It is a sad milestone day in so many ways, some close to home. The USA passed 200,000 deaths on the same day India overtook it as the country with the highest recorded numbers of infections. It now has over 5 million confirmed cases. This is thought to represent only a fraction of real cases, even though India has substantially ramped up testing – now at 50 million total tests. The country is recording some 90,000 cases a day, and 1,000 deaths per day. Simply astronomical figures. Amidst this, India continues to progressively open up sectors of the economy. It is a hugely resourceful and resilient country, but the pandemic is outsrtipping it and governance is pathetic. One US based epidemiologist estimates that the real figure of those that have been infected is closer to 100 million and  India is in real trouble. The hospital sector has now ceased to cope with the scale of presentations.

Asia in general is surging at present, particularly Indonesia which is hitting 4,000 cases per day. Diverse countries such as Argentina, Iran (in its second or prolonged 1^st wave), and Iraq are all surging. France, Spain, the Netherlands and the UK are all amidst second wave spikes, as is Israel. The UK is tracking on 5,000 cases per day and the Johnson government announces further restrictions, some of which are typically bizarre (pubs must close at 10 pm?). The last seven days saw a an overall global increase of 2 million cases. In the US rates have slowed (but this is relative to the car crash days of the summer), and the University of Washington is still estimating 378,000 deaths by the end of the year in the absence on stricter measures. Trump described the milestone as a ‘shame’, with the USA accounting for a one fifth of the global death toll. What is clear is that the virus is still out of control in many countries, is resurgent in others, and globally keeps increasing by some 6% per week in the last month.

Against this backdrop, in my sector – Higher Education – the open-up debate is still playing out in the UK presently. It is a deeply polarising issue for staff.  The open-up messaging mostly rotates around the claim that hospitalisations are declining overall, and are almost non-existent for youth. The younger generation are able to deal with COVID much better than those that are vulnerable. Much of the discourse treats the virus in terms of what we knew about it in March, that, once cleared in non-acute cases, problems are over. So the infection of students does not matter provided they are safely separated from staff and the wider population. Research on long-COVID and the often significant and life threatening morbidities the virus generates in multiple organs and systems is being ignored. Some 1 million students are in various stages of online and face to face teaching and have entered halls of residence and communities. What is happening here?

There has been no entry testing of students and very little coherent access to general population testing in the UK at present. There will be asymptomatic cases in both the domestic and overseas student cohorts. We are now certain that young adults are getting long covid, that they will spread it to vulnerable older people, and that campus outbreaks do drive infections around the campus and proximate populations. The USA has just performed exactly this natural experiment, and that with varying degress of testing being offered at entry and at subsequent intervals. The results were pretty dire to say the least. This is being studiously ignored in the UK, and all that seems to matter to many is that the students will not end up as acute cases in hospital and that the student experience is preserved. The problem with this (among many) is our understandings of the morbidities associated with COVID have moved on from the ancient past of of 2020. Nonetheless, a basic pick and mix of science and epidemiology is still being rolled out by those concerned with opening up, or even teaching face to face.

Yesterday (22nd September) it was announced that 500 hundred students in Abertay University, Dundee, will have to isolate in dormitories due to one positive case. This is also happening more widely in UK universities some one or two weeks into the new term. 12 students in Swansea tested positive this week. The University of Liverpool had 87 students and staff test positive. Glasgow University has 20 in halls. Reports of COVID outbreaks in British Universities, from Monday 14 September to Saturday 19 September, involved Oxford Brookes reporting it is dealing with a growing number of cases, and Bath, Manchester Met and Warwick all with initial outbreaks and students isolating. This is clearly going to get worse, yet we seem prepared in the UK to tolerate it. This will rapidly become the reality of UK student life in Semester 1 of the 2020/21 academic year. The VC Abertay of the university announced that isolating students will be supported. Imagine this playing out in some 160 plus universities in the UK, with institutions having to arrange support and care for isolated students. Can they supply medicines for those with diabetes or other chronic conditions? How will they clean kitchens, toilets and rooms? Who will do this and under what conditions? Has this all really been thought through, and have the universities drafted plans for isolation, infection control, testing, or access to check ups? Certainly, these plans have not been published. The logistics of infection on campus and in the community will be immense.

Of course, they will all close down soon enough and the Russell Group will wait for the first movers in this (as they did with closing down in March) and once a few of the big names close the rest will follow. Perhaps even the hapless government will be forced to make the call. When in October will UK universities have to close, and why did they open? These questions will be buried and blamed on students andtheir  behaviours. It is all another avoidable shambles.