Dora Guo

Remember the days when that annoying itch at the back of your throat heralded only a few days or so of minor inconvenience? When a cough was a mere non-issue next to your much more worrying upcoming quiz, when a runny nose was just a “me” problem and not a “Holy sh*t, I’m spreading the virus to my entire dormitory” situation? We do (and we mourn those days, we mourn).

Have things improved since then, now that the campus is enforcing social distancing rules and quarantines? What drives the “freshman plague”? Who gets it, and how badly?

Freshman plague, the phenomenon where first years en masse get sick during their first semester at Yale — obviously, a pre-COVID feature of the Yale experience — did vary in severity and strength. Kiscada Hastings ’23, a sophomore studying off campus, simply “got some meds from Yale Health and watched Dr. House for like two days.” Joshua Beale ’23, a sophomore living on campus, told the News, “I just remember feeling awful for a few weeks, [with a] stuffy/runny nose, a cough and general malaise.”

It appears that Yale’s contact tracing and social distancing rules for this semester, although markedly strict compared to past years (no gatherings of more than 10 people, staying 6 feet away from the vast majority of people, wearing masks etc.), have not fully eliminated the risk of infection. Beale stated further that he “got a really bad stuffy nose that refused to go away” this semester; however, it turned out to be only a cold. Aside from the freshman plague, what about minimizing the risk of contracting COVID-19, which is Yale’s much more pressing goal?

Yale went from only one coronavirus case on campus at the very start of the semester to almost 300 total students and faculty who have tested positive this fall. (It should be said that only seven have tested positive over the last week. Coronavirus cases on campus have come in spikes, not an exponential curve.)

Still, given the staggering rise of coronavirus cases throughout the United States, Yale has arguably been doing the best it can to keep students safe while still providing on-campus learning opportunities, or at least better than other institutions.

To get another perspective, I interviewed Paul Genecin, the CEO of Yale Health, about some of the risk factors involved behind the freshman plague and whether or not COVID-19 has changed the game.

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Q: Has social distancing worked to keep first years healthier?

 A: Yes, the infection control precautions for COVID-19 do decrease transmission of the usual respiratory infections. However, it is important to remember that people in general, including students, are seeking less primary care now than pre-COVID. We may be seeing underreporting of respiratory infections in those testing negative for COVID-19.

Q: The freshman plague apparently strikes first years every year (pre-COVID). What makes the first year immune system weaker? What are the risk factors? Were we (loosely defined as the Yale community) too relaxed about it?

 A: There is no known phenomenon of weak immune system affecting first years. Unless afflicted with diseases or taking medications that weaken immunity, we assume that college students have intact immunity. However, people newly residing communally in close quarters will transmit ordinary viral respiratory infections very efficiently. This accounts for the high levels of sore throats, headaches, coughs and sneezes that travel through dormitories. We could postulate that the first years are newest to this living environment and therefore more susceptible to viral illnesses that upperclassmen have already experienced. However, I am not aware of studies documenting that phenomenon.

Q: Will we see a return of the freshman plague after COVID restrictions have been lifted? Or has “mask culture” or “social distancing culture” become normalized?

 A: Everyone should fervently hope for an end to “mask culture” and “social distancing culture.” It is likely that common colds will become more prominent when these precautions cease. Of course, people should always try to avoid infection by hand-washing, wiping down surfaces and avoiding sharing glasses and utensils. Hopefully, those with sickness will cover their coughs/sneezes and keep themselves apart from the crowd if possible, even if their illness is just a cold. Students should take reassurance from the fact that respiratory illnesses like “freshman plague” have minimal impact on their ability to function in their academic and extracurricular pursuits.

Q: How many first years use Yale Health services during “plague season” (winter)? Do most first years get sick during the winter? Are enough students using Yale Health resources?

 A: Respiratory illness typically peak in winter, so the season was just beginning when Yale students left campus a week ago. In a normal year, the season of frequent mild respiratory infections finally ends with spring break. We normally see dozens of students each week with upper respiratory symptoms during the winter cold season. However, many students do not feel sick enough to seek care. In this atypical year of COVID-19, our data show a decrease in visits overall, with increases in telemedicine encounters as well as very high use of MyChart to communicate with providers. The triage nurses are also extremely busy providing telephone advice. Of course, students in COVID-19 isolation and quarantine have needed a great deal of attention. Thankfully, none of our students have become severely ill with COVID-19, although mild to moderate symptoms are common. This year, we need to hear from students if they have respiratory infections, regardless of whether they are severe and regardless of whether the student has tested negative on asymptomatic testing. Symptomatic COVID testing is important in addition to asymptomatic screening for finding coronavirus in our community. We also need to consider important non-COVID infections in symptomatic students, including strep throat and infectious mononucleosis among others. Although COVID has dominated this year’s headlines, we also know that students experience the full spectrum of physical and mental health concerns. We are available to help them with any health-related problem. Finally, a vital part of good health is preventive care. It would be an unfortunate consequence of the pandemic if our students were to suffer from preventable illnesses or avoidable exacerbation of chronic conditions.

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Only time will tell how, or if, the freshman plague will return once the COVID-19 pandemic passes. We can only hope that, even if the yearly uptick of respiratory illnesses among first years remains “a minimal impact,” students of future classes will take the necessary precautions to lower risks of preventable illnesses and the spread of infection. A healthier and more responsible campus will be better for us all.

Claire Ning Fang | claire.fang@yale.edu