible for its policy decisions, the federal government should shepherd universities through this next phase of the pandemic.
“Really, we need federal leadership laying out some guidance for campuses,” Sosin said. “This shouldn’t fall on individual institutions to make these decisions. We really need good policy thinking at the federal level around some of these questions.”