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Public Health Advisory Updates

Weekly updates from our epidemiologists explain how the team monitors the spread of COVID-19 at W&M and advises the university's operations.

Ending on the best note 

May 11, 2021

For the first time since the beginning of this semester, we had only one new case of COVID-19 to report to VDH this week. We should all congratulate ourselves on this achievement. The semester started just weeks after the highest number of cases in the nation, due to holiday travels and social mingling in December and January. Our initial case numbers reflected this, and within a few weeks we got to more cases than we had in the whole of last semester.

Our cases then started to decline steadily – until we had the convergence of St. Patrick’s Day and a Spring Break Day and this led to higher number of cases. But again with everyone’s diligence, cases went down rapidly and we have since had a steady decline.

Vaccination started in late January and the university worked with the City of Williamsburg to schedule faculty and staff for vaccination based on the criteria set up by the state, and then to students starting in late March as the criteria expanded.

Our lower COVID-19 transmission rates in the last four weeks reflect a combination of our vaccination rates increasing and our continued maintenance of the Healthy Together ideals.

This has not been an easy semester for students, staff or faculty. Over 300 members of our community were infected. Additionally, our community faced the effect of friends and family getting sick and the constraints of social isolation and changes in normal activities brought about by the pandemic. 

We made it, based on the commitment of the administration and the work of many at William & Mary, such as the indefatigable Corinne Picataggi and her whole Healthy Logistics team, as well as the COVID-19 Response Team. The coordination of testing, quarantine & isolation and vaccination scheduling is not as easy as they made it seem. 

We should be proud of our W&M community, we rose to the occasion. With vaccination rates rising, we hope the circumstances when we return in the fall 2021 semester will be much different, but we can be assured that due to how we handled the COVID-19 challenge this semester, we will handle whatever comes along together.

W&M Vaccine Survey Results

William & Mary asked students, faculty and staff this spring to voluntarily report their vaccine status in order to coordinate vaccination appointments and plan for fall. Here are self-reported results as of May 7, 2021:

Students

  • Two-thirds of the student population, or 5,781 students, responded.
  • Of those, 47% (2,728) report they are fully vaccinated. 
  • Thirty-eight percent (2,190) report they’ve had one dose. 
  • In total, 85% are either fully vaccinated or in the process of receiving vaccinations. 
  • Twelve percent (710) indicate they plan to be vaccinated.
  • Less than 3% (153) indicated they have no plans of being vaccinated at this time.
Faculty & Staff
  • Just over three-fourths, or 76%, of faculty & staff (1,949) responded.
  • Of those, 70% (1,371) report they are fully vaccinated. ​
  • Twenty-two percent (430) report they’ve had one dose.
  • In total, over 90% are either fully vaccinated or in the process of receiving vaccines.
  • Four percent indicate they plan to be vaccinated​.
  • Of those who responded, 3.4% reported they do not plan to be vaccinated at this time.

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Masks outside: Yes or no? It depends

May 4, 2021

This week the CDC advised Americans that masking was no longer necessary for fully vaccinated individuals when doing outdoor activities in small groupsThe statement also explained that unvaccinated people may go without masks outdoors when exercising with household members.

This guidance was issued at a time when India is experiencing a massive surge in cases and the World Health Organization’s director general highlighted the need for continued caution given the global increase in both cases and deaths. 

This may have seem confusing to many, but it’s logical -- based on local conditions and personal situations. 

This week I have asked myself the question, “Do I need a mask outdoors?” I have also fielded the same question on our local baseball fields and in Colonial Williamsburg.

The answer is: It depends.

This is unsatisfying -- but accurate. Whether you need to wear a mask outdoors depends on several factors. It depends on personal risk, immunization status (yours and those around you) and the setting.

At the university level, it is important to remember that we are in a communal setting, and people don’t move in and out of our population often. Our university can be considered as a semi-closed population in that we have generally the same people in it, but we are also interacting with the general population constantly and at different levelsThat means disease can be introduced and spread quickly if we aren’t vigilant.

It is also important to recognize that the CDC says masking is still recommended in public spaces. Everyone is still expected to wear them in the Sunken Gardens, at sporting events and at graduation. 

I am encouraging my friends to revisit the Know your Number approach as a way to communicate individual level approaches to masking. 

We recognize that inconsistencies in the global narrative can be confusing. We urge you to remain vigilant as we finish up our spring semester. We also continue to urge you to get vaccinated. Last week was World Immunization Week with the theme “Vaccines bring us closer.” Let’s continue the strong path we have created and bring ourselves closer together by staying healthy together.

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Vaccination prevents spread of COVID-19

April 27, 2021

The CDC has started to document cases of breakthrough infection in vaccinated individuals. These occur because vaccines are not 100% protective against getting the infection; the protection rate for available vaccines ranges from 85% to 95%.  

All breakthrough infections were introduced by unvaccinated persons, but vaccinated people either had no symptoms or mild symptoms, and those symptoms tend to occur in vaccinated older individuals with pre-existing conditions in nursing facilities.  

Vaccination also prevented secondary spread, which is when an infected person spreads the disease to others. Overall, this indicates that the way to stop cases of COVID-19 from occurring is to vaccinate as many people as possible. 

Some people may have health risks that prevent them from getting vaccinated. We advise people to not decide this based on their diagnosis alone, but instead should check with their health care provider. Our immune systems are robust! They evolved to keep us alive in the face of lots of environmental pathogens on earth’s surface, so they tend to work well except in severely immunocompromised individuals.  

We encourage people to get vaccinated, but we also understand that each person’s individual health status is different, and sometimes if you have another relatively mild condition such as a cold, it’s inadvisable to get vaccinated at the time.  

We therefore also encourage tolerance and understanding of others who have reasons for not wanting to get vaccinated immediately. Tolerance and patience with each other are important in helping us as an academic community within state, national and global communities to overcome this pandemic.   

Nationally, we are at 50% vaccination rate, so we are literally halfway there! 

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How long will the vaccine last?

April 20, 2021

If you are among our campus community that has recently been vaccinated, your next question might be, “How long is this vaccine going to last?” In our previous Epi Updates we have addressed how well the vaccines work (spoiler alert: very well) and research does indicate that so far, they are still effective.

What is less clear is exactly how long they will last and if a booster will be required. In a typical situation, we would have continued with Phase 3 clinical trials lasting several more years before the vaccine was used widely. Those trials would have given us the data on long-term immunity that we need to answer these questions. In the absence of this longitudinal data, we don’t know how long the protection will last. There are vaccines for other diseases that last a lifetime, while some last 10 years and others need annual boosters. 

Research on how long the immunity for the various COVID-19 vaccines will last is emerging, with initial possibilities ranging from six months to several years. We also know that factors such as strength of individual-level immune response and the emergence of variants could influence the duration of protection. In the future, we might see tests emerge that detect the level of antibody response. These could provide an indication of when a booster or vaccine is required.

In the meantime, let’s continue to get vaccinated, since we know this will help us develop a robust immune response and reduce the threats to efficiency of the vaccination. If the whole population gets vaccinated quickly, then we reduce the chance of variants developing, and reduce variants that don’t respond to the vaccine.

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The lost history of the smallpox vaccine

April 13, 2021

Vaccination, or immunization, is a natural phenomenonscience is just copying nature to protect humans from disease. Even before humans knew that micro-organisms cause disease, ancient cultures acknowledged that that some people exposed to a disease didn’t die from the disease, but instead became immune.  

In India and West, East and North Africa, many societies created methods of introducing individuals to disease in ways that made them sick but did not cause them to get a serious case of the disease, and resulted in immunity. For example, scarification in West Africa developed as a method to make people immune from smallpox: a blade was dipped into the pox on the body of a person sick with smallpox and that same blade was then used to make scarification on the body of a healthy personwho then had a mild form of the disease but never got full-blown smallpox.  

This form of immunization for a viral disease was described by Onesimus, a West African enslaved person, to the minister Cotton Mather, who subsequently introduced various forms of mild exposure to smallpox in Boston in the early 1700s. (History detailed the fascinating story a few days ago in How an Enslaved African Man in Boston Helped Save Generations from Smallpox.”) Such exposure without dosage could surely go wrong and many people did get full-blown smallpox with these methods.   

Vaccination has never been 100% safe, but science has made it safer over time, to the point of eradicating smallpox using it. Our current battle against COVID-19 is just as fierce as those of humans battling diseases from the beginning of time. Vaccination is a tool to keep us safe. With the four most common vaccines against COVID-19, no one can assure 100% safety. With the mRNA vaccines (Pfizer and Moderna), using a new method of delivery, we don’t know the long-term effects. With the vaccines using well-tried methods of vaccine delivery (AstraZeneca and Johnson & Johnson), association with blood clots has been found but occurs in less than 0.05% of people vaccinated. Out of an abundance of caution, the CDC has recommended a pause in use of Johnson & Johnson’s vaccine to further examine the association with blood clots. 

Yet no one vaccinated with any of the vaccines has died of COVID-19. The effects of COVID-19 can be severe, and we still don’t know all the reasons why it is severe in some people and mild in others. There is also the issue of long COVID and how that affects an individual’s long-term health and well-being.  Given how widespread COVID-19 is, the only way to guarantee our return to normal life and to protect ourselves, our families, our friends and neighbors is to get vaccinated so we achieve herd immunity as quickly as possible. William & Mary is now at the point of being able to offer vaccination to any faculty, staff or student who wants it. We urge you to be vaccinated as soon as possible. 

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I'm vaccinated: Is it safe for me to travel?

April 6, 2021

The pandemic limited where and when we could travel over the last year. Last week the CDC released new travel guidance for people who are vaccinated and those who are not. This guidance indicates that it is generally safe for fully vaccinated people to travel within the United States 

These people also do not need to get tested before or after travel, and do not need to self-quarantine unless they are required to by their destination or work.  

If you haven’t been vaccinated, then the CDC recommends holding off on travel for now. If you haven’t been vaccinated and you must travel, then you should get tested before and after you go, as well as quarantine once you get back.  

The updated travel guidance is exciting information, as many people who are fully vaccinated are ready to set off to somewhere other than our living rooms 

In this week’s update it is important to think about what this new guidance means for our campus community as some of us will begin to travel. It’s important to remember that we are part of a collective community that has a high level of contact. Crowded spaces and community living are among the most common risk factors for infectious disease spread.  

If you are vaccinated, and decide to travel, then it is important to understand that even domestic travel isn’t business as usual. Since you are part of a campus community, its important to build in time to research and plan your mitigation measures. All travelers should wear a mask, maintain social distance from people not in your group and wash your hands or use hand sanitizer often. 

It is our collective responsibility to look at the evidence that says that travelers are at lower risk when vaccinated. Equally important is our responsibility to continue to protect our campus community when we are making a change to behavior that may increase risk of infection. 

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Preventing exponential spread

March 30, 2021

In the past week the student case counts of COVID-19 continued to increase. In this Epi Update, we are urging you to limit your social contacts, because this combined with masking and handwashing will help us break the chain of transmission in our William & Mary community.

Each person infected with COVID-19 infects on average two people, but when a super-spreader event occurs, one infected person can infect many people. We developed the William & Mary Healthy Together Community Commitment guidelines to limit close contacts based on the CDC’s guidance, which follows universal prevention methods of disease prevention. If everyone is limiting their close contacts, whether we have a positive test result or not, then it allows the public health system to work effectively through contact tracing. When our public health system is working effectively, we can rapidly address the disease spread on campus.  The more contacts we have, the harder it is to trace contacts. And the harder it is to contain the spread of disease.

In addition, W&M testing protocol is based on the optimal time of detecting the virus. Getting tested during the disease incubation period will not lead to disease detection, but only provide a false sense of security. The incubation period for COVID-19 is at least 10 days after exposure, so a negative test immediately after a suspected exposure will be accurate but does not mean one is not infected. The danger of missing cases is that, because every positive case infects about two additional people, in a week W&M’s cases could double again.  

Our advice to students: Do not try to hide your symptoms or hide positive results taken off-campus! This only helps the disease spread further.

This infectious disease feeds on human behavior and habits. And we can thwart it by our appropriate behavior as well. We can work together as the Healthy Together Community Commitment outlines – not blame each other for exposure – to limit our own risk and exposure of others.   

Please limit your social contacts to smaller groups. Remember your masks and wash your hands. Together we can stop the chain of transmission in our community.

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COVID-19 variants: Moving the virus faster

March 22, 2021

As you’re no doubt aware, new strains of the SARS-CoV-2 virus are emerging. Viruses change over time to adapt to various situations; most adaptions allow the virus to overcome barriers to its replication and promote its continued survival. On March 18, the CDC's tracker at US COVID-19 Cases Caused by Variants indicated that variants across the United States cause 9,541 COVID-19 cases. The data also indicate that the variants are more easily transmitted from person to person. It is essential to understand that we do not think these variants are more virulent and therefore making people sicker, but they may spread faster if the precautions already in place, such as adequate social distancing and wearing masks, are not followed.

Since February many states have been reporting a steady decline in cases numbers. Unfortunately at the national level, we are starting to see hot spots of transmission as states are easing mandates around masking, handwashing and distancing a little bit too soon.

Emerging data indicate the variant virus is susceptible to the antibodies produced by the vaccines, meaning the current vaccines prevent disease from variants. The fact that vaccines and current mitigation measures are working against variants of the virus is excellent news, because we do not need to develop new public health interventions to keep our campus community safe.

We recognize that people are ready to move outside of their bubbles, especially if they have been fully vaccinated. The take-home message is that higher transmission potential can result in more cases and because these variants can increase transmission, we ask for continued support in adhering to our healthy campus commitment to ensure we keep cases down at William & Mary.

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Evaluating appropriate response in real-time

March 16, 2021

In Virginia the rate of COVID-19 continues to decrease, although national rates are currently level due to the opening up of some states. Easing our Healthy Together commitments too soon have the potential to boost variants and result in a resurgence of cases. PHAT is continuing to examine all available data and the details of our Healthy Together Commitment are evaluated several times a week to ensure they are still necessary to decrease or slow the spread of COVID-19 in our campus community. We are in good shape with our cases, but we do not want to stop here. These commitments will be relaxed when we have a stronger and consistent downward trend in cases. 

One tool we have to stop the pandemic is vaccinations, and national data indicates they are working.  Many people in our campus community are receiving vaccines from more sources, such as the drug store or their doctors' offices. Therefore, the university started collecting voluntary information on faculty and staff vaccinations in part to help us monitor the rate of vaccinations in our campus community. It is important to know the vaccination rates because the CDC has new guidelines for vaccinated people (Interim Public Health Recommendations for Fully Vaccinated People | CDC). Once we have comprehensive data on vaccination we will know when we can recommend the use of the new CDC guidelines on a wider, institutional scale. 

This is particularly important in planning for the fall at William & Mary. We anticipate that summer, while robust in curricular offerings, will be limited in-person and very limited at W&M in terms of campus housing. Summer represents an in-between time – not a period of uncontrolled pandemic but not an unabashed return to normal, pre-COVID life. William & Mary is currently planning for the fall to be the time when university life looks more like it did pre-pandemic. That hinges largely on sufficient vaccination levels among our students, faculty, staff and in the surrounding community. 

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A vaccine Q&A with the epidemiologists

March 9, 2021

Last week the FDA confirmed Emergency Use Authorization for the Johnson & Johnson vaccine, which is administered in one dose. This different kind of COVID-19 vaccine can be more easily distributed because it doesn’t need to be stored and refrigerated at very low temperatures. This is a game-changer when it comes to increasing the access to the general population. We’re seeing many questions around the new vaccine, though, so wanted to tackle those today, and then offer our regular weekly updates.

Is this vaccine effective?

The J&J vaccine is 66% effective, while Pfizer and Moderna vaccines are as high as 95%. However, the J&J vaccine appears to be even more effective against serious illness. Some people may also prefer the one-shot dose, given it provides a substantial amount of protection. For comparison, let’s think about the flu vaccine. At 40%-60% effective, it prevents thousands of cases of serious illness and death each year.

Why is the J&J vaccine different from Pfizer or Moderna?

The difference in efficacy has to do with the way each vaccine was created. Pfizer and Moderna use a new technology of mRNA delivery that relies on sending messages to our cells. There is no actual virus particle in these vaccines. It works by directing our cells to create the protein unique to the virus. Later, facing a real-life infection, our immune systems recognize the protein and prevent disease. You might be interested to know that a William & Mary alumna, Melissa Moore ’84, worked on the Moderna vaccine. You can learn more about her fascinating and critical work in this W&M Alumni Magazine feature story.

The J&J vaccine relies on the classic system of vaccination. It takes a minute piece of the virus, which cannot cause disease, and delivers it into our bodies in a way that activates our immune system, so when later we are exposed to a real-life infection, our immune system attacks it before it makes us sick.

Should I trust a new vaccine technology?

The mRNA technology has actually been under development for about a decade; the new part of it was adapting the emerging technology to respond to COVID-19, which was an entirely new virus to our species. But its class of coronaviruses has been known to us for some time, and scientists were already working on the mRNA vaccine technology that most effectively prevents illnesses associated with RNA viruses.

Is one vaccination technology safer than the other?

Both modes are safe. J&J uses the traditional technology, which is less (but still highly) effective against RNA viruses such as COVID-19. Pfizer and Moderna’s mRNA vaccines use new technology to boost immunity specifically against RNA viruses.

If I have the choice, which should I choose?

They all offer protection, and have no downsides, in our view. The J&J vaccine is just one dose and is easier to store and transport, offering greater convenience for both recipients and state and local health officials. The higher effectiveness rating of the Pfizer and Moderna vaccines might be more attractive to those who are at very high risk. Bottom line: Having more vaccine choices protects all of us, as everyone’s situation is different.

Regular Updates

Eating together is an important part of community and friendship, but because of the mode of transmission of the COVID-19 virus, sharing meals while in close proximity is a high-risk activity. Early studies indicated that restaurants and bars were some of the main places from which COVID-19 spreads quickly. To eat or drink, we have to remove our masks, creating opportunity for fomites in the air to be inhaled or ingested. Taking precautions such as eating alone is hard, since it's an activity we love to share with others, but please continue to follow best practices of eating in your personal spaces, outdoors and adequately distanced from others.

Right now, morale is high as we are seeing vaccine access increase and cases decrease. It is important to remember that vigilance is still imperative to keep our campus community safe. If we can stay the course and avoid the temptation to relax our vigilance too much and too fast, then we will really see a difference in the coming months. It is important to remember that if you have the vaccine, you may not be sick from COVID-19 but you can still be infected. That means you can give it to someone who might not be vaccinated and they could get really sick. It is important that we continue to stay the course by wearing our masks, washing our hands and maintaining physical distance. We are very close to being able to re-evaluate these interventions, but we aren’t there quite yet.

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The lag between national, state and local trends

March 2, 2021

Last Wednesday, Gov. Ralph Northam announced plans to ease some COVID-19 restrictions, including social gathering limits and the statewide stay-at-home order. The lifting of previous restrictions was in response to decreasing statewide COVID-19 rates, declines in hospitalizations and increasing vaccination rates.  

Given the expected lag between decreases in national, state and ultimately local COVID-19 rates, W&M will continue to adhere for now to existing restrictions and our Healthy Together Community Commitment as advised by the Public Health Advisory Team. 

As COVID-19 presents unique challenges for universities and our ultimate goal is to ensure the safety of students, staff, faculty and the surrounding community, we are continuing to actively monitor trends at national, state and local levels. If these trends continue to decline, the W&M guidelines will be re-evaluated to determine if easing our restrictions would be appropriate. Before we re-evaluate, we want to reach a level of reduction in cases significant enough that a reversal to higher rates is improbable. Early removal of restrictions during a downward trend can easily lead to a spike in cases. As cases further reduce there will be less likelihood of each of us coming in contact with a person actively shedding the virus, and therefore less likelihood of transmission. It is critical that we adhere to our current guidelines for this critical downward push.   

Because of the delays in shipping samples due to weather we are waiting on the most recent test results. We are also using other data, specifically wastewater treatment data, to focus and increase prevalence testing on areas of campus that need it the most. This targeted testing approach will help ensure that our declining numbers are not an aberration and that we have a consistent downward trend on campus. 

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Update and mask study at W&M

February 23, 2021

Although Williamsburg has been saved from the worst of the winter weather, apart from a dusting of snow over the last week, about 70% of the country is covered in snow, and we are seeing that weather impact Williamsburg through interruptions in the supply chain for both shipping test kits and vaccines. We want to thank the Athletics Department for stepping up and helping fill in the gap in testing supplies by sharing their test kits and having their personnel help with testing.  As the weather conditions ease up, prevalence testing will continue, so we can again ship large numbers of test kits to the test locations.  

Vaccine roll-out has been slow. Variants are arising and spreading. As our campus community adopts masking and handwashing as the norm, maintains social distancing and limits close contacts, we are starting to see the first traces of a reduction in terms of our infection and positivity rates. Thanks to W&M student researchers, we have new data that shows that 97% of our campus community wore masks and most commonly selected the cloth or surgical type of mask (94%) known to be the most effective at preventing disease spread. Despite the slowdown, it is critically important that we maintain our healthy commitments to a safe campus community.   

National, state, county and city COVID-19 rates continue to trend downward. Our numbers also continue to trend down. Your resilience in keeping the Healthy Together promise and doing your part means we are on the downside of the epidemic curve. We cannot relent yet, since this microorganism is a cunning foe, so we will be keeping all precautions in place as we trend down, and it's important that you continue to abide by those precautions.

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An introduction to the Public Health Advisory Team

February 16, 2021

With more regular epidemiological updates, we want to provide the William & Mary community additional information about how we respond to COVID-19 risk at the university and offer a snapshot of the current landscape, from an epidemiological perspective. Given the rapid changes in the landscape of available data at both global and local levels, this update doesn't provide an exhaustive list of all meaningful data we review. However, it does make accessible many significant sources and our process for reviewing data. Since COVID-19 is not contained by either artificial or campus borders, monitoring the changes over time and understanding what prevents new cases from occurring is a cornerstone of public health.

The type of data the Public Health Advisory Team reviews can be broken down into four categories.

Case surveillance data & monitoring

We monitor daily national, state, county and W&M-specific COVID-19 surveillance data. These data can tell us how the pandemic is changing, allowing us to assess severity and risk and to develop necessary interventions.

Even with the best surveillance and monitoring, cases will appear; W&M actively seeks COVID-19 primarily through wastewater testing and weekly prevalence testing (testing a percentage of students, faculty and staff). We use weekly wastewater test results to more effectively target prevalence testing for students living on campus.

In addition, W&M conducted population-wide (census) testing of students on campus and within 30 miles four times in the fall and is currently conducting the first round of student census testing this spring. Our goal with prevalence and census testing is to seek asymptomatic positives before large numbers of contact occur.

Predictive models

Next, we analyze 13 predictive models that illustrate the possible trajectories of the pandemic. These models are updated routinely.  Each makes a different set of assumptions, so looking at multiple models helps understand potential outcomes and best- and worse-case scenarios.

Contact tracing

Third, we review data from contract tracing. These data help us to identify people who may have been exposed to COVID-19 through direct contact or proximity. We can use these data to test for infection and ask people who have been associated with a positive case to isolate. The goal of using this data is to prevent new cases from occurring.

Intervention effectiveness

Finally, through primary data collection, we measure the effectiveness of our testing and mitigation interventions. We are collecting data on the effectiveness of different types of testing approaches and the implementation of mask adherence on campus.

CURRENT W&M LANDSCAPE

Currently, there are more students in post-infection than there are current cases. This means that the number of active cases and new positives is declining, which is excellent news, and just what we hoped to see. This trend mirrors the reduction in national, state and Historic Triangle rates. We expect this steady decline to continue, as increased COVID-19 was associated with the high rates that followed the holidays; such high population rates aren’t expected for the rest of the spring term. 

William & Mary’s first wastewater data of the semester came in and helped target sampling last week; they also reflected what we expected. Whole population, census testing also started last week. We expect that both will help us identify cases early and help mitigate spread, as happened last semester.

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