About halfway through the fall semester, Jessica Floyd, a curly haired undergraduate studying nursing at Central Methodist University, started feeling exhausted. She had been studying for four exams that week, so she didn’t think too much about it. Then she took one of the regular coronavirus tests that Central Methodist required. It came back positive. That night, she started feeling weak and short of breath. “It came on fast,” she said.

By the end of the fall semester, three of Floyd’s study partners and two more of her closest friends would test positive. Central Methodist, in rural Fayette, Mo., would see 28 percent of its 1,148 residential students test positive for Covid-19 as of December 11, the last day dorms were open for the fall semester. One student, a 19-year-old with no other health conditions, had to be hospitalized, according to Roger Drake, the president. She recovered.

Of the more than 1,900 colleges whose case counts were tracked by The New York Times, Central Methodist had one of the very highest shares of positive diagnoses. But it’s likely in crowded company. Some other small, rural liberal-arts colleges have posted student-infection rates of around 20 percent — one in five. Other institutions could have comparable numbers without knowing it, if they don’t test their student bodies regularly, as Central Methodist did. In young adults, especially, Covid-19 is silent spreader: Without surveillance testing, a school’s numbers are almost certainly underestimates of the true extent of infections among their students.

As colleges examine the fall in the rear-view mirror, much attention has been affixed to big-name universities and whether they followed best practices, some of which they pioneered: mandatory, frequent testing. Pervasive mask wearing. Safely distanced social activity.

For colleges like Central Methodist, best practices were never in the cards. At those institutions, in-person reopening was a necessity, prevention policies were well intentioned but insufficient, and students were resigned to the likelihood that they would fall ill. For the colleges that couldn’t marshal untold resources to fight the pandemic, the experience of Central Methodist might be a more representative picture of a fall semester like no other.

“Sometimes there just isn’t always a perfect correlation between planning and effort and care and love and the results that you have,” Drake said, “and that’s what happened in our case.”

Founded in 1854, Central Methodist mostly serves students who come from the 100-mile radius around it. The region immediately surrounding the university is largely rural and politically conservative, with every mid-Missouri county going for Donald Trump in the 2020 presidential election, except Boone, home to the University of Missouri flagship.

About 40 percent of Central Methodist students are eligible for federal Pell Grants, and almost a third of them are the first in their family to attend college. Drake said the needs of these students motivated the university to operate in person this fall. The residential experience was critical to retaining students, he said, especially ones from rural areas who might not have strong internet connections at home, or a family history of college-going.

“I was a poor kid in Appalachia, a place that does not have high college-going rates,” he said. “We have a lot of kids that, if they stop out one year, they are going to drop out of the pipeline, and their path to success will never come back to them.”

Chuong Doan for The Chronicle

When Jessica Floyd and others in her study group tested positive for Covid-19, “none of us were really surprised.”

Floyd grew up on a farm about a 20-minute drive from the Central Methodist campus. Inspired by her father, who had a second career as an EMT, she has wanted to work in health care since she was nine. “I saw how much he loved his job,” she said.

When she was a kid, she and her mother, Denise Floyd, would visit her father at work, where they got to know the other EMTs and their families. When she was 10, her father died. At one point, his co-workers came to the family’s farm in Boonville, to help with chores that Denise couldn’t do alone. “All the guys chipped in and were there for us,” Denise said. She took her husband’s stethoscope and the book of medicines that he kept in the side pocket of his work pants, and put them away.

Floyd began working as a certified nursing assistant in high school. When it came time to pick a college, she chose Central Methodist for its small, intimate nursing program. “The teachers knew you one on one, and if you had an issue, you could go directly to the teacher and it’s not like, ‘Oh, who are you? What class are you from?’” she said. “They really get to know you on a personal level.” As she prepared to leave, her mother presented her with her father’s EMT supplies.

Nursing at Central Methodist is rigorous and stressful. A passing grade is 80 percent, and students can only fail one class, which they have to retake. All of the seniors are thinking about the National Council Licensure Examination. It feels like everything they learn in class might be on there, and: “If you don’t pass, you don’t get to become a nurse,” said Rebeka Tratchel, another senior in the program and one of Floyd’s friends, “which is crazy to me.”

To prepare, Floyd and Tratchel are part of a close-knit group of six friends who meet nearly every week day to study over lunch. They pile into a snug debriefing room on the first floor of the allied-health building. They spread out their laptops, bags, water bottles, and snacks on the big table. There’s a TV on the wall, where they project questions from their iPads — Central Methodist gives one to every student. “We’ll sit there and talk and just kind of study and hang out,” Tratchel said.

Like her father, Floyd has found camaraderie in working in health care. Having friends to study with and who understand the stresses of the nursing program has been a lifesaver. “They know exactly what I’m going through,” she said.

In the fall, even as the virus raged around them, the friends continued holding their lunchtime study group. They seemed to get and give mixed messages. They were frustrated by photos they saw on social media of their classmates partying and poor compliance with mask-wearing on campus. “I’ve seen a lot of people wear the mask below their nose. Even teachers do it,” Floyd said. “You’re just spreading it more.” Yet they knew their study sessions weren’t quite kosher, either.

“We would fit six in a room that probably should only have three in it,” Floyd said.

“Probably not the smartest idea, but we do usually take our masks off. We don’t really distance from each other,” Tratchel said. (Students are supposed to wear masks at all times on university property.)

“When we got it, none of us were really surprised,” Floyd said, “because we knew we were breaking the rules.”

It’s impossible to know for certain how Floyd got Covid, but she thinks it was another friend in the study group.

Central Methodist applied care and spent money in preparing for the fall, but its plans didn’t seem to account for interactions like Floyd’s study group.

The university spent more than $900,000 in direct costs to prepare for the pandemic, including buying temperature monitors, improving airflow in buildings, and preparing for virtual lectures. It spent about $340,000 on antigen tests, which every student had to take every other week and sometimes more often, when the university saw more infections, Drake said. Students who felt sick could get a test at any time, and those who tested positive could go home or isolate on campus in dedicated recovery centers.

At the same time, when put into practice, major holes seem to have remained in Central Methodist’s fall plan.

About 70 to 80 percent of people on campus wore masks properly or at all, students told The Chronicle. (Scott Queen, a university spokesman, wrote in an email that he thought mask compliance was at 96 to 98 percent.)

And the university’s social-distancing rules left room for the sort of small gatherings — like Floyd’s study group — that can contribute to coronavirus spread.

Although eating together indoors is among one of the better-recognized sources of Covid-19 spread, the dining hall was open for sit-down meals, with part of the student center converted to additional dining space so that students could sit farther apart.

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Chuong Doan for The Chronicle

Nursing students (from top left, clockwise) Amy Leftridge, Emily Soto, Liz Wilson, Jessica Floyd, and Rebeka Tratchel gather for their study group.

Residence halls were filled to near-normal capacity, Queen said, which means roommates sharing rooms. Floyd said students could visit each other’s dorm rooms and be unmasked inside them, though they had to wear masks in residence-hall common areas. Drake said that dorm-room visits from off-campus friends were supposed to be restricted, and “masks and social distancing were encouraged.”

Floyd said her impression was that dorm-room hangouts were OK because of the testing protocol. “Because we do the every-other-week testing,” she said, “that definitely made them more comfortable to allow us to do that.”

That testing regimen leaves plenty of space for casual interactions like these to spread the virus. Covid-19’s roughly 10-day period of infection means a student who tests negative on a Monday, contracts the virus Tuesday, and then spends the next 10 days clearing the virus from their system and infecting others can test negative again at their next required swab.

“That is much more security theater than it is actual public-health security,” said Christopher Marsicano, an assistant professor who co-leads Davidson College’s College Crisis Initiative, a project that analyzes higher-ed institutions’ Covid-19 plans and outcomes. The College Crisis Initiative provides The Chronicle with data for its spring-plan tracker.

“It is really good at making people feel safe,” Marsicano said, “but not necessarily good at stopping the spread, once the spread has started.”

Central Methodist’s use of antigen tests, rather than PCR tests, may have made matters worse. Antigen tests are cheaper and faster than PCR ones, but they’re known to be less accurate. In data published in January, the Centers for Disease Control and Prevention found that at two universities in Wisconsin that used the same brand of antigen test that Central Methodist did, the tests frequently told people they didn’t have the coronavirus when they actually did. Among people with symptoms and a diagnosis of Covid-19 confirmed through PCR testing, 20 percent nevertheless got negative antigen-test results. Among people without symptoms and confirmed coronavirus infections, 59 percent had gotten negative antigen results.

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Chuong Doan for The Chronicle

Central Methodist U. spent more than $900,000 in direct costs to prepare for the pandemic, but when put into practice, major holes seem to have remained in the fall plan.

The university chose to use antigen tests, rather than PCR ones, because early on in the semester, the turnaround time for PCR tests in the area was several days, Drake said. That’s not ideal for quickly identifying students with infections and isolating them before they can spread the virus further. PCR tests also could have cost the university twice as much as it ultimately paid for its antigen tests, but Drake said the price tag wasn’t an issue. The university could have spent more than $1 million from its reserves on tests, he said. It chose not to, believing antigen tests were the best option.

Research has shown that more frequent testing can keep infections down. In an analysis posted in December, which hasn’t yet been peer reviewed, a team of scientists from Harvard University found that colleges that tested their students more often had fewer student infections. The American College Health Association has recommended that students be tested twice a week for in-person operations in the spring.

But Drake said Central Methodist’s community wouldn’t accept more testing. “I’ve never had a single parent or student say, ‘Why in the world aren’t you testing more?’” he said. “But we had many, many cases where students would say, ‘I’m going to transfer to another school. I don’t want to be tested this much.’”

“I don’t know what we possibly could have done more of,” Drake said. There was only one change he thought would have made a real difference to Central Methodist’s fall rates: if it hadn’t held fall sports. Many infections were among athletes, he said, who make up 60 percent of the student body.

“But that also would have had a horrible outcome for students,” he said. The college belongs to the National Association of Intercollegiate Athletics, which is far from a feeder to professional sports leagues. “This is kids’ last hurrah to play their sports. It’s what they really wanted to do, and we tried our best.”

As it was, Central Methodist ended up trapped in an unfortunate limbo, testing enough to know the extent of its Covid problem, yet failing to keep its rates low.

In hosting exceptionally high rates of Covid-19 infection, Central Methodist had company.

In The Times’s database, which is not comprehensive, four of the 10 institutions that saw the highest share of infection are small, residential, Midwestern, liberal-arts colleges. Bethel College, in Kansas; Iowa Wesleyan University; and Quincy University, in Illinois, all had about 20 percent of their students test positive in the fall.

Leaders at higher-rate colleges seemed at peace with the idea that one in five of their students got the coronavirus while in school. “The campus stayed safe throughout the semester. We never had a time where it was out of control,” said Meg Richtman, a spokeswoman for Iowa Wesleyan University. By “not out of control,” Richtman meant that throughout the fall, Iowa Wesleyan never ran out of isolation space and didn’t see sudden spikes in student cases. They just remained elevated all term.

“It’s not what anybody wants,” Richtman said. “That’s the reality that we live in today.”

Brian McGee, Quincy University’s president, defended his institution’s numbers in Quincy’s context: in the Midwest, serving a large number of Pell-eligible students. “A single student testing positive is one student too many,” he said in an interview with The Chronicle in January. At the same time, he said that many Quincy students were coming from homes and towns where people regularly flouted mask-wearing and social-distancing rules. Had they stayed home for a remote fall semester, many wouldn’t have had a quiet room to study in — or to isolate in, should they have contracted the virus there. Central Methodist is similarly situated.

The colleges that kept their numbers down this fall? “Most of them were either in parts of the country where there was a lot more community compliance with public-health recommendations or at very affluent institutions,” McGee said in a previous interview with The Chronicle. “There is a rich-poor gap here, and there are important geographic differences that we need to be respectful of.”

Affluent institutions like Duke and Cornell Universities, and mammoth public research universities like the University of Illinois at Urbana-Champaign, were among the fall’s success stories. Each had fall infection rates in the single-digit percentages.

The University of Illinois system operates on a budget in the billions and has fairly diverse sources of income, including state appropriations, tuition, and its medical system, from which it could also draw expertise for its cutting-edge Covid-prevention program. Illinois scientists developed their own spit-based, rapid coronavirus test, which meant the university didn’t have to buy tests from another provider. Cornell and Duke have budgets of the same order of magnitude and medical schools. Duke had its own in-house PCR test.

In contrast, Bethel, Central Methodist, Iowa Wesleyan, and Quincy all operate with budgets in the tens of millions. They don’t have medical schools. Just two years ago, Iowa Wesleyan faced the prospect of closing due to money problems. Among the four, Central Methodist has the largest endowment, with a market value of $51 million in 2019 — less than 1 percent the size of Duke’s.

The wealth differences mean that Central Methodist may have spent as large a proportion of its budget on Covid prevention, or larger, compared to more successful schools, Drake, the president, argued. “It was a huge financial commitment on the part of our Board of Trustees,” he said.

Central Methodist and its peers are also more tuition dependent. At Bethel College, student tuition and fees make up close to half of the overall revenue, while at Central Methodist, Iowa Wesleyan, and Quincy, tuition and fees are more than 60 percent. In contrast, at Cornell, Duke, and the Illinois system, the most that tuition contributed to revenue was 25 percent.

Central Methodist and its peers both had smaller budgets to put toward anti-pandemic measures, and faced greater financial pressure not to hold an all-online fall.

When asked about the bind that colleges like his faced, Drake said, “I don’t deny the correlation in general.” But, he said, “We have strong reserves. That wouldn’t be the reason why we would not have brought students back in the fall.”

For Marsicano, of Davidson College, the competing pressures that small colleges worked under this fall are a sign that they need outside help. “We need federal or state or some kind of funding to these institutions if we’re going to try to keep cases down,” he said. For example, he added, states could have batch purchased tests at discounted prices and distributed them to colleges. “There are legitimate policy solutions that can be done here, that can really slow the spread of this.”

When students came back to Central Methodist’s compact campus this fall, the shortcomings of the Covid plan meant they were in for a semester of frustration and foreboding.

“At one point, everyone in the music community was getting it,” Mikayla Kinkead, an undergraduate majoring in music ministry, wrote in a Facebook chat message. She and her friends “were just waiting for one of us to get it.” Luckily, they remained unscathed. “We were like the only music people to not get it,” she wrote.

Central Methodist leadership decided to finish the fall semester remotely after Thanksgiving break, to reduce how much their students would travel during the country’s winter surge. Still, Da’Jai Thomas, a neuroscience major living in a residence hall, decided to leave campus even earlier, in October, because of the cases around her. “It made it harder to be around my friends because they ended up testing positive,” she wrote in an instant message. She made efforts to ensure she wouldn’t bring the virus home to her family: “I made sure to get tested twice before leaving. I sanitized my whole room, washed my clothes twice and all my cloth masks, and I tried to stay in my room the day before I left.”

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Chuong Doan for The Chronicle

The reduced hands-on practice for nursing students in the fall left Rebeka Tratchel a little nervous: “I feel now I’m not going to be ready to be a nurse.”

She finished the semester over Zoom. Her instructors even mailed her materials for her labs, although she found them difficult to reproduce at home.

Then there was Tratchel, one of the nursing study-group members, who transferred to Central Methodist from the University of Alabama because she wanted a smaller college, closer to her family. She had to quarantine multiple times over the semester, during which she found herself adrift. “I would find myself having to Zoom into class, and I wouldn’t turn on my camera, and I would be up doing so many different things,” she said. “It was really hard to stay focused, knowing that I could just come sit on my couch and watch TV.”

She wouldn’t know why she’d been told to quarantine. To protect other students’ privacy, the university wouldn’t disclose the exact exposure. She’d just get the email in the morning, instructing her to stay in her apartment.

She finally got Covid-19 during finals week, after Thanksgiving break. The illness took its toll. She couldn’t stay awake for more than an hour at once. Her heart raced and her blood oxygen dropped. “I couldn’t get up from the couch and walk to the bathroom without feeling like I couldn’t catch my breath,” she said. She lost her sense of taste and smell, but got them back on the 10th day of her illness, and is now recovered.

In the nursing program, Floyd and Tratchel dealt with rolling waves of quarantines in their cohort. At one point, about half of their 19-member class was out, due to a combination of isolation, quarantine, and non-Covid-related reasons. The program had to push back a major hands-on skills test, which the students took at the beginning of the spring semester.

Between the quarantines, and cuts to their hours that the program’s hospital partners would have made anyway as a precaution against the pandemic, the spring-2021 graduating class has had much less hands-on practice than most of their predecessors.

That has been true across the nation. Central Methodist made up for it with what are called virtual unfolding case studies, in which students make decisions about a real-time patient scenario on a computer. The trimmed hours have left Tratchel a little nervous. “I feel now I’m not going to be ready to be a nurse,” she said. “I would definitely love to have more hours in the hospital.”

She’s looking forward to this spring semester, when their hours are supposed to be restored.

Floyd, too, recovered completely from Covid-19, after about a week during which she described herself as not having “all of the super-bad symptoms,” only “a couple” of them, including feeling like she’d run a marathon, just from walking across her one-bedroom apartment. In general, traditional college-age adults have avoided Covid’s worst immediate consequences, with colleges often reporting only one or no hospitalizations, even when thousands of their students have tested positive.

Students told The Chronicle they believed administrators had done as much as they could to prevent infections on campus. They were surprised to learn their college had one of the highest infection rates in the nation. To them, their fall seemed no more extraordinary than anything else during this extraordinary time.

For Floyd, the fall would have been worse had she and her friends not been able to gather in their conference room. “Just having that group of people that I could talk to and study with and just vent to if I need to — if we weren’t allowed to sit in that room and do that, I think it would have been a lot more stressful,” she said.

Altogether more than half of the friend group has had Covid-19. They’re still doing their study sessions.



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