COVID-19 among University of Otago students living in North Dunedin households in the first half of 2022: was the prevalence underestimated?
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Dunedin (the second largest city in Te Waipounamu, Aotearoa New Zealand) is often referred to as a student city, with the majority of University of Otago students coming from out of town and living in residential colleges in their first year and student flats in subsequent years. Much of this accommodation is concentrated in the North Dunedin area. In Semester 1 of 2022, there were about 16,965 University of Otago students enrolled in Dunedin-based courses (and 3,674 enrolled at campuses in other centres);[[1]] about 21% of these students lived in residential colleges, 4% lived in managed accommodation that mainly houses single-semester international students (University Flats, commonly known as Uni Flats), while the remainder mostly lived in student flats.
In mid-February 2022, COVID-19 began to spread through the University of Otago student population in Dunedin.[[2,3]] As has been the case throughout the pandemic, students were asked to (i) get tested if they had any symptoms suspicious of COVID-19 or if they were a close contact of a case, (ii) report positive results to the University via a designated channel, and (iii) follow the Ministry of Health’s guidance about self-isolation and other public health measures to minimise the spread of infection.[[4]] The number of student cases rose rapidly throughout late February and early March and the University, residential colleges and the Otago University Students’ Association (OUSA) mounted huge operations to support hundreds of students self-isolating in colleges and flats, including the delivery of food and care packages.[[5]]
With increasing community transmission of the Omicron variant of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) throughout Aotearoa New Zealand in early 2022, COVID-19 testing shifted from laboratory-based reverse transcription polymerase chain reaction (RT-PCR) tests using samples taken by health professionals to community-based rapid antigen tests (RATs), which can be self-administered.[[6]] One consequence of this shift was that individuals became responsible for reporting their RAT results via the Ministry of Health’s My Covid Record (RT-PCR test results continued to be automatically uploaded).[[7,8]]
While good mechanisms were established in residential colleges and Uni Flats for identifying and reporting COVID-19 cases among University of Otago students, anecdotal reports suggested that students living in other settings might have been less likely to report positive COVID-19 test results (RT-PCR or RATs) to the University, or to upload their RAT results to My Covid Record. However, the extent of any such under-reporting was unknown.
We undertook a study among the residents of North Dunedin student flats, to (i) estimate the prevalence of COVID-19 between the start of Flat Orientation Week (Flo-Week) and the end of Semester 1, (ii) investigate the potential under-reporting of positive COVID-19 test results to the University, (iii) investigate the potential under-recording of positive RAT results in My Covid Record, and (iv) explore the COVID-19 related experiences of students during the above period.
Methods
Random selection of households
We restricted the study area to North Dunedin, as this is the area with the highest density of student flats. For operational purposes, this was defined as the area covered on foot by the University of Otago Campus Watch (which corresponds to the Dunedin City Council’s designated “University area”). We used the online Dunedin City Council Rates Map[[9]] to create a list of all potential residential addresses within the study area and used the random number generator function within Microsoft Excel to randomly select 160 addresses. Households were eligible for inclusion in the study if at least one resident was a student enrolled at the University of Otago; other residents could include Otago Polytechnic students, as well as non-students.
Interviewer-administered questionnaire
We developed a short interviewer-administered questionnaire to collect a range of information from each household, including the number of people living in the household, the number of household members who had tested positive for COVID-19 between the start of Flo-Week on 14 February 2022 and the date of the interview (the study period), the number of University of Otago student cases within the household who notified the University that they had COVID-19, the number of cases who were diagnosed via a RAT and uploaded their result to My Covid Record, behaviour in households with cases, adherence to isolation requirements and the number of household members with confirmed re-infection. We also asked open-ended questions to explore the reasons for not reporting a positive COVID-19 status to the University, not uploading a positive RAT result to My Covid Record or not adhering to isolation requirements, and to learn about the general COVID-related experiences of household members during the study period.
Data collection
Interviews commenced during the final week in which Semester 1 lectures were held (the week starting 30 May). If no one was at home on the first visit, a maximum of two repeat visits were made on different days and at different times. Ensuring the safety of the interviewers (final year medical students) and household members in this field study was essential. To maximise physical safety, we approached households in pairs and notified a third team member when we started and finished a data-collection session. To minimise the risk of infection, we wore N95 face masks and conducted physically distanced interviews outside. In addition, we asked a screening question at the start of the interview to identify any households that unexpectedly had active COVID-19 cases (i.e., there were no signs at the entrance to indicate that the household was isolating); at these addresses the only information collected was the number of residents and the number of cases.
We sought verbal consent for an interview at each randomly selected household and gave assurances that any information provided would not be linked to the address. In order to ensure anonymity still further, we did not collect names or demographic data. All household members who were at home were free to take part in the interview, however, in practice, most interviews were conducted with one member of the household who responded to questions on behalf of the whole household. At the end of the interview, the participants were provided with a card that listed support services available to students, as well as information about how to notify the University of a positive COVID-19 test and how to upload a positive RAT result to My Covid Record.
We used Research Electronic Data Capture (REDCap) software,[[10,11]] a secure web-based survey application hosted by the University of Otago, for data collection and management. Although REDCap is hosted by the University, access to the study data was restricted to the members of our team.
Analyses
For the quantitative data, we conducted simple descriptive analyses and report numbers and proportions (percentages). Qualitative responses to the open-ended questions were analysed by identifying key themes.
Ethical approval
The project received ethical approval from the University of Otago Human Ethics Committee (Health), reference number: H22/050.
Results
In total, 1,720 potentially eligible households were identified in the study area (Figure 1). Of the 160 randomly selected households visited, 20 were found to be ineligible (no University student(s) living in the household, derelict/unoccupied residence, residence part of a residential college, or commercial premises). Of the remaining households, three declined to participate, two were visited on three occasions but no one was at home, and 135 (96.4%) agreed to take part. The majority of the interviews (n=111) took place between 30 May and 3 June, and the remainder on 9 June (n=21) and 16 June (n=3). Three of the participating households reported active cases in response to the screening question and therefore a full interview was not undertaken.
View Figure 1.
In 127 of 135 households, at least one resident tested positive for COVID-19 between the start of Flo-Week and the date of the interview (a mean period of 109 days [standard deviation 3.6]), giving a period prevalence at the household level of 94.1%; the period prevalence among individuals in the households surveyed was 73.6% (513/697). As noted above, at the time of data collection, three households had active cases of COVID-19 infection (9 of 13 residents), giving a point prevalence at the household and individual levels of 2.2% (3/135) and 1.3% (9/697), respectively.
Table 1 provides information about the numbers of confirmed COVID-19 cases per household according to the number of residents in the household. Household size ranged from two to 14 residents, with the majority (72.6%) of households containing four to six residents. The proportion of households in which at least one resident tested positive for COVID-19 during the study period increased with increasing household size (75% of households with two and three residents, 90% of households with four residents, 97.6% of households with five residents, and 100% of households with six or more residents).
Table 2 shows the numbers and percentages of households in which everyone had tested positive for COVID-19 between the start of Flo-Week and the date of the visit, according to the number of residents in the household. In 56 of 135 (41.5%) households, every occupant had confirmed COVID-19 at some time during the study period. When restricted to the 127 households with at least one case, the proportion was 44.1%.
View Tables 1–2.
The findings discussed from this point onwards relate to households without active COVID-19 cases at the time of the interview (n=132). Of the 684 residents living in these households, 504 (73.7%) tested positive for COVID-19 during the study period. Of the 444 cases who were University of Otago students, 268 (60.4%) reported their positive status to the University, 130 (29.3%) did not report, and for 46 (10.4%) the reporting status was unknown. Reasons for not reporting were explored at a household level and of the 43 households in which at least one student did not report their positive status, 26 (60.5%) stated that they were unaware that reporting was a requirement, eight (18.6%) did not know how to report, and 10 (23.3%) felt that reporting provided no benefit for individuals. Others noted technical difficulties, that it was “a hassle”, or that there was “no need to report” as they did not require any extra support.
The diagnosis of COVID-19 was made via a RAT for 429 of the 504 cases; 287 (66.9%) of these cases uploaded their result to My Covid Record, 71 (16.6%) did not upload their result, and for 71 (16.6%) the upload status was unknown. Of the 29 households in which at least one resident did not upload their result, four (13.8%) stated that they were unaware that this was required and 11 (37.9%) considered that reporting provided no benefit for individuals. Several households also noted that COVID-19 was so widespread in the student community that they felt there was no point in uploading positive results as it “would not change anything”, while others forgot, felt it was a hassle, were unable to backdate a positive result in My Covid Record or believed that they had “the right not to report”.
In households in which there was at least one confirmed COVID-19 case during the study period (n=124), behaviour within the household during the required isolation period(s) varied; 29.0% of households reported that COVID-19 negative residents actively avoided the case(s) (including some households in which residents took particular care to protect immunocompromised members), 53.2% reported they interacted normally with the case(s), and 24.2% reported they deliberately attempted catch COVID-19 from the case(s). The sum of these percentages is greater than 100 because some households described a dynamic approach—initially attempting to avoid infection, but subsequently behaving normally or making an effort to contract the virus. Reasons cited for attempting to become infected included trying to reduce the total isolation period (at a time when each new infection reset a 10-day isolation period for all occupants of a household), minimising time off paid employment and the desire to “get it over with”.
While most households adhered to isolation requirements, six (4.8%) reported they did not. Three cited the need to meet social commitments and one cited academic obligations. Non-adherent households also commented on the need for exercise, the need to obtain food, and that it was “pointless” isolating from others in the neighbourhood who also had COVID-19.
In relation to re-infection, three (2.3%) households reported that at least one resident had more than one episode of confirmed COVID-19 during the study period.
Responses to an open-ended question about students’ experiences revealed that the general COVID-19 situation during the study period had created various academic, financial and mental health stresses. Academic challenges arising from personal illness or a requirement to isolate as the household contact of a case, as well as the University-wide introduction of online learning for the first half of Semester 1, included IT issues, fatigue from increased screen time, difficulties in maintaining motivation, concerns about missing important practical aspects of courses (such as laboratory sessions and field trips) and problems in catching up on work that had been missed due to illness. Some students also reported significant financial consequences arising from the COVID-19 situation, including being made redundant, withdrawing from papers as fewer casual and evening/weekend employment opportunities were available and variable access to COVID-19 hardship relief funds and wage subsidies due to the type of work in which students were engaged. For some students, their mental health and wellbeing suffered during the study period, with cancelled social events and feelings of loneliness, and apprehensiveness about returning to situations in which there were large numbers of people. The experience of isolating as a household was mixed—for some it was difficult, while others reported that it strengthened their relationships. There were also physical impacts for those who had caught COVID-19, with some students describing being very unwell and having ongoing issues. Some also described the negative impact of contracting influenza or other respiratory illnesses during the study period, in addition to COVID-19. Finally, many households reported that the University and OUSA initiatives to supply food and care packages were of huge benefit, alleviating a lot of stress and supporting them to meet their isolation requirements.
Discussion
In this field study of randomly selected University of Otago student households in North Dunedin, the period prevalence of COVID-19 between the start of Flo-Week and the end of Semester 1 was very high; about 94% of households had a least one confirmed COVID-19 case during that period and this corresponded to about three quarters of the residents in the participating households. We also found that just under two thirds of University of Otago student cases notified the University that they had COVID-19 and two thirds of cases with a positive RAT uploaded their result to My Covid Record.
Key strengths of this study include the random selection of households and very high participation proportion, the use of a standardised interviewer-administered questionnaire and the collection of both quantitative and qualitative data. In addition, the interviews were conducted by final year medical students and it is likely that these “peer interviewers” elicited more open responses from participants than would have been the case if non-student interviewers had been used.
The study also has some limitations that should be considered. For pragmatic reasons, interviews were generally carried out with one member of each household, and this has implications for the potential accuracy of their responses. While these individuals knew whether their fellow household members had tested positive for COVID-19, they were sometimes less certain about their flatmates’ reporting behaviours—as reflected in the number of “unknown” responses. However, even in the best-case scenario (in which it is assumed that all of these students did report their positive status), the proportions who notified the University and uploaded their RAT results to My Covid Record would only be 70.7% and 83.4%, respectively. Moreover, when asking people about their behaviour there is always the potential for social desirability bias (in which participants tell interviewers what they think they want to hear); if such bias had occurred in this study, the effect would have been to over-estimate the reporting proportions. Hence, while there might be some uncertainty about the exact proportions, it is still apparent that there was considerable under-reporting. This conclusion is supported by University data; in total, the University was notified of 3,820 cases during the study period (22.5% of the 16, 965 students studying on campus in Dunedin).[[1]] About half (n=1,958) of these cases were self-reported by students (the remainder were reported by support teams at residential colleges and Uni Flats), and considering that our random sample of about 10% of potentially eligible households in North Dunedin identified 513 cases, this is consistent with substantial under-reporting.
Our interviews with one household member also mean that some of the barriers to reporting might have been missed. Nonetheless, the responses that were given have provided valuable information to assist with planning for future COVID-19 waves, including ensuring that students understand the importance for themselves and the community of reporting their positive status to the University and uploading positive RAT results to My Covid Record—and making it easy for them to do so.
Our findings also provide insights into the behaviour within households with at least one case, with less than a third initially taking active steps to avoid within-house transmission. Fortunately, the Omicron variants circulating during the study period generally did not cause very severe illness among the predominantly young and healthy student population, however, this might not be the situation with future variants of SARS-CoV-2.
We focussed on a particular group of students and therefore our findings cannot necessarily be generalised to University of Otago students living outside the North Dunedin area. For instance, many of the cases in our study occurred during the orientation period before classes began, whereas for students living elsewhere in Dunedin, potentially different patterns of social mixing mean that COVID-19 infections might have occurred later and therefore created even more academic stress. In addition, we focussed on a time when COVID-19 vaccination was mandatory for enrolled students; hence transmission rates in future waves might differ, depending on vaccination rates and the transmissibility of the predominant SARS-CoV-2 variants at the time.
We found no published investigations of self-reporting of positive COVID-19 status by university students elsewhere; however, the Ministry of Health’s recent COVID-19 Trends and Insight Reports assume considerable under-reporting in the general population which may differ by age, ethnicity and deprivation,[[12]] and national COVID-19 modellers have assumed that reported case numbers capture only 50% of symptomatic cases.[[13,14]]
Finally, our findings regarding the academic, financial and mental health impacts for students of the COVID-19 situation are consistent with findings from elsewhere, including at other universities in Aotearoa New Zealand[[15–17]] and internationally.[[18–23]]
Conclusions
The proportion of University of Otago student households in North Dunedin that had to isolate between Flo-Week and the end of Semester 1 because at least one resident had COVID-19 was extremely high. At the same time, there was substantial under-reporting of student cases to the University of Otago and under-recording of positive RAT results in My Covid Record—this has obvious implications for authorities responsible for making prevention and control decisions, as well as for students who could miss out on key support from the University and their healthcare providers.
Summary
Abstract
Aim
To estimate the prevalence of COVID-19 among occupants of North Dunedin student flats between Flat Orientation Week (Flo-Week, week starting 14 February 2022) and the end of Semester 1 (week starting 30 May 2022); to investigate the potential under-reporting of cases to the University of Otago and under-recording of positive rapid antigen test (RAT) results in My Covid Record; to explore the COVID-related experiences of students during the above period.
Method
Randomly selected households in the North Dunedin area were visited at the end of Semester 1 and oral consent was sought for a short interview comprising closed- and open-ended questions. Households were eligible for inclusion if at least one resident was a University of Otago student.
Results
One hundred and thirty-five (96.4%) of 140 eligible households participated, and in 94.1% of these households at least one resident tested positive for COVID-19 between the start of Flo-Week and the date of the interview (a mean period of 109 days [standard deviation 3.6]). In total, 73.6% of the occupants in the participating households tested positive. Of the cases who were University of Otago students, 60.4% reported their positive status to the University. Of all cases diagnosed via a RAT, 66.9% uploaded their result to My Covid Record. Students reported various academic, financial and mental health stresses associated with the general COVID-19 situation during the study period.
Conclusion
These findings suggest that the number of COVID-19 cases reported to the University of Otago between Flo-Week and the end of Semester 1 was a substantial underestimate of the true number, as was the number of cases recorded in My Covid Record. The findings also highlight the considerable impact that COVID-19 had on students during Semester 1.
Author Information
Acknowledgements
Correspondence
Correspondence Email
Competing Interests
1) Paul McNamara, University of Otago Emergency Management and Continuity Manager. Personal communication. 2022 Jun 28.
2) Otago Daily Times. Castle and Howe St parties confirmed as close contact sites. 2022 Feb 17. Available at: www.odt.co.nz/news/dunedin/castle-and-howe-st-parties-confirmed-close-contact-sites [accessed 2022 Apr 7].
3) Otago Daily Times. Uni offers support amid Covid concerns. 2022 Feb 19. Available at: www.odt.co.nz/news/dunedin/campus/uni-offers-support-amid-covid-concerns [2022 Apr 7].
4) University of Otago. COVID-19 update. 2022 Feb 19. Available at: www.otago.ac.nz/coronavirus/updates/otago837767 [accessed 2022 Apr 7].
5) University of Otago. Care packages being delivered to isolating students. 2022 Feb 23. Available at: www.otago.ac.nz/news/news/otago837863.html [accessed 2022 Apr 7].
6) Ministry of Health. Rapid antigen testing (RAT). Available at: www.health.govt.nz/covid-19-novel-coronavirus/covid-19-health-advice-public/assessment-and-testing-covid-19/rapid-antigen-testing-rat [updated 2022 Apr 6, accessed 2022 Apr 7].
7) Ministry of Health. How to use My Covid Record. Available at: https://covid19.govt.nz/covid-19-vaccines/vaccine-passes-and-certificates/my-covid-record/#covid-19-test-results [updated 2022 Apr 5, accessed 2022 Apr 7].
8) Ministry of Health. How to report your RAT results. Available at: https://covid19.govt.nz/testing-and-tracing/covid-19-testing/report-your-rat-with-my-covid-record/ [updated 14 March 2022, accessed 7 April 2022].
9) Dunedin City Council Rates Map. Available at: www.dunedin.govt.nz/services/rates-information/search-by-map [updated 2020 Feb 10, accessed 2022 May 24].
10) Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap): a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-81.
11) Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: building an international community of software partners. J Biomed Inform. 2019;95:103208.
12) Ministry of Health. COVID-19 Trends and Insights Reports. Available at: www.health.govt.nz/covid-19-novel-coronavirus/covid-19-data-and-statistics/covid-19-trends-and-insights [updated 2022 Oct 30, accessed 2022 Nov 4].
13) Vattiatio G, Lustig A, Maclaren O, Plank M. Modelling the dynamics of infection, waning of immunity and reinfection with the Omicron variant of SARS-CoV-2 in Aotearoa New Zealand. 2022 Jun 2. Available at: www.covid19modelling.ac.nz/waning-of-immunity-and-re-infection-with-omicron/ [accessed 2022 Nov 4].
14) Lustig A, Vattiato G, Maclaren O, Watson L, Datta S, Plank MJ. Modelling the effects of Omicron sub-variant BA.5 in New Zealand. 2022 Aug 23. Available at: www.covid19modelling.ac.nz/modelling-ba5/ [accessed 2022 Nov 4].
15) Akuhata-Huntington Z. Impacts of the COVID-19 lockdown on Māori university students. Wellington: Te Mana Ākonga, 2020.
16) Stevenson E, Smith-Han K, Nicholson H. Medical students' experience of studying while working part-time and the effects of COVID-19. N Z Med J. 2022;135(1557):38-48.
17) Cameron M, Fogarty-Perry B, Piercy G. The impacts of the COVID-19 pandemic on higher education students in New Zealand. JOFDL. 2022;26(1):42-62.
18) Aristovnik A, Keržič D, Ravšelj D, Tomaževič N, Umek L. Impacts of the COVID-19 pandemic on life of higher education students: a global perspective. Sustainability. 2020;12(20):8438.
19) Appleby JA, King N, Saunders KE, et al. Impact of the COVID-19 pandemic on the experience and mental health of university students studying in Canada and the UK: a cross-sectional study. BMJ Open. 2022;12(1):e050187.
20) Kohls E, Baldofski S, Moeller R, Klemm SL, Rummel-Kluge C. Mental health, social and emotional well-being, and perceived burdens of university students during COVID-19 pandemic lockdown in Germany. Front Psychiatry. 2021;12:643957.
21) Van de Velde S, Buffel V, Bracke P, et al. The COVID-19 International Student Well-being Study. Scand J Public Health. 2021;49(1):114-22.
22) Buffel V, Van de Velde S, Akvardar Y, et al. Depressive symptoms in higher education students during the COVID-19 pandemic: the role of containment measures. Eur J Public Health. 2022;32(3):481-7.
23) Sharaievska I, McAnirlin O, Browning M, et al. "Messy transitions": Students' perspectives on the impacts of the COVID-19 pandemic on higher education. High Educ. 2022;1-18.
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COVID-19 among University of Otago students living in North Dunedin households in the first half of 2022: was the prevalence underestimated?
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Dunedin (the second largest city in Te Waipounamu, Aotearoa New Zealand) is often referred to as a student city, with the majority of University of Otago students coming from out of town and living in residential colleges in their first year and student flats in subsequent years. Much of this accommodation is concentrated in the North Dunedin area. In Semester 1 of 2022, there were about 16,965 University of Otago students enrolled in Dunedin-based courses (and 3,674 enrolled at campuses in other centres);[[1]] about 21% of these students lived in residential colleges, 4% lived in managed accommodation that mainly houses single-semester international students (University Flats, commonly known as Uni Flats), while the remainder mostly lived in student flats.
In mid-February 2022, COVID-19 began to spread through the University of Otago student population in Dunedin.[[2,3]] As has been the case throughout the pandemic, students were asked to (i) get tested if they had any symptoms suspicious of COVID-19 or if they were a close contact of a case, (ii) report positive results to the University via a designated channel, and (iii) follow the Ministry of Health’s guidance about self-isolation and other public health measures to minimise the spread of infection.[[4]] The number of student cases rose rapidly throughout late February and early March and the University, residential colleges and the Otago University Students’ Association (OUSA) mounted huge operations to support hundreds of students self-isolating in colleges and flats, including the delivery of food and care packages.[[5]]
With increasing community transmission of the Omicron variant of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) throughout Aotearoa New Zealand in early 2022, COVID-19 testing shifted from laboratory-based reverse transcription polymerase chain reaction (RT-PCR) tests using samples taken by health professionals to community-based rapid antigen tests (RATs), which can be self-administered.[[6]] One consequence of this shift was that individuals became responsible for reporting their RAT results via the Ministry of Health’s My Covid Record (RT-PCR test results continued to be automatically uploaded).[[7,8]]
While good mechanisms were established in residential colleges and Uni Flats for identifying and reporting COVID-19 cases among University of Otago students, anecdotal reports suggested that students living in other settings might have been less likely to report positive COVID-19 test results (RT-PCR or RATs) to the University, or to upload their RAT results to My Covid Record. However, the extent of any such under-reporting was unknown.
We undertook a study among the residents of North Dunedin student flats, to (i) estimate the prevalence of COVID-19 between the start of Flat Orientation Week (Flo-Week) and the end of Semester 1, (ii) investigate the potential under-reporting of positive COVID-19 test results to the University, (iii) investigate the potential under-recording of positive RAT results in My Covid Record, and (iv) explore the COVID-19 related experiences of students during the above period.
Methods
Random selection of households
We restricted the study area to North Dunedin, as this is the area with the highest density of student flats. For operational purposes, this was defined as the area covered on foot by the University of Otago Campus Watch (which corresponds to the Dunedin City Council’s designated “University area”). We used the online Dunedin City Council Rates Map[[9]] to create a list of all potential residential addresses within the study area and used the random number generator function within Microsoft Excel to randomly select 160 addresses. Households were eligible for inclusion in the study if at least one resident was a student enrolled at the University of Otago; other residents could include Otago Polytechnic students, as well as non-students.
Interviewer-administered questionnaire
We developed a short interviewer-administered questionnaire to collect a range of information from each household, including the number of people living in the household, the number of household members who had tested positive for COVID-19 between the start of Flo-Week on 14 February 2022 and the date of the interview (the study period), the number of University of Otago student cases within the household who notified the University that they had COVID-19, the number of cases who were diagnosed via a RAT and uploaded their result to My Covid Record, behaviour in households with cases, adherence to isolation requirements and the number of household members with confirmed re-infection. We also asked open-ended questions to explore the reasons for not reporting a positive COVID-19 status to the University, not uploading a positive RAT result to My Covid Record or not adhering to isolation requirements, and to learn about the general COVID-related experiences of household members during the study period.
Data collection
Interviews commenced during the final week in which Semester 1 lectures were held (the week starting 30 May). If no one was at home on the first visit, a maximum of two repeat visits were made on different days and at different times. Ensuring the safety of the interviewers (final year medical students) and household members in this field study was essential. To maximise physical safety, we approached households in pairs and notified a third team member when we started and finished a data-collection session. To minimise the risk of infection, we wore N95 face masks and conducted physically distanced interviews outside. In addition, we asked a screening question at the start of the interview to identify any households that unexpectedly had active COVID-19 cases (i.e., there were no signs at the entrance to indicate that the household was isolating); at these addresses the only information collected was the number of residents and the number of cases.
We sought verbal consent for an interview at each randomly selected household and gave assurances that any information provided would not be linked to the address. In order to ensure anonymity still further, we did not collect names or demographic data. All household members who were at home were free to take part in the interview, however, in practice, most interviews were conducted with one member of the household who responded to questions on behalf of the whole household. At the end of the interview, the participants were provided with a card that listed support services available to students, as well as information about how to notify the University of a positive COVID-19 test and how to upload a positive RAT result to My Covid Record.
We used Research Electronic Data Capture (REDCap) software,[[10,11]] a secure web-based survey application hosted by the University of Otago, for data collection and management. Although REDCap is hosted by the University, access to the study data was restricted to the members of our team.
Analyses
For the quantitative data, we conducted simple descriptive analyses and report numbers and proportions (percentages). Qualitative responses to the open-ended questions were analysed by identifying key themes.
Ethical approval
The project received ethical approval from the University of Otago Human Ethics Committee (Health), reference number: H22/050.
Results
In total, 1,720 potentially eligible households were identified in the study area (Figure 1). Of the 160 randomly selected households visited, 20 were found to be ineligible (no University student(s) living in the household, derelict/unoccupied residence, residence part of a residential college, or commercial premises). Of the remaining households, three declined to participate, two were visited on three occasions but no one was at home, and 135 (96.4%) agreed to take part. The majority of the interviews (n=111) took place between 30 May and 3 June, and the remainder on 9 June (n=21) and 16 June (n=3). Three of the participating households reported active cases in response to the screening question and therefore a full interview was not undertaken.
View Figure 1.
In 127 of 135 households, at least one resident tested positive for COVID-19 between the start of Flo-Week and the date of the interview (a mean period of 109 days [standard deviation 3.6]), giving a period prevalence at the household level of 94.1%; the period prevalence among individuals in the households surveyed was 73.6% (513/697). As noted above, at the time of data collection, three households had active cases of COVID-19 infection (9 of 13 residents), giving a point prevalence at the household and individual levels of 2.2% (3/135) and 1.3% (9/697), respectively.
Table 1 provides information about the numbers of confirmed COVID-19 cases per household according to the number of residents in the household. Household size ranged from two to 14 residents, with the majority (72.6%) of households containing four to six residents. The proportion of households in which at least one resident tested positive for COVID-19 during the study period increased with increasing household size (75% of households with two and three residents, 90% of households with four residents, 97.6% of households with five residents, and 100% of households with six or more residents).
Table 2 shows the numbers and percentages of households in which everyone had tested positive for COVID-19 between the start of Flo-Week and the date of the visit, according to the number of residents in the household. In 56 of 135 (41.5%) households, every occupant had confirmed COVID-19 at some time during the study period. When restricted to the 127 households with at least one case, the proportion was 44.1%.
View Tables 1–2.
The findings discussed from this point onwards relate to households without active COVID-19 cases at the time of the interview (n=132). Of the 684 residents living in these households, 504 (73.7%) tested positive for COVID-19 during the study period. Of the 444 cases who were University of Otago students, 268 (60.4%) reported their positive status to the University, 130 (29.3%) did not report, and for 46 (10.4%) the reporting status was unknown. Reasons for not reporting were explored at a household level and of the 43 households in which at least one student did not report their positive status, 26 (60.5%) stated that they were unaware that reporting was a requirement, eight (18.6%) did not know how to report, and 10 (23.3%) felt that reporting provided no benefit for individuals. Others noted technical difficulties, that it was “a hassle”, or that there was “no need to report” as they did not require any extra support.
The diagnosis of COVID-19 was made via a RAT for 429 of the 504 cases; 287 (66.9%) of these cases uploaded their result to My Covid Record, 71 (16.6%) did not upload their result, and for 71 (16.6%) the upload status was unknown. Of the 29 households in which at least one resident did not upload their result, four (13.8%) stated that they were unaware that this was required and 11 (37.9%) considered that reporting provided no benefit for individuals. Several households also noted that COVID-19 was so widespread in the student community that they felt there was no point in uploading positive results as it “would not change anything”, while others forgot, felt it was a hassle, were unable to backdate a positive result in My Covid Record or believed that they had “the right not to report”.
In households in which there was at least one confirmed COVID-19 case during the study period (n=124), behaviour within the household during the required isolation period(s) varied; 29.0% of households reported that COVID-19 negative residents actively avoided the case(s) (including some households in which residents took particular care to protect immunocompromised members), 53.2% reported they interacted normally with the case(s), and 24.2% reported they deliberately attempted catch COVID-19 from the case(s). The sum of these percentages is greater than 100 because some households described a dynamic approach—initially attempting to avoid infection, but subsequently behaving normally or making an effort to contract the virus. Reasons cited for attempting to become infected included trying to reduce the total isolation period (at a time when each new infection reset a 10-day isolation period for all occupants of a household), minimising time off paid employment and the desire to “get it over with”.
While most households adhered to isolation requirements, six (4.8%) reported they did not. Three cited the need to meet social commitments and one cited academic obligations. Non-adherent households also commented on the need for exercise, the need to obtain food, and that it was “pointless” isolating from others in the neighbourhood who also had COVID-19.
In relation to re-infection, three (2.3%) households reported that at least one resident had more than one episode of confirmed COVID-19 during the study period.
Responses to an open-ended question about students’ experiences revealed that the general COVID-19 situation during the study period had created various academic, financial and mental health stresses. Academic challenges arising from personal illness or a requirement to isolate as the household contact of a case, as well as the University-wide introduction of online learning for the first half of Semester 1, included IT issues, fatigue from increased screen time, difficulties in maintaining motivation, concerns about missing important practical aspects of courses (such as laboratory sessions and field trips) and problems in catching up on work that had been missed due to illness. Some students also reported significant financial consequences arising from the COVID-19 situation, including being made redundant, withdrawing from papers as fewer casual and evening/weekend employment opportunities were available and variable access to COVID-19 hardship relief funds and wage subsidies due to the type of work in which students were engaged. For some students, their mental health and wellbeing suffered during the study period, with cancelled social events and feelings of loneliness, and apprehensiveness about returning to situations in which there were large numbers of people. The experience of isolating as a household was mixed—for some it was difficult, while others reported that it strengthened their relationships. There were also physical impacts for those who had caught COVID-19, with some students describing being very unwell and having ongoing issues. Some also described the negative impact of contracting influenza or other respiratory illnesses during the study period, in addition to COVID-19. Finally, many households reported that the University and OUSA initiatives to supply food and care packages were of huge benefit, alleviating a lot of stress and supporting them to meet their isolation requirements.
Discussion
In this field study of randomly selected University of Otago student households in North Dunedin, the period prevalence of COVID-19 between the start of Flo-Week and the end of Semester 1 was very high; about 94% of households had a least one confirmed COVID-19 case during that period and this corresponded to about three quarters of the residents in the participating households. We also found that just under two thirds of University of Otago student cases notified the University that they had COVID-19 and two thirds of cases with a positive RAT uploaded their result to My Covid Record.
Key strengths of this study include the random selection of households and very high participation proportion, the use of a standardised interviewer-administered questionnaire and the collection of both quantitative and qualitative data. In addition, the interviews were conducted by final year medical students and it is likely that these “peer interviewers” elicited more open responses from participants than would have been the case if non-student interviewers had been used.
The study also has some limitations that should be considered. For pragmatic reasons, interviews were generally carried out with one member of each household, and this has implications for the potential accuracy of their responses. While these individuals knew whether their fellow household members had tested positive for COVID-19, they were sometimes less certain about their flatmates’ reporting behaviours—as reflected in the number of “unknown” responses. However, even in the best-case scenario (in which it is assumed that all of these students did report their positive status), the proportions who notified the University and uploaded their RAT results to My Covid Record would only be 70.7% and 83.4%, respectively. Moreover, when asking people about their behaviour there is always the potential for social desirability bias (in which participants tell interviewers what they think they want to hear); if such bias had occurred in this study, the effect would have been to over-estimate the reporting proportions. Hence, while there might be some uncertainty about the exact proportions, it is still apparent that there was considerable under-reporting. This conclusion is supported by University data; in total, the University was notified of 3,820 cases during the study period (22.5% of the 16, 965 students studying on campus in Dunedin).[[1]] About half (n=1,958) of these cases were self-reported by students (the remainder were reported by support teams at residential colleges and Uni Flats), and considering that our random sample of about 10% of potentially eligible households in North Dunedin identified 513 cases, this is consistent with substantial under-reporting.
Our interviews with one household member also mean that some of the barriers to reporting might have been missed. Nonetheless, the responses that were given have provided valuable information to assist with planning for future COVID-19 waves, including ensuring that students understand the importance for themselves and the community of reporting their positive status to the University and uploading positive RAT results to My Covid Record—and making it easy for them to do so.
Our findings also provide insights into the behaviour within households with at least one case, with less than a third initially taking active steps to avoid within-house transmission. Fortunately, the Omicron variants circulating during the study period generally did not cause very severe illness among the predominantly young and healthy student population, however, this might not be the situation with future variants of SARS-CoV-2.
We focussed on a particular group of students and therefore our findings cannot necessarily be generalised to University of Otago students living outside the North Dunedin area. For instance, many of the cases in our study occurred during the orientation period before classes began, whereas for students living elsewhere in Dunedin, potentially different patterns of social mixing mean that COVID-19 infections might have occurred later and therefore created even more academic stress. In addition, we focussed on a time when COVID-19 vaccination was mandatory for enrolled students; hence transmission rates in future waves might differ, depending on vaccination rates and the transmissibility of the predominant SARS-CoV-2 variants at the time.
We found no published investigations of self-reporting of positive COVID-19 status by university students elsewhere; however, the Ministry of Health’s recent COVID-19 Trends and Insight Reports assume considerable under-reporting in the general population which may differ by age, ethnicity and deprivation,[[12]] and national COVID-19 modellers have assumed that reported case numbers capture only 50% of symptomatic cases.[[13,14]]
Finally, our findings regarding the academic, financial and mental health impacts for students of the COVID-19 situation are consistent with findings from elsewhere, including at other universities in Aotearoa New Zealand[[15–17]] and internationally.[[18–23]]
Conclusions
The proportion of University of Otago student households in North Dunedin that had to isolate between Flo-Week and the end of Semester 1 because at least one resident had COVID-19 was extremely high. At the same time, there was substantial under-reporting of student cases to the University of Otago and under-recording of positive RAT results in My Covid Record—this has obvious implications for authorities responsible for making prevention and control decisions, as well as for students who could miss out on key support from the University and their healthcare providers.
Summary
Abstract
Aim
To estimate the prevalence of COVID-19 among occupants of North Dunedin student flats between Flat Orientation Week (Flo-Week, week starting 14 February 2022) and the end of Semester 1 (week starting 30 May 2022); to investigate the potential under-reporting of cases to the University of Otago and under-recording of positive rapid antigen test (RAT) results in My Covid Record; to explore the COVID-related experiences of students during the above period.
Method
Randomly selected households in the North Dunedin area were visited at the end of Semester 1 and oral consent was sought for a short interview comprising closed- and open-ended questions. Households were eligible for inclusion if at least one resident was a University of Otago student.
Results
One hundred and thirty-five (96.4%) of 140 eligible households participated, and in 94.1% of these households at least one resident tested positive for COVID-19 between the start of Flo-Week and the date of the interview (a mean period of 109 days [standard deviation 3.6]). In total, 73.6% of the occupants in the participating households tested positive. Of the cases who were University of Otago students, 60.4% reported their positive status to the University. Of all cases diagnosed via a RAT, 66.9% uploaded their result to My Covid Record. Students reported various academic, financial and mental health stresses associated with the general COVID-19 situation during the study period.
Conclusion
These findings suggest that the number of COVID-19 cases reported to the University of Otago between Flo-Week and the end of Semester 1 was a substantial underestimate of the true number, as was the number of cases recorded in My Covid Record. The findings also highlight the considerable impact that COVID-19 had on students during Semester 1.
Author Information
Acknowledgements
Correspondence
Correspondence Email
Competing Interests
1) Paul McNamara, University of Otago Emergency Management and Continuity Manager. Personal communication. 2022 Jun 28.
2) Otago Daily Times. Castle and Howe St parties confirmed as close contact sites. 2022 Feb 17. Available at: www.odt.co.nz/news/dunedin/castle-and-howe-st-parties-confirmed-close-contact-sites [accessed 2022 Apr 7].
3) Otago Daily Times. Uni offers support amid Covid concerns. 2022 Feb 19. Available at: www.odt.co.nz/news/dunedin/campus/uni-offers-support-amid-covid-concerns [2022 Apr 7].
4) University of Otago. COVID-19 update. 2022 Feb 19. Available at: www.otago.ac.nz/coronavirus/updates/otago837767 [accessed 2022 Apr 7].
5) University of Otago. Care packages being delivered to isolating students. 2022 Feb 23. Available at: www.otago.ac.nz/news/news/otago837863.html [accessed 2022 Apr 7].
6) Ministry of Health. Rapid antigen testing (RAT). Available at: www.health.govt.nz/covid-19-novel-coronavirus/covid-19-health-advice-public/assessment-and-testing-covid-19/rapid-antigen-testing-rat [updated 2022 Apr 6, accessed 2022 Apr 7].
7) Ministry of Health. How to use My Covid Record. Available at: https://covid19.govt.nz/covid-19-vaccines/vaccine-passes-and-certificates/my-covid-record/#covid-19-test-results [updated 2022 Apr 5, accessed 2022 Apr 7].
8) Ministry of Health. How to report your RAT results. Available at: https://covid19.govt.nz/testing-and-tracing/covid-19-testing/report-your-rat-with-my-covid-record/ [updated 14 March 2022, accessed 7 April 2022].
9) Dunedin City Council Rates Map. Available at: www.dunedin.govt.nz/services/rates-information/search-by-map [updated 2020 Feb 10, accessed 2022 May 24].
10) Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap): a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-81.
11) Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: building an international community of software partners. J Biomed Inform. 2019;95:103208.
12) Ministry of Health. COVID-19 Trends and Insights Reports. Available at: www.health.govt.nz/covid-19-novel-coronavirus/covid-19-data-and-statistics/covid-19-trends-and-insights [updated 2022 Oct 30, accessed 2022 Nov 4].
13) Vattiatio G, Lustig A, Maclaren O, Plank M. Modelling the dynamics of infection, waning of immunity and reinfection with the Omicron variant of SARS-CoV-2 in Aotearoa New Zealand. 2022 Jun 2. Available at: www.covid19modelling.ac.nz/waning-of-immunity-and-re-infection-with-omicron/ [accessed 2022 Nov 4].
14) Lustig A, Vattiato G, Maclaren O, Watson L, Datta S, Plank MJ. Modelling the effects of Omicron sub-variant BA.5 in New Zealand. 2022 Aug 23. Available at: www.covid19modelling.ac.nz/modelling-ba5/ [accessed 2022 Nov 4].
15) Akuhata-Huntington Z. Impacts of the COVID-19 lockdown on Māori university students. Wellington: Te Mana Ākonga, 2020.
16) Stevenson E, Smith-Han K, Nicholson H. Medical students' experience of studying while working part-time and the effects of COVID-19. N Z Med J. 2022;135(1557):38-48.
17) Cameron M, Fogarty-Perry B, Piercy G. The impacts of the COVID-19 pandemic on higher education students in New Zealand. JOFDL. 2022;26(1):42-62.
18) Aristovnik A, Keržič D, Ravšelj D, Tomaževič N, Umek L. Impacts of the COVID-19 pandemic on life of higher education students: a global perspective. Sustainability. 2020;12(20):8438.
19) Appleby JA, King N, Saunders KE, et al. Impact of the COVID-19 pandemic on the experience and mental health of university students studying in Canada and the UK: a cross-sectional study. BMJ Open. 2022;12(1):e050187.
20) Kohls E, Baldofski S, Moeller R, Klemm SL, Rummel-Kluge C. Mental health, social and emotional well-being, and perceived burdens of university students during COVID-19 pandemic lockdown in Germany. Front Psychiatry. 2021;12:643957.
21) Van de Velde S, Buffel V, Bracke P, et al. The COVID-19 International Student Well-being Study. Scand J Public Health. 2021;49(1):114-22.
22) Buffel V, Van de Velde S, Akvardar Y, et al. Depressive symptoms in higher education students during the COVID-19 pandemic: the role of containment measures. Eur J Public Health. 2022;32(3):481-7.
23) Sharaievska I, McAnirlin O, Browning M, et al. "Messy transitions": Students' perspectives on the impacts of the COVID-19 pandemic on higher education. High Educ. 2022;1-18.
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COVID-19 among University of Otago students living in North Dunedin households in the first half of 2022: was the prevalence underestimated?
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Dunedin (the second largest city in Te Waipounamu, Aotearoa New Zealand) is often referred to as a student city, with the majority of University of Otago students coming from out of town and living in residential colleges in their first year and student flats in subsequent years. Much of this accommodation is concentrated in the North Dunedin area. In Semester 1 of 2022, there were about 16,965 University of Otago students enrolled in Dunedin-based courses (and 3,674 enrolled at campuses in other centres);[[1]] about 21% of these students lived in residential colleges, 4% lived in managed accommodation that mainly houses single-semester international students (University Flats, commonly known as Uni Flats), while the remainder mostly lived in student flats.
In mid-February 2022, COVID-19 began to spread through the University of Otago student population in Dunedin.[[2,3]] As has been the case throughout the pandemic, students were asked to (i) get tested if they had any symptoms suspicious of COVID-19 or if they were a close contact of a case, (ii) report positive results to the University via a designated channel, and (iii) follow the Ministry of Health’s guidance about self-isolation and other public health measures to minimise the spread of infection.[[4]] The number of student cases rose rapidly throughout late February and early March and the University, residential colleges and the Otago University Students’ Association (OUSA) mounted huge operations to support hundreds of students self-isolating in colleges and flats, including the delivery of food and care packages.[[5]]
With increasing community transmission of the Omicron variant of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) throughout Aotearoa New Zealand in early 2022, COVID-19 testing shifted from laboratory-based reverse transcription polymerase chain reaction (RT-PCR) tests using samples taken by health professionals to community-based rapid antigen tests (RATs), which can be self-administered.[[6]] One consequence of this shift was that individuals became responsible for reporting their RAT results via the Ministry of Health’s My Covid Record (RT-PCR test results continued to be automatically uploaded).[[7,8]]
While good mechanisms were established in residential colleges and Uni Flats for identifying and reporting COVID-19 cases among University of Otago students, anecdotal reports suggested that students living in other settings might have been less likely to report positive COVID-19 test results (RT-PCR or RATs) to the University, or to upload their RAT results to My Covid Record. However, the extent of any such under-reporting was unknown.
We undertook a study among the residents of North Dunedin student flats, to (i) estimate the prevalence of COVID-19 between the start of Flat Orientation Week (Flo-Week) and the end of Semester 1, (ii) investigate the potential under-reporting of positive COVID-19 test results to the University, (iii) investigate the potential under-recording of positive RAT results in My Covid Record, and (iv) explore the COVID-19 related experiences of students during the above period.
Methods
Random selection of households
We restricted the study area to North Dunedin, as this is the area with the highest density of student flats. For operational purposes, this was defined as the area covered on foot by the University of Otago Campus Watch (which corresponds to the Dunedin City Council’s designated “University area”). We used the online Dunedin City Council Rates Map[[9]] to create a list of all potential residential addresses within the study area and used the random number generator function within Microsoft Excel to randomly select 160 addresses. Households were eligible for inclusion in the study if at least one resident was a student enrolled at the University of Otago; other residents could include Otago Polytechnic students, as well as non-students.
Interviewer-administered questionnaire
We developed a short interviewer-administered questionnaire to collect a range of information from each household, including the number of people living in the household, the number of household members who had tested positive for COVID-19 between the start of Flo-Week on 14 February 2022 and the date of the interview (the study period), the number of University of Otago student cases within the household who notified the University that they had COVID-19, the number of cases who were diagnosed via a RAT and uploaded their result to My Covid Record, behaviour in households with cases, adherence to isolation requirements and the number of household members with confirmed re-infection. We also asked open-ended questions to explore the reasons for not reporting a positive COVID-19 status to the University, not uploading a positive RAT result to My Covid Record or not adhering to isolation requirements, and to learn about the general COVID-related experiences of household members during the study period.
Data collection
Interviews commenced during the final week in which Semester 1 lectures were held (the week starting 30 May). If no one was at home on the first visit, a maximum of two repeat visits were made on different days and at different times. Ensuring the safety of the interviewers (final year medical students) and household members in this field study was essential. To maximise physical safety, we approached households in pairs and notified a third team member when we started and finished a data-collection session. To minimise the risk of infection, we wore N95 face masks and conducted physically distanced interviews outside. In addition, we asked a screening question at the start of the interview to identify any households that unexpectedly had active COVID-19 cases (i.e., there were no signs at the entrance to indicate that the household was isolating); at these addresses the only information collected was the number of residents and the number of cases.
We sought verbal consent for an interview at each randomly selected household and gave assurances that any information provided would not be linked to the address. In order to ensure anonymity still further, we did not collect names or demographic data. All household members who were at home were free to take part in the interview, however, in practice, most interviews were conducted with one member of the household who responded to questions on behalf of the whole household. At the end of the interview, the participants were provided with a card that listed support services available to students, as well as information about how to notify the University of a positive COVID-19 test and how to upload a positive RAT result to My Covid Record.
We used Research Electronic Data Capture (REDCap) software,[[10,11]] a secure web-based survey application hosted by the University of Otago, for data collection and management. Although REDCap is hosted by the University, access to the study data was restricted to the members of our team.
Analyses
For the quantitative data, we conducted simple descriptive analyses and report numbers and proportions (percentages). Qualitative responses to the open-ended questions were analysed by identifying key themes.
Ethical approval
The project received ethical approval from the University of Otago Human Ethics Committee (Health), reference number: H22/050.
Results
In total, 1,720 potentially eligible households were identified in the study area (Figure 1). Of the 160 randomly selected households visited, 20 were found to be ineligible (no University student(s) living in the household, derelict/unoccupied residence, residence part of a residential college, or commercial premises). Of the remaining households, three declined to participate, two were visited on three occasions but no one was at home, and 135 (96.4%) agreed to take part. The majority of the interviews (n=111) took place between 30 May and 3 June, and the remainder on 9 June (n=21) and 16 June (n=3). Three of the participating households reported active cases in response to the screening question and therefore a full interview was not undertaken.
View Figure 1.
In 127 of 135 households, at least one resident tested positive for COVID-19 between the start of Flo-Week and the date of the interview (a mean period of 109 days [standard deviation 3.6]), giving a period prevalence at the household level of 94.1%; the period prevalence among individuals in the households surveyed was 73.6% (513/697). As noted above, at the time of data collection, three households had active cases of COVID-19 infection (9 of 13 residents), giving a point prevalence at the household and individual levels of 2.2% (3/135) and 1.3% (9/697), respectively.
Table 1 provides information about the numbers of confirmed COVID-19 cases per household according to the number of residents in the household. Household size ranged from two to 14 residents, with the majority (72.6%) of households containing four to six residents. The proportion of households in which at least one resident tested positive for COVID-19 during the study period increased with increasing household size (75% of households with two and three residents, 90% of households with four residents, 97.6% of households with five residents, and 100% of households with six or more residents).
Table 2 shows the numbers and percentages of households in which everyone had tested positive for COVID-19 between the start of Flo-Week and the date of the visit, according to the number of residents in the household. In 56 of 135 (41.5%) households, every occupant had confirmed COVID-19 at some time during the study period. When restricted to the 127 households with at least one case, the proportion was 44.1%.
View Tables 1–2.
The findings discussed from this point onwards relate to households without active COVID-19 cases at the time of the interview (n=132). Of the 684 residents living in these households, 504 (73.7%) tested positive for COVID-19 during the study period. Of the 444 cases who were University of Otago students, 268 (60.4%) reported their positive status to the University, 130 (29.3%) did not report, and for 46 (10.4%) the reporting status was unknown. Reasons for not reporting were explored at a household level and of the 43 households in which at least one student did not report their positive status, 26 (60.5%) stated that they were unaware that reporting was a requirement, eight (18.6%) did not know how to report, and 10 (23.3%) felt that reporting provided no benefit for individuals. Others noted technical difficulties, that it was “a hassle”, or that there was “no need to report” as they did not require any extra support.
The diagnosis of COVID-19 was made via a RAT for 429 of the 504 cases; 287 (66.9%) of these cases uploaded their result to My Covid Record, 71 (16.6%) did not upload their result, and for 71 (16.6%) the upload status was unknown. Of the 29 households in which at least one resident did not upload their result, four (13.8%) stated that they were unaware that this was required and 11 (37.9%) considered that reporting provided no benefit for individuals. Several households also noted that COVID-19 was so widespread in the student community that they felt there was no point in uploading positive results as it “would not change anything”, while others forgot, felt it was a hassle, were unable to backdate a positive result in My Covid Record or believed that they had “the right not to report”.
In households in which there was at least one confirmed COVID-19 case during the study period (n=124), behaviour within the household during the required isolation period(s) varied; 29.0% of households reported that COVID-19 negative residents actively avoided the case(s) (including some households in which residents took particular care to protect immunocompromised members), 53.2% reported they interacted normally with the case(s), and 24.2% reported they deliberately attempted catch COVID-19 from the case(s). The sum of these percentages is greater than 100 because some households described a dynamic approach—initially attempting to avoid infection, but subsequently behaving normally or making an effort to contract the virus. Reasons cited for attempting to become infected included trying to reduce the total isolation period (at a time when each new infection reset a 10-day isolation period for all occupants of a household), minimising time off paid employment and the desire to “get it over with”.
While most households adhered to isolation requirements, six (4.8%) reported they did not. Three cited the need to meet social commitments and one cited academic obligations. Non-adherent households also commented on the need for exercise, the need to obtain food, and that it was “pointless” isolating from others in the neighbourhood who also had COVID-19.
In relation to re-infection, three (2.3%) households reported that at least one resident had more than one episode of confirmed COVID-19 during the study period.
Responses to an open-ended question about students’ experiences revealed that the general COVID-19 situation during the study period had created various academic, financial and mental health stresses. Academic challenges arising from personal illness or a requirement to isolate as the household contact of a case, as well as the University-wide introduction of online learning for the first half of Semester 1, included IT issues, fatigue from increased screen time, difficulties in maintaining motivation, concerns about missing important practical aspects of courses (such as laboratory sessions and field trips) and problems in catching up on work that had been missed due to illness. Some students also reported significant financial consequences arising from the COVID-19 situation, including being made redundant, withdrawing from papers as fewer casual and evening/weekend employment opportunities were available and variable access to COVID-19 hardship relief funds and wage subsidies due to the type of work in which students were engaged. For some students, their mental health and wellbeing suffered during the study period, with cancelled social events and feelings of loneliness, and apprehensiveness about returning to situations in which there were large numbers of people. The experience of isolating as a household was mixed—for some it was difficult, while others reported that it strengthened their relationships. There were also physical impacts for those who had caught COVID-19, with some students describing being very unwell and having ongoing issues. Some also described the negative impact of contracting influenza or other respiratory illnesses during the study period, in addition to COVID-19. Finally, many households reported that the University and OUSA initiatives to supply food and care packages were of huge benefit, alleviating a lot of stress and supporting them to meet their isolation requirements.
Discussion
In this field study of randomly selected University of Otago student households in North Dunedin, the period prevalence of COVID-19 between the start of Flo-Week and the end of Semester 1 was very high; about 94% of households had a least one confirmed COVID-19 case during that period and this corresponded to about three quarters of the residents in the participating households. We also found that just under two thirds of University of Otago student cases notified the University that they had COVID-19 and two thirds of cases with a positive RAT uploaded their result to My Covid Record.
Key strengths of this study include the random selection of households and very high participation proportion, the use of a standardised interviewer-administered questionnaire and the collection of both quantitative and qualitative data. In addition, the interviews were conducted by final year medical students and it is likely that these “peer interviewers” elicited more open responses from participants than would have been the case if non-student interviewers had been used.
The study also has some limitations that should be considered. For pragmatic reasons, interviews were generally carried out with one member of each household, and this has implications for the potential accuracy of their responses. While these individuals knew whether their fellow household members had tested positive for COVID-19, they were sometimes less certain about their flatmates’ reporting behaviours—as reflected in the number of “unknown” responses. However, even in the best-case scenario (in which it is assumed that all of these students did report their positive status), the proportions who notified the University and uploaded their RAT results to My Covid Record would only be 70.7% and 83.4%, respectively. Moreover, when asking people about their behaviour there is always the potential for social desirability bias (in which participants tell interviewers what they think they want to hear); if such bias had occurred in this study, the effect would have been to over-estimate the reporting proportions. Hence, while there might be some uncertainty about the exact proportions, it is still apparent that there was considerable under-reporting. This conclusion is supported by University data; in total, the University was notified of 3,820 cases during the study period (22.5% of the 16, 965 students studying on campus in Dunedin).[[1]] About half (n=1,958) of these cases were self-reported by students (the remainder were reported by support teams at residential colleges and Uni Flats), and considering that our random sample of about 10% of potentially eligible households in North Dunedin identified 513 cases, this is consistent with substantial under-reporting.
Our interviews with one household member also mean that some of the barriers to reporting might have been missed. Nonetheless, the responses that were given have provided valuable information to assist with planning for future COVID-19 waves, including ensuring that students understand the importance for themselves and the community of reporting their positive status to the University and uploading positive RAT results to My Covid Record—and making it easy for them to do so.
Our findings also provide insights into the behaviour within households with at least one case, with less than a third initially taking active steps to avoid within-house transmission. Fortunately, the Omicron variants circulating during the study period generally did not cause very severe illness among the predominantly young and healthy student population, however, this might not be the situation with future variants of SARS-CoV-2.
We focussed on a particular group of students and therefore our findings cannot necessarily be generalised to University of Otago students living outside the North Dunedin area. For instance, many of the cases in our study occurred during the orientation period before classes began, whereas for students living elsewhere in Dunedin, potentially different patterns of social mixing mean that COVID-19 infections might have occurred later and therefore created even more academic stress. In addition, we focussed on a time when COVID-19 vaccination was mandatory for enrolled students; hence transmission rates in future waves might differ, depending on vaccination rates and the transmissibility of the predominant SARS-CoV-2 variants at the time.
We found no published investigations of self-reporting of positive COVID-19 status by university students elsewhere; however, the Ministry of Health’s recent COVID-19 Trends and Insight Reports assume considerable under-reporting in the general population which may differ by age, ethnicity and deprivation,[[12]] and national COVID-19 modellers have assumed that reported case numbers capture only 50% of symptomatic cases.[[13,14]]
Finally, our findings regarding the academic, financial and mental health impacts for students of the COVID-19 situation are consistent with findings from elsewhere, including at other universities in Aotearoa New Zealand[[15–17]] and internationally.[[18–23]]
Conclusions
The proportion of University of Otago student households in North Dunedin that had to isolate between Flo-Week and the end of Semester 1 because at least one resident had COVID-19 was extremely high. At the same time, there was substantial under-reporting of student cases to the University of Otago and under-recording of positive RAT results in My Covid Record—this has obvious implications for authorities responsible for making prevention and control decisions, as well as for students who could miss out on key support from the University and their healthcare providers.
Summary
Abstract
Aim
To estimate the prevalence of COVID-19 among occupants of North Dunedin student flats between Flat Orientation Week (Flo-Week, week starting 14 February 2022) and the end of Semester 1 (week starting 30 May 2022); to investigate the potential under-reporting of cases to the University of Otago and under-recording of positive rapid antigen test (RAT) results in My Covid Record; to explore the COVID-related experiences of students during the above period.
Method
Randomly selected households in the North Dunedin area were visited at the end of Semester 1 and oral consent was sought for a short interview comprising closed- and open-ended questions. Households were eligible for inclusion if at least one resident was a University of Otago student.
Results
One hundred and thirty-five (96.4%) of 140 eligible households participated, and in 94.1% of these households at least one resident tested positive for COVID-19 between the start of Flo-Week and the date of the interview (a mean period of 109 days [standard deviation 3.6]). In total, 73.6% of the occupants in the participating households tested positive. Of the cases who were University of Otago students, 60.4% reported their positive status to the University. Of all cases diagnosed via a RAT, 66.9% uploaded their result to My Covid Record. Students reported various academic, financial and mental health stresses associated with the general COVID-19 situation during the study period.
Conclusion
These findings suggest that the number of COVID-19 cases reported to the University of Otago between Flo-Week and the end of Semester 1 was a substantial underestimate of the true number, as was the number of cases recorded in My Covid Record. The findings also highlight the considerable impact that COVID-19 had on students during Semester 1.
Author Information
Acknowledgements
Correspondence
Correspondence Email
Competing Interests
1) Paul McNamara, University of Otago Emergency Management and Continuity Manager. Personal communication. 2022 Jun 28.
2) Otago Daily Times. Castle and Howe St parties confirmed as close contact sites. 2022 Feb 17. Available at: www.odt.co.nz/news/dunedin/castle-and-howe-st-parties-confirmed-close-contact-sites [accessed 2022 Apr 7].
3) Otago Daily Times. Uni offers support amid Covid concerns. 2022 Feb 19. Available at: www.odt.co.nz/news/dunedin/campus/uni-offers-support-amid-covid-concerns [2022 Apr 7].
4) University of Otago. COVID-19 update. 2022 Feb 19. Available at: www.otago.ac.nz/coronavirus/updates/otago837767 [accessed 2022 Apr 7].
5) University of Otago. Care packages being delivered to isolating students. 2022 Feb 23. Available at: www.otago.ac.nz/news/news/otago837863.html [accessed 2022 Apr 7].
6) Ministry of Health. Rapid antigen testing (RAT). Available at: www.health.govt.nz/covid-19-novel-coronavirus/covid-19-health-advice-public/assessment-and-testing-covid-19/rapid-antigen-testing-rat [updated 2022 Apr 6, accessed 2022 Apr 7].
7) Ministry of Health. How to use My Covid Record. Available at: https://covid19.govt.nz/covid-19-vaccines/vaccine-passes-and-certificates/my-covid-record/#covid-19-test-results [updated 2022 Apr 5, accessed 2022 Apr 7].
8) Ministry of Health. How to report your RAT results. Available at: https://covid19.govt.nz/testing-and-tracing/covid-19-testing/report-your-rat-with-my-covid-record/ [updated 14 March 2022, accessed 7 April 2022].
9) Dunedin City Council Rates Map. Available at: www.dunedin.govt.nz/services/rates-information/search-by-map [updated 2020 Feb 10, accessed 2022 May 24].
10) Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap): a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-81.
11) Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: building an international community of software partners. J Biomed Inform. 2019;95:103208.
12) Ministry of Health. COVID-19 Trends and Insights Reports. Available at: www.health.govt.nz/covid-19-novel-coronavirus/covid-19-data-and-statistics/covid-19-trends-and-insights [updated 2022 Oct 30, accessed 2022 Nov 4].
13) Vattiatio G, Lustig A, Maclaren O, Plank M. Modelling the dynamics of infection, waning of immunity and reinfection with the Omicron variant of SARS-CoV-2 in Aotearoa New Zealand. 2022 Jun 2. Available at: www.covid19modelling.ac.nz/waning-of-immunity-and-re-infection-with-omicron/ [accessed 2022 Nov 4].
14) Lustig A, Vattiato G, Maclaren O, Watson L, Datta S, Plank MJ. Modelling the effects of Omicron sub-variant BA.5 in New Zealand. 2022 Aug 23. Available at: www.covid19modelling.ac.nz/modelling-ba5/ [accessed 2022 Nov 4].
15) Akuhata-Huntington Z. Impacts of the COVID-19 lockdown on Māori university students. Wellington: Te Mana Ākonga, 2020.
16) Stevenson E, Smith-Han K, Nicholson H. Medical students' experience of studying while working part-time and the effects of COVID-19. N Z Med J. 2022;135(1557):38-48.
17) Cameron M, Fogarty-Perry B, Piercy G. The impacts of the COVID-19 pandemic on higher education students in New Zealand. JOFDL. 2022;26(1):42-62.
18) Aristovnik A, Keržič D, Ravšelj D, Tomaževič N, Umek L. Impacts of the COVID-19 pandemic on life of higher education students: a global perspective. Sustainability. 2020;12(20):8438.
19) Appleby JA, King N, Saunders KE, et al. Impact of the COVID-19 pandemic on the experience and mental health of university students studying in Canada and the UK: a cross-sectional study. BMJ Open. 2022;12(1):e050187.
20) Kohls E, Baldofski S, Moeller R, Klemm SL, Rummel-Kluge C. Mental health, social and emotional well-being, and perceived burdens of university students during COVID-19 pandemic lockdown in Germany. Front Psychiatry. 2021;12:643957.
21) Van de Velde S, Buffel V, Bracke P, et al. The COVID-19 International Student Well-being Study. Scand J Public Health. 2021;49(1):114-22.
22) Buffel V, Van de Velde S, Akvardar Y, et al. Depressive symptoms in higher education students during the COVID-19 pandemic: the role of containment measures. Eur J Public Health. 2022;32(3):481-7.
23) Sharaievska I, McAnirlin O, Browning M, et al. "Messy transitions": Students' perspectives on the impacts of the COVID-19 pandemic on higher education. High Educ. 2022;1-18.
Contact diana@nzma.org.nz
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COVID-19 among University of Otago students living in North Dunedin households in the first half of 2022: was the prevalence underestimated?
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Dunedin (the second largest city in Te Waipounamu, Aotearoa New Zealand) is often referred to as a student city, with the majority of University of Otago students coming from out of town and living in residential colleges in their first year and student flats in subsequent years. Much of this accommodation is concentrated in the North Dunedin area. In Semester 1 of 2022, there were about 16,965 University of Otago students enrolled in Dunedin-based courses (and 3,674 enrolled at campuses in other centres);[[1]] about 21% of these students lived in residential colleges, 4% lived in managed accommodation that mainly houses single-semester international students (University Flats, commonly known as Uni Flats), while the remainder mostly lived in student flats.
In mid-February 2022, COVID-19 began to spread through the University of Otago student population in Dunedin.[[2,3]] As has been the case throughout the pandemic, students were asked to (i) get tested if they had any symptoms suspicious of COVID-19 or if they were a close contact of a case, (ii) report positive results to the University via a designated channel, and (iii) follow the Ministry of Health’s guidance about self-isolation and other public health measures to minimise the spread of infection.[[4]] The number of student cases rose rapidly throughout late February and early March and the University, residential colleges and the Otago University Students’ Association (OUSA) mounted huge operations to support hundreds of students self-isolating in colleges and flats, including the delivery of food and care packages.[[5]]
With increasing community transmission of the Omicron variant of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) throughout Aotearoa New Zealand in early 2022, COVID-19 testing shifted from laboratory-based reverse transcription polymerase chain reaction (RT-PCR) tests using samples taken by health professionals to community-based rapid antigen tests (RATs), which can be self-administered.[[6]] One consequence of this shift was that individuals became responsible for reporting their RAT results via the Ministry of Health’s My Covid Record (RT-PCR test results continued to be automatically uploaded).[[7,8]]
While good mechanisms were established in residential colleges and Uni Flats for identifying and reporting COVID-19 cases among University of Otago students, anecdotal reports suggested that students living in other settings might have been less likely to report positive COVID-19 test results (RT-PCR or RATs) to the University, or to upload their RAT results to My Covid Record. However, the extent of any such under-reporting was unknown.
We undertook a study among the residents of North Dunedin student flats, to (i) estimate the prevalence of COVID-19 between the start of Flat Orientation Week (Flo-Week) and the end of Semester 1, (ii) investigate the potential under-reporting of positive COVID-19 test results to the University, (iii) investigate the potential under-recording of positive RAT results in My Covid Record, and (iv) explore the COVID-19 related experiences of students during the above period.
Methods
Random selection of households
We restricted the study area to North Dunedin, as this is the area with the highest density of student flats. For operational purposes, this was defined as the area covered on foot by the University of Otago Campus Watch (which corresponds to the Dunedin City Council’s designated “University area”). We used the online Dunedin City Council Rates Map[[9]] to create a list of all potential residential addresses within the study area and used the random number generator function within Microsoft Excel to randomly select 160 addresses. Households were eligible for inclusion in the study if at least one resident was a student enrolled at the University of Otago; other residents could include Otago Polytechnic students, as well as non-students.
Interviewer-administered questionnaire
We developed a short interviewer-administered questionnaire to collect a range of information from each household, including the number of people living in the household, the number of household members who had tested positive for COVID-19 between the start of Flo-Week on 14 February 2022 and the date of the interview (the study period), the number of University of Otago student cases within the household who notified the University that they had COVID-19, the number of cases who were diagnosed via a RAT and uploaded their result to My Covid Record, behaviour in households with cases, adherence to isolation requirements and the number of household members with confirmed re-infection. We also asked open-ended questions to explore the reasons for not reporting a positive COVID-19 status to the University, not uploading a positive RAT result to My Covid Record or not adhering to isolation requirements, and to learn about the general COVID-related experiences of household members during the study period.
Data collection
Interviews commenced during the final week in which Semester 1 lectures were held (the week starting 30 May). If no one was at home on the first visit, a maximum of two repeat visits were made on different days and at different times. Ensuring the safety of the interviewers (final year medical students) and household members in this field study was essential. To maximise physical safety, we approached households in pairs and notified a third team member when we started and finished a data-collection session. To minimise the risk of infection, we wore N95 face masks and conducted physically distanced interviews outside. In addition, we asked a screening question at the start of the interview to identify any households that unexpectedly had active COVID-19 cases (i.e., there were no signs at the entrance to indicate that the household was isolating); at these addresses the only information collected was the number of residents and the number of cases.
We sought verbal consent for an interview at each randomly selected household and gave assurances that any information provided would not be linked to the address. In order to ensure anonymity still further, we did not collect names or demographic data. All household members who were at home were free to take part in the interview, however, in practice, most interviews were conducted with one member of the household who responded to questions on behalf of the whole household. At the end of the interview, the participants were provided with a card that listed support services available to students, as well as information about how to notify the University of a positive COVID-19 test and how to upload a positive RAT result to My Covid Record.
We used Research Electronic Data Capture (REDCap) software,[[10,11]] a secure web-based survey application hosted by the University of Otago, for data collection and management. Although REDCap is hosted by the University, access to the study data was restricted to the members of our team.
Analyses
For the quantitative data, we conducted simple descriptive analyses and report numbers and proportions (percentages). Qualitative responses to the open-ended questions were analysed by identifying key themes.
Ethical approval
The project received ethical approval from the University of Otago Human Ethics Committee (Health), reference number: H22/050.
Results
In total, 1,720 potentially eligible households were identified in the study area (Figure 1). Of the 160 randomly selected households visited, 20 were found to be ineligible (no University student(s) living in the household, derelict/unoccupied residence, residence part of a residential college, or commercial premises). Of the remaining households, three declined to participate, two were visited on three occasions but no one was at home, and 135 (96.4%) agreed to take part. The majority of the interviews (n=111) took place between 30 May and 3 June, and the remainder on 9 June (n=21) and 16 June (n=3). Three of the participating households reported active cases in response to the screening question and therefore a full interview was not undertaken.
View Figure 1.
In 127 of 135 households, at least one resident tested positive for COVID-19 between the start of Flo-Week and the date of the interview (a mean period of 109 days [standard deviation 3.6]), giving a period prevalence at the household level of 94.1%; the period prevalence among individuals in the households surveyed was 73.6% (513/697). As noted above, at the time of data collection, three households had active cases of COVID-19 infection (9 of 13 residents), giving a point prevalence at the household and individual levels of 2.2% (3/135) and 1.3% (9/697), respectively.
Table 1 provides information about the numbers of confirmed COVID-19 cases per household according to the number of residents in the household. Household size ranged from two to 14 residents, with the majority (72.6%) of households containing four to six residents. The proportion of households in which at least one resident tested positive for COVID-19 during the study period increased with increasing household size (75% of households with two and three residents, 90% of households with four residents, 97.6% of households with five residents, and 100% of households with six or more residents).
Table 2 shows the numbers and percentages of households in which everyone had tested positive for COVID-19 between the start of Flo-Week and the date of the visit, according to the number of residents in the household. In 56 of 135 (41.5%) households, every occupant had confirmed COVID-19 at some time during the study period. When restricted to the 127 households with at least one case, the proportion was 44.1%.
View Tables 1–2.
The findings discussed from this point onwards relate to households without active COVID-19 cases at the time of the interview (n=132). Of the 684 residents living in these households, 504 (73.7%) tested positive for COVID-19 during the study period. Of the 444 cases who were University of Otago students, 268 (60.4%) reported their positive status to the University, 130 (29.3%) did not report, and for 46 (10.4%) the reporting status was unknown. Reasons for not reporting were explored at a household level and of the 43 households in which at least one student did not report their positive status, 26 (60.5%) stated that they were unaware that reporting was a requirement, eight (18.6%) did not know how to report, and 10 (23.3%) felt that reporting provided no benefit for individuals. Others noted technical difficulties, that it was “a hassle”, or that there was “no need to report” as they did not require any extra support.
The diagnosis of COVID-19 was made via a RAT for 429 of the 504 cases; 287 (66.9%) of these cases uploaded their result to My Covid Record, 71 (16.6%) did not upload their result, and for 71 (16.6%) the upload status was unknown. Of the 29 households in which at least one resident did not upload their result, four (13.8%) stated that they were unaware that this was required and 11 (37.9%) considered that reporting provided no benefit for individuals. Several households also noted that COVID-19 was so widespread in the student community that they felt there was no point in uploading positive results as it “would not change anything”, while others forgot, felt it was a hassle, were unable to backdate a positive result in My Covid Record or believed that they had “the right not to report”.
In households in which there was at least one confirmed COVID-19 case during the study period (n=124), behaviour within the household during the required isolation period(s) varied; 29.0% of households reported that COVID-19 negative residents actively avoided the case(s) (including some households in which residents took particular care to protect immunocompromised members), 53.2% reported they interacted normally with the case(s), and 24.2% reported they deliberately attempted catch COVID-19 from the case(s). The sum of these percentages is greater than 100 because some households described a dynamic approach—initially attempting to avoid infection, but subsequently behaving normally or making an effort to contract the virus. Reasons cited for attempting to become infected included trying to reduce the total isolation period (at a time when each new infection reset a 10-day isolation period for all occupants of a household), minimising time off paid employment and the desire to “get it over with”.
While most households adhered to isolation requirements, six (4.8%) reported they did not. Three cited the need to meet social commitments and one cited academic obligations. Non-adherent households also commented on the need for exercise, the need to obtain food, and that it was “pointless” isolating from others in the neighbourhood who also had COVID-19.
In relation to re-infection, three (2.3%) households reported that at least one resident had more than one episode of confirmed COVID-19 during the study period.
Responses to an open-ended question about students’ experiences revealed that the general COVID-19 situation during the study period had created various academic, financial and mental health stresses. Academic challenges arising from personal illness or a requirement to isolate as the household contact of a case, as well as the University-wide introduction of online learning for the first half of Semester 1, included IT issues, fatigue from increased screen time, difficulties in maintaining motivation, concerns about missing important practical aspects of courses (such as laboratory sessions and field trips) and problems in catching up on work that had been missed due to illness. Some students also reported significant financial consequences arising from the COVID-19 situation, including being made redundant, withdrawing from papers as fewer casual and evening/weekend employment opportunities were available and variable access to COVID-19 hardship relief funds and wage subsidies due to the type of work in which students were engaged. For some students, their mental health and wellbeing suffered during the study period, with cancelled social events and feelings of loneliness, and apprehensiveness about returning to situations in which there were large numbers of people. The experience of isolating as a household was mixed—for some it was difficult, while others reported that it strengthened their relationships. There were also physical impacts for those who had caught COVID-19, with some students describing being very unwell and having ongoing issues. Some also described the negative impact of contracting influenza or other respiratory illnesses during the study period, in addition to COVID-19. Finally, many households reported that the University and OUSA initiatives to supply food and care packages were of huge benefit, alleviating a lot of stress and supporting them to meet their isolation requirements.
Discussion
In this field study of randomly selected University of Otago student households in North Dunedin, the period prevalence of COVID-19 between the start of Flo-Week and the end of Semester 1 was very high; about 94% of households had a least one confirmed COVID-19 case during that period and this corresponded to about three quarters of the residents in the participating households. We also found that just under two thirds of University of Otago student cases notified the University that they had COVID-19 and two thirds of cases with a positive RAT uploaded their result to My Covid Record.
Key strengths of this study include the random selection of households and very high participation proportion, the use of a standardised interviewer-administered questionnaire and the collection of both quantitative and qualitative data. In addition, the interviews were conducted by final year medical students and it is likely that these “peer interviewers” elicited more open responses from participants than would have been the case if non-student interviewers had been used.
The study also has some limitations that should be considered. For pragmatic reasons, interviews were generally carried out with one member of each household, and this has implications for the potential accuracy of their responses. While these individuals knew whether their fellow household members had tested positive for COVID-19, they were sometimes less certain about their flatmates’ reporting behaviours—as reflected in the number of “unknown” responses. However, even in the best-case scenario (in which it is assumed that all of these students did report their positive status), the proportions who notified the University and uploaded their RAT results to My Covid Record would only be 70.7% and 83.4%, respectively. Moreover, when asking people about their behaviour there is always the potential for social desirability bias (in which participants tell interviewers what they think they want to hear); if such bias had occurred in this study, the effect would have been to over-estimate the reporting proportions. Hence, while there might be some uncertainty about the exact proportions, it is still apparent that there was considerable under-reporting. This conclusion is supported by University data; in total, the University was notified of 3,820 cases during the study period (22.5% of the 16, 965 students studying on campus in Dunedin).[[1]] About half (n=1,958) of these cases were self-reported by students (the remainder were reported by support teams at residential colleges and Uni Flats), and considering that our random sample of about 10% of potentially eligible households in North Dunedin identified 513 cases, this is consistent with substantial under-reporting.
Our interviews with one household member also mean that some of the barriers to reporting might have been missed. Nonetheless, the responses that were given have provided valuable information to assist with planning for future COVID-19 waves, including ensuring that students understand the importance for themselves and the community of reporting their positive status to the University and uploading positive RAT results to My Covid Record—and making it easy for them to do so.
Our findings also provide insights into the behaviour within households with at least one case, with less than a third initially taking active steps to avoid within-house transmission. Fortunately, the Omicron variants circulating during the study period generally did not cause very severe illness among the predominantly young and healthy student population, however, this might not be the situation with future variants of SARS-CoV-2.
We focussed on a particular group of students and therefore our findings cannot necessarily be generalised to University of Otago students living outside the North Dunedin area. For instance, many of the cases in our study occurred during the orientation period before classes began, whereas for students living elsewhere in Dunedin, potentially different patterns of social mixing mean that COVID-19 infections might have occurred later and therefore created even more academic stress. In addition, we focussed on a time when COVID-19 vaccination was mandatory for enrolled students; hence transmission rates in future waves might differ, depending on vaccination rates and the transmissibility of the predominant SARS-CoV-2 variants at the time.
We found no published investigations of self-reporting of positive COVID-19 status by university students elsewhere; however, the Ministry of Health’s recent COVID-19 Trends and Insight Reports assume considerable under-reporting in the general population which may differ by age, ethnicity and deprivation,[[12]] and national COVID-19 modellers have assumed that reported case numbers capture only 50% of symptomatic cases.[[13,14]]
Finally, our findings regarding the academic, financial and mental health impacts for students of the COVID-19 situation are consistent with findings from elsewhere, including at other universities in Aotearoa New Zealand[[15–17]] and internationally.[[18–23]]
Conclusions
The proportion of University of Otago student households in North Dunedin that had to isolate between Flo-Week and the end of Semester 1 because at least one resident had COVID-19 was extremely high. At the same time, there was substantial under-reporting of student cases to the University of Otago and under-recording of positive RAT results in My Covid Record—this has obvious implications for authorities responsible for making prevention and control decisions, as well as for students who could miss out on key support from the University and their healthcare providers.
Summary
Abstract
Aim
To estimate the prevalence of COVID-19 among occupants of North Dunedin student flats between Flat Orientation Week (Flo-Week, week starting 14 February 2022) and the end of Semester 1 (week starting 30 May 2022); to investigate the potential under-reporting of cases to the University of Otago and under-recording of positive rapid antigen test (RAT) results in My Covid Record; to explore the COVID-related experiences of students during the above period.
Method
Randomly selected households in the North Dunedin area were visited at the end of Semester 1 and oral consent was sought for a short interview comprising closed- and open-ended questions. Households were eligible for inclusion if at least one resident was a University of Otago student.
Results
One hundred and thirty-five (96.4%) of 140 eligible households participated, and in 94.1% of these households at least one resident tested positive for COVID-19 between the start of Flo-Week and the date of the interview (a mean period of 109 days [standard deviation 3.6]). In total, 73.6% of the occupants in the participating households tested positive. Of the cases who were University of Otago students, 60.4% reported their positive status to the University. Of all cases diagnosed via a RAT, 66.9% uploaded their result to My Covid Record. Students reported various academic, financial and mental health stresses associated with the general COVID-19 situation during the study period.
Conclusion
These findings suggest that the number of COVID-19 cases reported to the University of Otago between Flo-Week and the end of Semester 1 was a substantial underestimate of the true number, as was the number of cases recorded in My Covid Record. The findings also highlight the considerable impact that COVID-19 had on students during Semester 1.
Author Information
Acknowledgements
Correspondence
Correspondence Email
Competing Interests
1) Paul McNamara, University of Otago Emergency Management and Continuity Manager. Personal communication. 2022 Jun 28.
2) Otago Daily Times. Castle and Howe St parties confirmed as close contact sites. 2022 Feb 17. Available at: www.odt.co.nz/news/dunedin/castle-and-howe-st-parties-confirmed-close-contact-sites [accessed 2022 Apr 7].
3) Otago Daily Times. Uni offers support amid Covid concerns. 2022 Feb 19. Available at: www.odt.co.nz/news/dunedin/campus/uni-offers-support-amid-covid-concerns [2022 Apr 7].
4) University of Otago. COVID-19 update. 2022 Feb 19. Available at: www.otago.ac.nz/coronavirus/updates/otago837767 [accessed 2022 Apr 7].
5) University of Otago. Care packages being delivered to isolating students. 2022 Feb 23. Available at: www.otago.ac.nz/news/news/otago837863.html [accessed 2022 Apr 7].
6) Ministry of Health. Rapid antigen testing (RAT). Available at: www.health.govt.nz/covid-19-novel-coronavirus/covid-19-health-advice-public/assessment-and-testing-covid-19/rapid-antigen-testing-rat [updated 2022 Apr 6, accessed 2022 Apr 7].
7) Ministry of Health. How to use My Covid Record. Available at: https://covid19.govt.nz/covid-19-vaccines/vaccine-passes-and-certificates/my-covid-record/#covid-19-test-results [updated 2022 Apr 5, accessed 2022 Apr 7].
8) Ministry of Health. How to report your RAT results. Available at: https://covid19.govt.nz/testing-and-tracing/covid-19-testing/report-your-rat-with-my-covid-record/ [updated 14 March 2022, accessed 7 April 2022].
9) Dunedin City Council Rates Map. Available at: www.dunedin.govt.nz/services/rates-information/search-by-map [updated 2020 Feb 10, accessed 2022 May 24].
10) Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap): a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-81.
11) Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: building an international community of software partners. J Biomed Inform. 2019;95:103208.
12) Ministry of Health. COVID-19 Trends and Insights Reports. Available at: www.health.govt.nz/covid-19-novel-coronavirus/covid-19-data-and-statistics/covid-19-trends-and-insights [updated 2022 Oct 30, accessed 2022 Nov 4].
13) Vattiatio G, Lustig A, Maclaren O, Plank M. Modelling the dynamics of infection, waning of immunity and reinfection with the Omicron variant of SARS-CoV-2 in Aotearoa New Zealand. 2022 Jun 2. Available at: www.covid19modelling.ac.nz/waning-of-immunity-and-re-infection-with-omicron/ [accessed 2022 Nov 4].
14) Lustig A, Vattiato G, Maclaren O, Watson L, Datta S, Plank MJ. Modelling the effects of Omicron sub-variant BA.5 in New Zealand. 2022 Aug 23. Available at: www.covid19modelling.ac.nz/modelling-ba5/ [accessed 2022 Nov 4].
15) Akuhata-Huntington Z. Impacts of the COVID-19 lockdown on Māori university students. Wellington: Te Mana Ākonga, 2020.
16) Stevenson E, Smith-Han K, Nicholson H. Medical students' experience of studying while working part-time and the effects of COVID-19. N Z Med J. 2022;135(1557):38-48.
17) Cameron M, Fogarty-Perry B, Piercy G. The impacts of the COVID-19 pandemic on higher education students in New Zealand. JOFDL. 2022;26(1):42-62.
18) Aristovnik A, Keržič D, Ravšelj D, Tomaževič N, Umek L. Impacts of the COVID-19 pandemic on life of higher education students: a global perspective. Sustainability. 2020;12(20):8438.
19) Appleby JA, King N, Saunders KE, et al. Impact of the COVID-19 pandemic on the experience and mental health of university students studying in Canada and the UK: a cross-sectional study. BMJ Open. 2022;12(1):e050187.
20) Kohls E, Baldofski S, Moeller R, Klemm SL, Rummel-Kluge C. Mental health, social and emotional well-being, and perceived burdens of university students during COVID-19 pandemic lockdown in Germany. Front Psychiatry. 2021;12:643957.
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COVID-19 among University of Otago students living in North Dunedin households in the first half of 2022: was the prevalence underestimated?
We undertook a study among the residents of North Dunedin student flats, to (i) estimate the prevalence of COVID-19 between the start of Flat Orientation Week (Flo-Week) and the end of Semester 1, (ii) investigate the potential under-reporting of positive COVID-19 test results to the University, (iii) investigate the potential under-recording of positive RAT results in My Covid Record, and (iv) explore the COVID-19 related experiences of students during the above period.
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