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<front>
<journal-meta>
<journal-id journal-id-type="publisher">mjm</journal-id>
<journal-title-group>
<journal-title>Michigan Journal of Medicine (MJM)</journal-title>
</journal-title-group>
<issn pub-type="ppub">2470-9727</issn>
<issn pub-type="epub"></issn>
</journal-meta>
<article-meta>
<article-id pub-id-type="publisher-id">4813</article-id>
<article-id pub-id-type="manuscript">2a-manuscript_cleanedup.docx</article-id>
<article-id pub-id-type="doi">10.3998/mjm.4813</article-id>
<title-group>
<article-title>A Missed Opportunity to Engage Students During a Crisis</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Irani</surname>
<given-names>Sarosh</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>*</sup></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Klein</surname>
<given-names>Samuel</given-names>
</name>
<xref ref-type="aff" rid="aff2"><sup>&#x2020;</sup></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Gondy</surname>
<given-names>Keerthi</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="aff3"><sup>&#x2021;</sup></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Waselewski</surname>
<given-names>Marika</given-names>
</name>
<degrees>MPH</degrees>
<xref ref-type="aff" rid="aff4"><sup>&#x00A7;</sup></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Chang</surname>
<given-names>Tammy</given-names>
</name>
<degrees>MD, MPH, MS</degrees>
<xref ref-type="aff" rid="aff5"><sup>&#x00B6;</sup></xref>
</contrib>
<aff id="aff1"><label>*</label><institution>University of Michigan Medical School</institution>, <email>iranisa@med.umich.edu</email></aff>
<aff id="aff2"><label>&#x2020;</label><institution>University of Michigan College of Literature, Science, and the Arts</institution>, <email>samkle@umich.edu</email></aff>
<aff id="aff3"><label>&#x2021;</label><institution>University of California San Francisco</institution>, <email>keerthi.gondy@ucsf.edu</email></aff>
<aff id="aff4"><label>&#x00A7;</label><institution>Michigan Medicine</institution>, <email>marikag@med.umich.edu</email></aff>
<aff id="aff5"><label>&#x00B6;</label><institution>Michigan Medicine; University of Michigan</institution>, <email>tachang@med.umich.edu</email> (corresponding author)</aff>
</contrib-group>
<author-notes>
<p>Conflicts of interest:</p>
<p>The authors have no conflicts of interest to disclose</p>
</author-notes>
<pub-date><day>19</day><month>11</month><year>2023</year></pub-date>
<volume>7</volume><issue>0</issue>
<issue-title/>
<history>
<date date-type="received"><day></day><month></month><year></year></date>
<date date-type="rev-recd"><day></day><month></month><year></year></date>
<date date-type="accepted"><day>30</day><month>6</month><year>2023</year></date>
</history>
<permissions>
<copyright-statement>&#x00A9; 2024 Author(s)</copyright-statement>
<copyright-year>2024</copyright-year>
<license>
<license-p>CC-BY-NC-SA 4.0</license-p>
<license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International license, which permits anyone to download, copy, distribute, display, or adapt the text without asking for permission, provided that the creator(s) are given full credit.</license-p>
</license>
</permissions>
<abstract id="ABS1">
<p id="P1"></p>
</abstract>
<kwd-group>
<kwd>COVID-19</kwd>
<kwd>student engagement</kwd>
<kwd>institutions of higher education</kwd>
<kwd>education</kwd>
</kwd-group>
<funding-group/>
<counts>
<fig-count count="0"/>
</counts>
<custom-meta-group><custom-meta id="competing-interest"><meta-name></meta-name><meta-value></meta-value></custom-meta></custom-meta-group>
</article-meta>
</front>
<body>
<p>In March of 2020, mere hours after the first cases of COVID-19 were discovered in the state of Michigan, the University of Michigan announced it was canceling all in-person classes for the remainder of the academic year. The next week, on-campus students were asked to leave their residences, causing thousands of students to go back home. Many college students reported feelings of frustration and guilt &#x2014; they wanted to help, but their hands were tied by the choices of university administration. Despite being required to watch from afar, students around the nation stepped up and played a crucial role in serving their classmates and communities.</p>
<sec id="S1">
<title>MASCUP! Initiative</title>
<p>At the University of Michigan (U-M) and 59 other universities nationwide, students fought against COVID-19 by serving as leaders and volunteer observers for the US Centers for Disease Control and Prevention (CDC) Mask Adherence Surveillance at Colleges and Universities Project (MASCUP!).<xref ref-type="bibr" rid="R1"><sup>1</sup></xref> The goal of the initiative was to collect real-time mask usage data that institutions of higher education (IHEs) could use to adjust training and messaging to improve student mask usage on campus.</p>
<p>At U-M, after merely 3 days of recruitment through the School of Public Health, Medical School, and undergraduate population, all student observer positions were filled. Over 30 students indicated interest, with more than 20 students selected to participate based on experience and timing of interest. Due to high demand, a waitlist was established, and students continued to ask to participate well after data collection began. Students were trained via an online CDC training video and Zoom meeting hosted by the U-M student leaders. Observers selected times and locations to observe mask usage with the goal of at least 400 weekly observations over 10 weeks.</p>
<p>MASCUP!, along with countless other student-led initiatives, also highlights how IHEs would benefit from harnessing students&#x2019; passion and experience in future public health crises. The results of this initiative indicated that students were eager to positively contribute to the evolving public health crisis. For example, during the first meeting hosted by the student leaders, student volunteers were asked why they decided to participate in MASCUP! Student volunteers noted that their interest stemmed from several factors, including limited opportunities for students to engage in hands-on learning during campus closures, a desire to participate in pandemic-related efforts, and interest in understanding and improving mask usage in their communities. This suggests students could have benefited from and bolstered opportunities to address the pandemic and critically important risk mitigation efforts.</p>
</sec>
<sec id="S2">
<title>Lessons Learned</title>
<p>The willingness of students to participate in the MASCUP! study supports a deeper desire among students to engage with the pandemic response. However, these results were not just isolated to U-M. At the University of Southern California (USC), undergraduate students worked with the City of Los Angeles and the Los Angeles Fire Department to better understand how the virus impacted local communities.<xref ref-type="bibr" rid="R2"><sup>2</sup></xref> Additionally, microbiology students at California State University, Long Beach held Zoom meetings to educate their peers about the virus and combat misinformation shared on social media.<xref ref-type="bibr" rid="R3"><sup>3</sup></xref> These student-involving efforts, along with high rates of mask usage among college students (92% said they &#x201C;always&#x201D; or &#x201C;very often&#x201D; mask up in public),<xref ref-type="bibr" rid="R4"><sup>4</sup></xref> likely improved countless lives and suggests a missed opportunity for IHEs to deliberately engage students in more opportunities to learn and contribute to this global crisis.</p>
<p>There were occurrences of off-campus gatherings of students leading to spikes of COVID-19 cases, and, as a result, it is understandable why some may perceive college students as part of the problem and less of the solution.<xref ref-type="bibr" rid="R5"><sup>5</sup></xref> However, data, including our own, demonstrate that those in and around campuses wear masks.<xref ref-type="bibr" rid="R4"><sup>4</sup></xref><sup>,</sup><xref ref-type="bibr" rid="R6"><sup>6</sup></xref> A few small groups of poor actors do not represent the larger community of conscientious and public health&#x2013;aware students. In fact, as of September 2021, data indicate that high numbers of students (85%-90% or more) have received the vaccine, especially at IHEs with mandates. Even universities lacking a mandate are reporting high vaccination rates.<xref ref-type="bibr" rid="R7"><sup>7</sup></xref> In addition, the U-M MASCUP! data collected from February 8, 2021, to April 17, 2021, indicate that 95% of the 2956 observed individuals wore masks and 93% wore their masks correctly.<xref ref-type="bibr" rid="R1"><sup>1</sup></xref> These data support that students are making health conscientious choices by properly wearing masks and getting vaccinated.</p>
</sec>
<sec id="S3">
<title>Future Steps</title>
<p>The safety of students was clearly a priority for most universities, which likely led to the decision to send students away from campus. However, IHEs could have approached the situation differently to both maintain students&#x2019; health and allow them to contribute to the pandemic response. Initially, university administration could have allowed student leaders to have a seat at the table when making these decisions and solicit input from students. This may have led to less frustration from students, who felt sidelined from the decision-making process. At Harvard Medical School, students created their own task force in March 2020 to work with university administration on the COVID-19 response.<xref ref-type="bibr" rid="R8"><sup>8</sup></xref> Although we would have preferred to see the university invite the students to join the discussion, this is a seemingly well-received example of students working with IHE administrators to augment the response. Further underscoring the importance of collaborating with students, the Organisation for Economic Co-operation and Development (OECD) crafted a policy brief indicating the importance of youth and student partnerships in governments&#x2019; responses to COVID-19.<xref ref-type="bibr" rid="R9"><sup>9</sup></xref> We realize that governments are not the same as IHEs, but many of the same principles that focus on youth activism and involvement can be applied.</p>
<p>In addition, university administration could have recruited students to serve as virtual ambassadors regarding COVID-19 safety and policies. However, efforts to use students to enforce COVID-19 rules and regulations on campus often received mixed reviews by the student body.<xref ref-type="bibr" rid="R10"><sup>10</sup></xref><sup>,</sup><xref ref-type="bibr" rid="R11"><sup>11</sup></xref> These ambassadors were tasked with the tough responsibility of ensuring their friends were following public health regulations &#x2014; an unenviable role that could easily lead to resentment and bitterness within the student body. Ensuring that students could promote COVID-19 safety without being tasked with enforcing regulations could have been a more appropriate way to engage students in the effort. This could include students sharing information about COVID-19 safety and handing out masks<xref ref-type="bibr" rid="R12"><sup>12</sup></xref> or creating educational videos about safe practices and the latest COVID-19 information.<xref ref-type="bibr" rid="R13"><sup>13</sup></xref></p>
</sec>
<sec id="S4">
<title>Conclusion</title>
<p>Throughout the pandemic, IHEs have taken various approaches to engaging their students in mitigating the effects of the COVID-19 pandemic.<xref ref-type="bibr" rid="R14"><sup>14</sup></xref> Our experiences with MASCUP! demonstrate that college students overwhelmingly followed masking guidelines. Rather than increasing the disease burden, students have taken the necessary steps to protect the health of their community and have played an important role in helping combat the COVID-19 pandemic.<xref ref-type="bibr" rid="R2"><sup>2</sup></xref> This is a consequential moment for IHEs to support student involvement in campus policy and event response. During crises, IHEs have the responsibility to protect their students but also have the opportunity to further their missions to prepare students for the future. Students and campus leadership alike stand to benefit from greater engagement of their students in addressing crises through safe and appropriate opportunities. As students, we are studying at IHEs to be prepared to deal with difficult challenges, and our training does not have to be put on pause when such a challenge arises. Rather, we are eager, willing, and ready to do our part.</p>
</sec>
</body>
<back>
<ref-list><title>References</title>
<ref id="R1"><label>1</label><mixed-citation publication-type="web"><person-group person-group-type="author"><collab>Michigan Institute for Healthcare Policy &amp; Innovation</collab></person-group>. <article-title>High rates of mask use seen in study on and near U-M campus</article-title>. Updated <month>April</month> <day>28</day>, <year>2021</year>. Accessed <date-in-citation>July 23, 2021</date-in-citation>. <ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:type="simple" xlink:href="https://ihpi.umich.edu/news/high-rates-mask-use-seen-study-and-near-u-m-campus">https://ihpi.umich.edu/news/high-rates-mask-use-seen-study-and-near-u-m-campus</ext-link></mixed-citation></ref>
<ref id="R2"><label>2</label><mixed-citation publication-type="web"><person-group person-group-type="author"><string-name><surname>Schmidt</surname> <given-names>G</given-names></string-name></person-group>. <article-title>Meet the students who fight COVID-19 through research. USC Dornsife, College of Letters, Arts and Sciences</article-title>. Published <month>March</month> <day>23</day>, <year>2021</year>. Accessed <date-in-citation>July 23, 2021</date-in-citation>. <ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:type="simple" xlink:href="https://dornsifecms.usc.edu/news/stories/students-who-fight-covid-19-through-research/">https://dornsifecms.usc.edu/news/stories/students-who-fight-covid-19-through-research/</ext-link></mixed-citation></ref>
<ref id="R3"><label>3</label><mixed-citation publication-type="book"><person-group person-group-type="author"><string-name><surname>Getahun</surname> <given-names>H</given-names></string-name>, <string-name><surname>Beck</surname> <given-names>M</given-names></string-name>, <string-name><surname>Reagan</surname> <given-names>M</given-names></string-name></person-group>. <chapter-title>As cases rise, college students take COVID-19 prevention into their own hands</chapter-title>. <publisher-name>CalMatters</publisher-name>. Updated <month>December</month> <day>18</day>, <year>2020</year>. Accessed <date-in-citation>July 23, 2021</date-in-citation>. <ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:type="simple" xlink:href="https://calmatters.org/education/higher-education/college-beat-higher-education/2020/12/college-students-coronavirus-safety/">https://calmatters.org/education/higher-education/college-beat-higher-education/2020/12/college-students-coronavirus-safety/</ext-link></mixed-citation></ref>
<ref id="R4"><label>4</label><mixed-citation publication-type="web"><person-group person-group-type="author"><collab>Missouri Partners in Prevention</collab></person-group>. <article-title>What are college students doing to prevent COVID-19?</article-title> Published <month>December</month> <day>1</day>, <year>2020</year>. Accessed <date-in-citation>July 23, 2021</date-in-citation>. <ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:type="simple" xlink:href="https://www.mopip.org/blog/tag/2020-well-being-survey/">https://www.mopip.org/blog/tag/2020-well-being-survey/</ext-link></mixed-citation></ref>
<ref id="R5"><label>5</label><mixed-citation publication-type="book"><person-group person-group-type="author"><string-name><surname>Dickler</surname> <given-names>J</given-names></string-name></person-group>. <chapter-title>Coronavirus cases on college campuses spike, linked to parties</chapter-title>. <publisher-name>CNBC</publisher-name>. Updated <publisher-name>November</publisher-name> <day>20</day>, <year>2020</year>. Accessed <date-in-citation>July 23, 2021</date-in-citation>. <ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:type="simple" xlink:href="https://www.cnbc.com/2020/11/20/coronavirus-cases-on-college-campuses-spike-linked-to-parties.html">https://www.cnbc.com/2020/11/20/coronavirus-cases-on-college-campuses-spike-linked-to-parties.html</ext-link></mixed-citation></ref>
<ref id="R6"><label>6</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><string-name><surname>Barrios</surname> <given-names>LC</given-names></string-name>, <string-name><surname>Riggs</surname> <given-names>MA</given-names></string-name>, <string-name><surname>Green</surname> <given-names>RF</given-names></string-name></person-group>, <etal>et al.</etal> <article-title>Observed face mask use at six universities &#x2014; United States</article-title>, <month>September</month>-<month>November</month> <year>2020</year>. <source>MMWR Morb Mortal Wkly Rep</source>. <year>2021</year>;<volume>70</volume>(<issue>6</issue>):<fpage>211</fpage>. doi:<ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="doi" xlink:type="simple" xlink:href="http://dx.doi.org/10.15585/mmwr.mm7006e1">10.15585/mmwr.mm7006e1</ext-link></mixed-citation></ref>
<ref id="R7"><label>7</label><mixed-citation publication-type="web"><person-group person-group-type="author"><string-name><surname>Nietzel</surname> <given-names>MT</given-names></string-name></person-group>. <article-title>Students and faculty are complying with college vaccination mandates</article-title>. <source>Forbes</source>. Published <month>September</month> <day>2</day>, <year>2021</year>. Accessed <date-in-citation>July 30, 2022</date-in-citation>. <ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:type="simple" xlink:href="https://www.forbes.com/sites/michaeltnietzel/2021/09/02/students-and-faculty-are-complying-with-college-vaccination-mandates/?sh=1825fe2835ec">https://www.forbes.com/sites/michaeltnietzel/2021/09/02/students-and-faculty-are-complying-with-college-vaccination-mandates/?sh=1825fe2835ec</ext-link></mixed-citation></ref>
<ref id="R8"><label>8</label><mixed-citation publication-type="web"><person-group person-group-type="author"><collab>Harvard Medical School</collab></person-group>. <article-title>HMS COVID-19 student response team</article-title>. Accessed <date-in-citation>July 30, 2022</date-in-citation>. <ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:type="simple" xlink:href="https://hms.harvard.edu/returning-campus/hms-responds-coronavirus/hms-covid-19-student-response-team">https://hms.harvard.edu/returning-campus/hms-responds-coronavirus/hms-covid-19-student-response-team</ext-link></mixed-citation></ref>
<ref id="R9"><label>9</label><mixed-citation publication-type="web"><person-group person-group-type="author"><collab>Organisation for Economic Co-operation and Development (OECD)</collab></person-group>. <article-title>Youth and COVID-19: Response, recovery and resilience</article-title>. Published <month>June</month> <day>11</day>, <year>2020</year>. Accessed <date-in-citation>July 30, 2022</date-in-citation>. <ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:type="simple" xlink:href="https://www.oecd.org/coronavirus/policy-responses/youth-and-covid-19-response-recovery-and-resilience-c40e61c6/">https://www.oecd.org/coronavirus/policy-responses/youth-and-covid-19-response-recovery-and-resilience-c40e61c6/</ext-link></mixed-citation></ref>
<ref id="R10"><label>10</label><mixed-citation publication-type="web"><person-group person-group-type="author"><string-name><surname>Anderson</surname> <given-names>G</given-names></string-name></person-group>. <article-title>Peer-led punishment for flouting pandemic rules</article-title>. <source>Inside Higher Ed</source>. Published <month>December</month> <day>10</day>, <year>2020</year>. Accessed <date-in-citation>July 31, 2022</date-in-citation>. <ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:type="simple" xlink:href="https://www.insidehighered.com/news/2020/12/11/students-and-administrators-note-pros-and-cons-peer-led-public-health-enforcement">https://www.insidehighered.com/news/2020/12/11/students-and-administrators-note-pros-and-cons-peer-led-public-health-enforcement</ext-link></mixed-citation></ref>
<ref id="R11"><label>11</label><mixed-citation publication-type="web"><person-group person-group-type="author"><string-name><surname>Closson</surname> <given-names>T</given-names></string-name></person-group>. <article-title>College students, told to report COVID parties, ask: To snitch or not to snitch?</article-title> <source>New York Times</source>. Updated <month>September</month> <day>9</day>, <year>2020</year>. Accessed <date-in-citation>July 31, 2022</date-in-citation>. <ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:type="simple" xlink:href="https://www.nytimes.com/2020/09/02/nyregion/colleges-universities-covid-parties.html">https://www.nytimes.com/2020/09/02/nyregion/colleges-universities-covid-parties.html</ext-link></mixed-citation></ref>
<ref id="R12"><label>12</label><mixed-citation publication-type="web"><person-group person-group-type="author"><string-name><surname>Hovis</surname> <given-names>K</given-names></string-name></person-group>. <person-group person-group-type="author"><collab>A&amp;S COVID ambassadors help spread message of safety</collab></person-group>. <article-title>Cornell University, College of Arts and Sciences</article-title>. Published <month>November</month> <day>2</day>, <year>2020</year>. Accessed <date-in-citation>July 31, 2022</date-in-citation>. <ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:type="simple" xlink:href="https://as.cornell.edu/news/covid-ambassadors-help-spread-message-safety">https://as.cornell.edu/news/covid-ambassadors-help-spread-message-safety</ext-link></mixed-citation></ref>
<ref id="R13"><label>13</label><mixed-citation publication-type="web"><person-group person-group-type="author"><collab>Study Melbourne Student Ambassadors helping to slow the spread of coronavirus (COVID-19)</collab></person-group>. <article-title>Study Melbourne</article-title>. Accessed <date-in-citation>July 30, 2022</date-in-citation>. <ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:type="simple" xlink:href="https://www.studymelbourne.vic.gov.au/news-updates/ambassadors-coronavirus-community-videos">https://www.studymelbourne.vic.gov.au/news-updates/ambassadors-coronavirus-community-videos</ext-link></mixed-citation></ref>
<ref id="R14"><label>14</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><string-name><surname>Freeman</surname> <given-names>S</given-names></string-name>, <string-name><surname>Nguyen</surname> <given-names>TV</given-names></string-name>, <string-name><surname>Beliveau</surname> <given-names>J</given-names></string-name></person-group>, <etal>et al.</etal> <article-title>COVID-19 response strategies at large institutes of higher education in the United States: A landscape analysis, Fall 2020</article-title>. <source>J Adolesc Health</source>. <year>2021</year>;<volume>68</volume>(<issue>4</issue>):<fpage>683</fpage>&#x2013;<lpage>685</lpage>. doi:<ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="doi" xlink:type="simple" xlink:href="http://dx.doi.org/10.1016/j.jadohealth.2021.01.016">10.1016/j.jadohealth.2021.01.016</ext-link></mixed-citation></ref></ref-list>
</back>
</article>
