In addition to national COVID-19 restrictions, UK universities implemented a range of measures to reduce transmission from September 2020. This included providing blended learning with lectures online and in-person teaching in smaller Covid secure classrooms and labs. Universities also introduced ‘living circles’ to help prevent the spread of the virus from different student groups and accommodation, together with increased measures such as cleaning regimes in accommodation and learning environments. However, despite these measures, outbreaks of COVID-19 have still occurred across many UK universities.
Mass migration of students to and from university occurs at the start and end of each term and students have different contact patterns to the rest of the population. Understanding these contact patterns in real time, and how people physically distance from each other in different settings and among different groups, is important to help mathematical modelling experts and policy makers design effective control strategies for preventing infection transmission.
In response, researchers from the Bristol UNCOVER group launched CON-QUEST (COroNavirus QUESTionnaire), an anonymous online questionnaire to find out from University of Bristol students and staff about their contacts, symptoms and behaviours. The questionnaire began in June 2020 and is ongoing. In the preprint, the researchers have focused on student responses from the start of the 2020/2021 academic year (740 students had completed the questionnaire between 14 September and 1 November 2020).
The study found students reported an average of six daily number of contacts, which is lower than in previous student contact questionnaires conducted before the pandemic, (such as 29.9 contacts in the Warwick social contact survey and 11.7 contacts in the POLYMOD [Improving Public Health Policy in Europe through the Modelling and Economic Evaluation of Interventions for the Control of Infectious Diseases] study). This suggests students have changed their behaviour in response to the guidance issued during the current pandemic. However, the study found that some students have large numbers of daily contacts, mainly dictated by their large household sizes, seen particularly in halls of residence.
There was variety in the number of daily contacts reported, with one being the most common number of daily contacts, while eight per cent of students had more than 20 contacts. However, selection bias for those who are particularly concerned about COVID-19 may have occurred and led to under-representation of those who are less likely to abide by the guidelines and so there may be a higher percentage of students having large numbers of contacts than was captured in the questionnaire. Reporting bias may also be an issue where individuals fail to recall or report the extent of their true contacts. Around 40 per cent of student contacts were with individuals not affiliated with the University, indicating the potential for transmission outside of the University. Encouragingly, 99 per cent of students in the questionnaire who had tested positive in the prior fortnight had been self-isolating.
In terms of symptoms, the research findings show that among students who tested positive for COVID-19, 19 per cent did not report having any of the main symptoms (fever, cough, loss of taste or smell), while 43 per cent did not report a cough or a fever. This is important, given that at present a person must have one of these main symptoms to be eligible for a free NHS COVID-19 test. Testing asymptomatic students, has recently been initiated as part of the voluntary mass testing events of all students in the run up to the winter break. The data from this mass testing initiative will be valuable in establishing the incidence and prevalence of COVID-19 in the student population. The data generated in this study provides useful insights into student contact patterns and behaviours during the University term and will therefore help to inform future models of transmission dynamics for 2021.
The researchers make a series of recommendations, these include:
- Some students have large numbers of daily contacts, largely due to their household size and even self-isolating students cannot eliminate social contact entirely, this needs to be taken into account by planners and policy makers.
- Students should be encouraged to limit their contacts with those outside of the university where possible to avoid community transmission.
- Testing students who are not displaying the main COVID-19 symptoms, for example, in mass testing events, is likely to be important in understanding more about the incidence and prevalence in this population
- As students are more likely to be asymptomatic than the general population, they should be encouraged to adhere to physical distancing, hand washing and mask wearing measures.
Emily Nixon, Research Associate in Bristol’s School of Biological Sciences and Bristol Veterinary School, who is leading the study, said: “While university students, due to their young age, are generally less adversely affected by COVID-19 than other groups, they have the potential to transmit the virus to others, including their family, so it is important for us to understand how the virus is transmitted in the student population.
“Our findings provide a clearer picture of how contact patterns and physical distancing behaviours change over time and with different measures in place within the student population. We hope our latest recommendations can be used to help guide higher education sector measures and government policy.
“We would also like to express our thanks to Bristol students and staff for taking the time to complete this important questionnaire.”
The study, funded by the Elizabeth Blackwell Institute and supported by the NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, is one of a number being conducted by UNCOVER Bristol's COVID Emergency Research Group. Other questionnaires are focusing on under-represented groups, including children and older adults.
If you are a University of Bristol student or member of staff you can still take part in this ongoing questionnaire that will enable researchers to collect data as the pandemic progresses and help researchers monitor changes as testing is rolled out, over the winter holidays and when students return in January.
Link to the questionnaire (for University of Bristol staff and students only): https://is.gd/uob_covid19
Preprint: Contact patterns and behaviours in university students during the COVID-19 pandemic of Autumn 2020 by E Nixon et al in medRxiv
Please note this is a preprint, so it is a preliminary piece of research that has not yet been through peer review and has not been published in a scientific journal – so this is early data.
About the CONQUEST questionnaire
CONQUEST (COroNavirus QUESTionnaire) is an ongoing questionnaire on contacts, behaviour, and potential SARS-Cov-2 symptoms for staff and students at the University of Bristol. This questionnaire has been live since the 23r June 2020. Participants complete an initial questionnaire which includes questions on background demographics and then are given the option to fill out a shorter version of the questionnaire on contacts, symptoms, and whether they’ve had COVID-19, repeating every eight days.
The questionnaire captured demographic information, information about participant’s contacts on the previous day, information about symptoms during the previous week, whether participants had been self-isolating during the previous week, and COVID-19 status if known.
Demographic information on participants was captured when they filled out the initial questionnaire. This included data on age, gender, ethnicity, whether they were part of a high-risk group, whether they were a student, staff or both, whether they were an undergraduate or postgraduate, their study year, their UoB department, their residence, and the age of their housemates.
Participants were asked about three types of contacts they had had on the previous day:
- Individual contacts - those who they spoke to in person one-on-one, including those in your household and support bubble.
- Other contacts - if they spoke in person to many people one-on-one in the same setting (but they did not have the opportunity to speak to each other), for example, as part of working in a customer service role in a shop.
- Group contacts - large groups of individuals in the same setting (e.g. sports teams, tutorials, lectures, religious services, large gatherings with friends and family).
About the NIHR Health Protection Research Unit [HPRU] in Behavioural Science and Evaluation at the University of Bristol
The NIHR HPRU in Behavioural Science and Evaluation at University of Bristol is one of 14 HPRUs across England, part of a £58.7 million investment by the NIHR to protect the health of the nation.
The NIHR HPRU in Behavioural Science and Evaluation is a partnership between Public Health England and University of Bristol, in collaboration with MRC Biostatistics Research Unit at the University of Cambridge and University of the West of England.
Each NIHR HPRU undertakes high quality research that is used by PHE to keep the public safe from current and emerging public health threats.
About the NIHR
The National Institute for Health Research (NIHR) is the nation's largest funder of health and care research. The NIHR:
- funds, supports and delivers high quality research that benefits the NHS, public health and social care
- engages and involves patients, carers and the public in order to improve the reach, quality and impact of research
- attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future
- invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services
- partners with other public funders, charities and industry to maximise the value of research to patients and the economy.
The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR supports applied health research for the direct and primary benefit of people in low- and middle-income countries, using UK aid from the UK government.