Sidelined by Fear and Bureaucracy

Lauryn Craine-Farries was supposed to be on campus at Missouri Valley College when she recently showed up at her family home near Chicago. She had driven nearly seven hours from the private liberal arts college in Marshall, Mo. and was very upset -- "just hysterical," according to her mother -- by the time she arrived.

Craine-Farries said she had been having repeated panic attacks while on campus and that they were prompted by worries about the pandemic and the fear that she might become infected with the coronavirus. Her concerns about growing numbers of sick students at the college and the lack of enforcement of  social distancing and mask wearing rules were amplified by her anxiety disorder.

She was also concerned that Missouri Valley officials were mishandling COVID-19 testing by testing students, faculty, and staff members for COVID-19 antibodies and not actual coronavirus infections, as recommended by the Centers for Disease Control and Prevention.

Craine-Farries said she initially felt fine during the first few weeks of the fall semester, which started in August. But then she started to see groups of students on campus not wearing masks or social distancing. Some professors, who are required by the college to wear masks and make sure students have them on in classrooms, were not doing either, Craine-Farries and other students said.

What's more, the college reported on Sept.1 that 11 people on campus, including students, faculty or staff members, had tested positive for the virus since the start of the semester. There were 31 active COVID-19 cases at Missouri Valley as of Oct. 6, according to the most recent update to the college's online dashboard.

The small liberal arts college enrolls about 1,500 students and the college originally did not have a dashboard to report active COVID-19 cases or testing data to provide information about the health status of the campus population. It was instead issuing infrequent updates by email and posting notices on the college's website. Craine-Farries emailed Bonnie Humphrey, Missouri Valley’s president, in early September and urged her to create a dashboard, which Humphrey did. By then, Craine-Farries and the rest of campus had received notice from the college that several people had tested positive for the virus. She later learned that all the students living in a residence hall were required to quarantine after some who lived there tested positive for the virus -- and that the rest of campus was not notified.

The lack of notification and other aspects about the college's response to the pandemic made Craine-Farries uneasy being on campus. She requested that the college allow her to learn remotely for the remainder of the semester due to her documented mental health diagnosis. Her request was denied, as was a similar request by another student with a mental health condition that makes being on campus during a major public health crisis difficult -- and in some cases even dangerous for people coping with stressful or fear-inducing situations.

At least two other Missouri Valley students with mental health challenges have requested accommodations under the Americans With Disabilities Act, the law that prohibits discrimination against individuals with disabilities in federally funded institutions. Colleges routinely make accommodations such as allowing extra time for test taking or providing course materials in various formats for students with disabilites under the ADA, but Missouri Valley officials contend that allowing students suffering with problems like Craine-Farries' to learn remotely during the pandemic is not a "reasonable" accommodation. (Note:This article was updated to reflect that the accommodations referred to in this paragraph are not "special accommodations" but accommodations to give students with disabilities equal access to an education.)

Things worsened emotionally for Craine-Farries when she learned that the COVID-19 tests being administered at the college’s health center were for COVID-19 antibodies, not for current infections. She sent a lengthy email to Humphrey and cited guidance by the CDC, saying that “antibody tests should not be used to diagnose a current COVID-19 infection.”

Learning about the use of antibody tests on campus “has been giving me anxiety attacks,” Craine-Farries wrote in the email. She noted that the antibody test only identifies people who previously had and recovered from COVID-19, not those who may be sick and potentially spreading the disease.

Humphrey responded that the testing procedures were approved by Missouri Valley's Board of Trustees and in consultation with Saline County health officials and Fitzgibbon Hospital administrators.

Angy Littrell, president and CEO of Fitzgibbon Hospital, said the hospital did not participate in any discussions with the college about its testing procedures.

“We support our community by providing PCR tests, which are the standard for COVID-19 detection," Littrell said in an emailed statement. "We were not involved in the evaluation or recommendation of the antibody test that is currently being utilized at Missouri Valley College. We are always a resource for the college and for our community as we continue to strive through this pandemic.” (Note:This article was updated to include information from Fitzgibbon Hospital and to clarify the hospital's relationship with Missouri Valley College.) 

The college is using the “COVID-19 IgG and IgM rapid test … to serve as a screening tool for our entire campus community,” said a joint statement from the college, the Saline County Health Department and Fitzgibbon Hospital, a nonprofit community hospital about two miles from the Missouri Valley campus where students and others on campus who test positive for COVID-19 antibodies, or who show symptoms of infection, are sent to get tested for the actual virus.

“An antibody test may not be able to show if you have a current infection, because it can take 1-3 weeks after infection to make antibodies,” according to a fact sheet by the makers of the rapid test. It only helps determine if a person has “antibodies to the virus that causes COVID-19.”

The tests have become a point of contention for Craine-Farries and classmates with mental health or other medical conditions that make them feel unsafe on campus. They've informed college administrators about their concerns and have been told that the measures the college is taking are appropriate.

It's unclear if those measures are in fact appropriate.

Heather Pierce, senior director of science policy and regulatory counsel for the Association of American Medical Colleges, or AAMC, said all of the college and university testing protocols of which she is aware “focus exclusively on testing for current infection, meaning PCR and antigen tests.” An antigen test is a rapid-result, lower-cost test for current COVID-19 infection that is less sensitive than the PCR test, according to an AAMC guide to COVID-19 testing published on Oct. 5. A PCR, or polymerase chain reaction, test is used to detect a current COVID-19 infection from a saliva or nasal sample.

Both tests look “for evidence of the virus itself,” while an antibody test is used to determine whether a person has had COVID-19 in the past, Pierce said.

“You’re looking for the virus because you want to know who is infected and who’s contagious,” Pierce said. “The antibody test tells you none of that … Antibody tests are not a screening tool. They are an indicator of past infection.”

Unlike Missouri Valley, the much larger University of Missouri system's four campuses are using PCR tests to determine whether students have a current COVID-19 infection, said Christian Basi, director of media relations for the system..

Heath Morgan, vice president of student affairs at Missouri Valley, said in an interview that if a student tests positive for an antibody test on campus, they are sent to Fitzgibbon Hospital for a PCR test which, in addition to the CDC ,is also recommended by public health officials. Any student can request to receive a diagnostic test at Fitzgibbon, Morgan said.

“We send students to get a diagnostic test if they are exhibiting strong symptoms or if they request one,” Morgan said. “We know that our test is nondiagnostic. It’s for screening purposes.”

The joint statement issued by the college and other public health officials said Missouri Valley “always refers the campus community for diagnostic testing” at the hospital, including “individuals who are symptomatic or who have tested positive” for antibodies.

A “Fall 2020 Return to Campus” document distributed to students before the start of the semester says all students were given a “COVID-19 test” upon arrival to campus. The document did not make clear if students were strictly tested for antibodies, but it said if a student tested positive, “that student must go to Fitzgibbon Hospital for a PCR test” to determine a current infection. Missouri Valley administrators did not clarify if all students were tested for a current COVID-19 infection at the start of the semester.

Tara Brewer, administrator for the Saline County Health Department, said she does not know if every antibody test administered by the college's health center is followed by a PCR test to determine whether a student is currently infected with COVID-19. The health department only learns of new infections on campus when a student, faculty, or staff member has a positive PCR test at Fitzgibbon Hospital, Brewer said.

Pierce, of the AAMC, said antibody tests are generally “much cheaper” than PCR tests and noted that not every institution may have PCR testing capability, which requires a lab or testing facility for results. She sympathized with colleges that are trying to track the course of the virus on campus but may not have the resources to do so effectively.

“We have a real problem in a real lack of a national testing strategy,” Pierce said. “Every institution is making it up and financing it on their own. It’s not a way of getting a country through a pandemic."

Ethan Hofer-Cassianni, a senior at Missouri Valley and a resident assistant, said when he and other students were tested at the campus health center they initially believed the test would indicate whether they were infected.

Hofer-Cassianni said the college implied in the Fall 2020 Return to Campus document that the tests checked for COVID-19 infection, "but we’ve only ever done the antibody test here."

He's worried about his physical and mental health.

"I have a lot of problems breathing," he said, "and getting COVID is a risk for me."

Hofer-Cassianni, who was previously diagnosed with labored breathing and depression, said being at the college this semester has been “a scary experience” that makes him more susceptible to becoming ill with the virus. Unlike Craine-Farries, who left the campus, Hofer-Cassianni said he doesn’t have “any home to go to.” He said he left an abusive household when he enrolled at Missouri Valley and is independent of his parents. He called the college’s COVID-19 strategy “extremely neglectful.”

“At best it’s irresponsible,” he said, noting that other campuses are offering instruction online because they have deemed in-person classes unsafe. “At worst, it’s sacrificing students for the sake of profit.”

Both Craine-Farries and Hofer-Cassianni said they're distressed by the idea of attending classes in person and not knowing whether students are being adequately tested or whether they are unknowlngly infecting each other.

One student, Kori Szabo-Smith, who would have graduated in spring 2021, decided to drop out as a result of the college’s response to the public health emergency. Szabo-Smith has a mental disorder that he wants to keep private, which makes it difficult for him to be on campus during the pandemic. He said he doesn't trust the college to protect students' health.

“It was depressing to see how things were going on campus,” he said. “There’s hardships to stopping my education and resuming somewhere else. But it better serves my conscience and my health … I’ve been fortunate to have warm support from my family and friends with regard to my decision.”

When Craine-Farries and Hofer-Cassianni requested to take classes remotely for the remainder of the semester due to their mental health challenges, their request was denied by Debbie Coleman, the college’s director of accessibility and disability. Despite both students providing doctors' notes that backed up their requests in writing, they were told by Coleman that “going all remote is not a reasonable accommodation” under the ADA, according to emails they received from Coleman.

“I have spoken to other colleges and they are following the same protocol,” Coleman wrote in one of the emails. “Cases are going up everywhere, not just colleges and MVC. Make sure you wear a mask, wash your hands frequently and social distance.”

Mary Vargas, an attorney with Stein & Vargas LLP and a nationally recognized expert on discrimination against individuals with disabilities, said accommodation determinations made based on what other colleges are doing or what is being offered to other students is a “completely irrelevant response.” A determination should be made solely on what a student’s individual needs are based on their disability and the documentation provided, Vargas said.

Vargas said she has heard from students and faculty members with anxiety disorder that are requesting to learn or work from home due to the risk of getting COVID-19. She believes the ADA would allow for such accommodations to be made, “unless the school could show that it was some kind of undue hardship.”

“COVID has created a particularly difficult challenge for folks with anxiety who are trying to navigate this scary new world order, and they already have anxiety disorder that makes things harder for them,” she said. “If the student has a disability that makes it necessary for them, in these circumstances, to have distance learning when others are in person, then that’s a request that should be granted.”

Marion Quirici, a disability studies professor at Duke University who advises the Duke Disability Alliance, said in an email that smaller and less wealthy institutions that have reopened this semester may be applying more pressure on students with disabilities to attend in-person classes. Duke, on the other hand, is allowing students to switch to remote learning at any time and professors should be prepared to accommodate them, Quirici wrote.

"Classifying those accommodations as unreasonable actually puts the students' lives at risk, which makes it especially egregious," Quirici wrote.

Coleman did not respond to requests for comment. Chad Jaecques, director of marketing and public relations for Missouri Valley, did not respond directly to questions about what constitutes a “reasonable accommodation” for the mental health disorders with which Craine-Farries and Hofer-Cassianni struggle. Instead, Jaecques sent an email stating, “The Accessibility/Disability Services Office will work with students to develop a reasonable accommodation for a disability after adequate documentation and a completed ADA Initial Intake Application Form have been received. Under emergency needs, temporary accommodations may be approved by the Director of Accessibility/Disability Support Services while waiting for adequate documentation.”

Tiffany Farries, Craine-Farries's mother, said she had a phone conversation with Coleman on Sept. 29 in which Coleman reiterated that Craine-Farries continuing her classes online from home was not a “reasonable accommodation.” Craine-Farries said professors had allowed her to unofficially complete assignments remotely and participate in class through videoconferencing, but they eventually told her she had need to get an official accommodation from the college.

Craine-Farries also noted, and the college's fall 2020 document confirmed, that only small classes at the college are meeting in-person and that larger classes are conducted in a hybrid format where students physically meet only once weekly in smaller groups and the remaining days are taught online. 

Farries said Coleman told her that Craine-Farries had to return to the campus by Oct. 12 or withdraw from classes for the semester, According to the college’s medical withdrawal and refund policy, no tuition refund would be offered because it is past the fourth week of fall classes. Farries said withdrawing would cost her daughter 15 course credits and $5,000 to $6,000 in tuition payments and student loans.

Farries said Missouri Valley is forcing Craine-Farries “to do something that her brain cannot accept.”  She is concerned about how returning to the campus will affect her daughter's mental health.

"If you think in your mind that COVID is going to kill you, I don’t care how much gloves, masks, social distancing is in place -- your brain is telling you you’re going to die," Farries said.