From the moment he wakes up around 6:30 most mornings, his mind is already consumed with tension and concern. He's immediately thinking about COVID-19 spread, nervously checking his iPad for case numbers even before he gets outs of bed, or reading the latest news story that makes him wonder how low rock bottom could possibly be.
And in the nation's worst wave of the COVID-19 pandemic, there's a new low everyday.
"There is no bottom," Dr. Aaron Carroll, IU’s director of mitigation testing and most public leader of the school’s COVID-19 response, often tweets.
Carroll used to take walks as the sun rose. He'd check his email and plan for the day. But more recently, his doctor recommended focusing on strength training over aerobic exercise. Now he spends his mornings in his basement, following workouts from an app on his phone.
It’s his stress reliever, the few moments every day where he isn’t focused on the pandemic.
During his workout on the Tuesday before IU’s students would go home for Thanksgiving, Carroll was looking forward to his week off. It was the final day of data collection before the latest IU COVID-19 dashboard update — which showed large increases in positivity rates for greek-life students and more than 150 new cases. But even with students going home, Carroll still feels responsible for taking care of students, especially with new cases on the rise in Indiana and the country.
His father passed away last week, but Carroll’s world couldn’t stop to properly mourn. His father’s death was not related to the coronavirus, but the pandemic prevented Carroll from having a funeral or being in Las Vegas with his mother and brother.
“It’s just trying to live in COVID,” Carroll said. “It’s hard.”
The COVID-19 pandemic has taken from all of us, even the ones who are supposed to lead us through it. When his father died, he and his family needed each other the most, Carroll couldn’t be there. He was still at home in Indiana, not taking any days off, shouldering all the other lives he’d never been a part of that relied on him anyway.
It’s a difficult experiment, really, devising a plan to bring 40,000 college students from across the country back to one small town. Conflicting research makes decisions arduous throughout the COVID-19 pandemic. It’s difficult to know if any decision is the right one.
As IU’s COVID-19 response committee worked over the summer determining how to open the school, roughly 150,000 Americans had already died from the virus. Today, that number is past 250,000. The total deaths from the disease would fill up Assembly Hall almost 15 times. More than 3,000 positive tests have been collected by IU-Bloomington, which doesn’t include the many students who tested positive at non-IU facilities.
In deciding whether to bring students back, public health officials thought about their own college years. They knew they’d want to return to their campuses and see their friends. They’d want to go to the restaurants or bars that would become settings for stories shared across dinner tables decades later.
But public health protocol would suggest dispersing the population, closing down gathering spaces and that reopening a major state university was likely not the best idea.
Even after all those years in school spent learning why opening a college in a pandemic goes against all public health guidance, university experts made the call: IU would open its campuses for fall 2020.
Over the summer, IU’s COVID-19 restart team — led by Jay Hess, dean of the IU school of medicine — debated how to do that safely.
Each member saw their selection of the committee as their duty, as the highlight of their careers. The committee members had worked in epidemiology, hospital wards and public health. But they had never carried the weight of more than 40,000 lives with every decision that they made.
The re-opening plan was released in May. It detailed social distancing policies, dorm arrangements, contactless dining, a new academic calendar, mandated mask wearing and strategic classroom set ups. The report covered down the smallest details: water fountains, what direction students could walk in a given hallway and hand sanitizing stations at every door.
As the summer progressed, the committee composed what Carroll described as one of “the most robust testing systems,” on a college campus.
Carroll and other committee members said the question was never whether or not to bring students back, regardless of what they thought was the right thing to do. They said they knew students were coming anyway, and they had to find a way to make it safe.
Many students said IU was not doing enough. IU's testing program is among the nation's largest, but it isn’t even the biggest in the Big Ten. Other students say IU is testing too much, complaining of being selected repeatedly.
At this point, only one student is known to have been hospitalized with COVID-19 according to Carroll. There are no known COVID-19 deaths from IU students.
With students heading home for Thanksgiving, Carroll and IU have completed the first part of their COVID-19 experiment. The campus never closed.
It wasn’t always easy to tell if a decision the committee made was the right one.
IU reopening in the fall was a clear risk. Medical leaders constantly had to choose from options where some group would feel attacked or unhappy. IU couldn’t give parents clear answers on how safe their children were. At points, Monroe County had to step in and take action where IU could not.
Yet somehow, college life resumed in Bloomington this fall.
Between his comic book collection, unrivaled joy for video games and his dog named after a Marvel villain, Carroll, 48, pretty much fits your definition of a nerd. He’d call himself such, too.
His life before the pandemic surrounds him at his desk at home in Carmel, Indiana. There are the many books he’s written and the many more he’s read.
More than 20,000 comic books rest within his stacks of books.
On the other side of those office walls are his wife and three children, Jacob, Noah and Sydney. His life as a husband and a father that often gets put on hold for the lives of thousands of students he’s never met.
From his office, Carroll pilots a pandemic response at one of the nation’s largest universities. He is the face most people around IU understand to be the leader of IU’s COVID-19 team.
But Carroll calls himself an introvert. Despite his tens of thousands of Twitter followers and more than 300,000 YouTube subscribers, Carroll would much prefer to seclude himself and read.
He loves video games too, playing many first-person-shooter games. He plays Contagion — a pandemic game — on his phone and bought the Pandemic Legacy board game for his family to play.
In a way it’s like real life, but without real lives at stake.
That’s especially so for Carroll, who said he is immunocompromised because of his ulcerative colitis, a chronic inflammatory bowel disease.
Before the pandemic, Carroll’s work fit into three main categories — health policy and decision making, mentorship programs and science communications. While his specialty is in pediatrics, he rarely does any clinical work. Most of his pediatric work is within IU.
Carroll called himself “nerd famous.” He appeared on "The Colbert Report" in 2009 and created a YouTube channel in 2013 called Healthcare Triage. He partnered with author and vlogger John Green, who also lives in Indianapolis, to create the channel.
In 2014, he began a health care column to the New York Times. His columns now focus on COVID-19 and how he believes the nation should approach the pandemic. He’s written about preparing to live with the pandemic for another year and why kids should still go trick-or-treating. He’s criticized the government’s response to the pandemic.
“I swear to God this is the busiest I’ve ever been in my life,” Carroll said. “I was busy before I knew what busy was, and this is different.”
Carroll was selected to aid in IU’s COVID-19 response because of his infectious disease experience. He has training, too, in epidemiology. His research into health care policy often covered infectious disease and it has long been a topic on his YouTube channel. Carroll denied all in-person interview requests from the Indiana Daily Student, saying he wanted to set a good example.
Carroll is still learning how to do his job with every new challenge that comes with the pandemic. Research and practice are two different categories.
He’s playing real-life Contagion.
On Jan. 21, Graham McKeen, IU’s assistant university director for public and environmental health, sent an email to IU staff members about the original outbreak of COVID-19 in China. At 9:42 a.m. that day, McKeen reported a low risk to the U.S. and all the unknowns of the novel coronavirus. But he wrote the disease warranted the school’s attention.
At 3:48 p.m. that same day, McKeen sent a second email.
“Wasn’t anticipating an update today, but the following has occurred since the previous message,” the message read. “The US has confirmed an imported case in Washington State. Atlanta and Chicago airports have been added to the list of US airports screening arriving travelers. The CDC increased the alert level to – Alert 2 –Practice Enhanced Precautions – recommending travelers to Wuhan avoid contact with sick people, dead or living animals, and animal markets.”
McKeen has continued to monitor the pandemic everyday from a spare bedroom which has become his makeshift command center. To him it feels like a closet.
He has four screens — two desktop monitors, a laptop and an iPad — set up on a table. The light of screens reflects off his face and his eyes dart around to all the data in front of him. On one screen is testing data, another contact tracing interviews and, on the iPad, Zoom calls. There’s too much to keep track of at once.
The restart committee knew students were going to come back to campus regardless of the pandemic. But in July, they began to worry. As the nation reopened and new cases began to spike, there was concern over whether it would be possible to have students return to IU. At one point, IU took a line of credit in case it wouldn’t be able to open in the fall.
Whereas many universities planned to be fully online for the fall or have only symptomatic testing programs if they opened campus, the risk mitigation subcommittee pushed IU administrators to fund its large testing program. They would have a test available for any student that needed one. They would test every student when they arrived and randomly select roughly 10,000 students for mitigation testing every week.
But IU’s testing plan isn’t even the largest in the Big Ten. The University of Illinois has conducted more than 800,000 COVID-19 tests — nearly eight times more than IU. It administers roughly 10,000 tests every day.
“Universities that have had regular testing programs, effective isolation, students that are cooperative and willing to play along have done well,” said Howard Forman, a professor of public health and director of Yale's health care management program.
When Forman says regular testing, he is describing multiple tests per week. IU does not currently have that, but plans to in the future. Forman also said it’s hard to judge IU’s program right now since Indiana is going through one of the worst outbreaks in the nation.
IU said it required students to test negative in on-arrival testing to come on campus, but enforcement was only strict for on-campus residents. The school had little control over what its off-campus students did.
Committee members said IU’s administration was willing to take any cost for testing to open school. But it is conducting far fewer tests at this point in the school year than originally planned, despite now-opened on-campus labs that were supposed to dramatically cut testing costs.
By testing on such a large scale, the school had data on where the cases were spreading, how they were spreading and thus how to focus its response efforts.
IU conducted 33,000 on-arrival tests as students came back to Bloomington. Only 346 came back positive, a rate of roughly 1%. But while IU believed there were not many infected students on campus to start with, students who partied and gathered at bars the week before classes had yet to begin experiencing symptoms.
IU said it was prepared to handle an early semester spike, but Carroll, McKeen and others were surprised and alarmed by the reality.
Most committee members contacted for this story wouldn’t say if they wanted to bring students back. McKeen, however, was clear: Public health guidelines certainly would not advise bringing the vast majority of the student body back to Indiana.
His biggest fear was students would spread COVID-19 into the community. So far, McKeen and IU have said that hasn’t happened. But with cases rising as students go home, McKeen still worries.
“Any time we have people traveling and moving about during a pandemic, we have a concern for increased spread, especially given that the overwhelming majority of us have yet to be exposed to this virus,” McKeen said.
Tommy Reynolds, a freshman from New York, thought IU treated Ashton — the quarantine and isolation facility for on-campus residents — as a threat. He said he was told if he didn’t follow protocol, he could get sick and be sent to Ashton. That would be his punishment, it seemed.
As an out-of-state student, he faced a dilemma. Reynolds lives in McNutt, and he didn’t know anyone at IU. Should he stay in his room, and lose pivotal early weeks in the year to make new friends? Or should he risk getting sick and disciplined simply for trying to not feel so lonely?
He chose the latter and eventually tested positive for COVID-19.
“Necessary risks with being on campus,” Reynolds said, speaking to an IDS reporter from six feet away during his daily outdoor time while isolating at Ashton in late September.
Reynolds still wants to rush a fraternity, the same greek houses that had massive spikes in cases early in the school year due to Weeks of Welcome parties — IU's replacement for the traditional Welcome Week — and the simple reality of living in a communal house. More than 30 of the houses had been placed under quarantine.
During the first weeks of the semester, new cases rose at a rate IU struggled to control. On Sept. 8, IU’s COVID-19 dashboard reported a nearly 25% positivity rate among greek house residents and more than 700 total new cases. This was the second week of IU’s mitigation testing, new cases had tripled and almost all of them were in greek houses. The school knew the houses would have high positivity rates — such is the nature of communal living — but houses opened anyway. IU alone does not have power to shut down the greek houses.
IU’s plan early in the semester was less to limit new cases and more to endure whatever was to come.
The school’s own team of contact tracers worked 80-hour weeks with greek houses at the start of the school year, though that has lessened with an increasing staff and fewer cases.
No matter how IU chose to handle the greek houses, they knew their choices would anger someone. But sometimes, administrators said, the unpopular choice had to be made to keep classrooms open.
Students quarantined in greek houses complained IU and Monroe County’s policies were too strict, that they couldn’t go on walks and that whole houses had to be shut down because a few members were sick with coronavirus.
Some even saw getting the virus, and the 90-day so-called immunity that comes with it, was their only way out of the locked-down greek houses. Some students reportedly shared a Juul with a student who had COVID-19, purposefully trying to get the coronavirus themselves.
Students in greek life felt IU made them a scapegoat. It was easy to blame them for new cases when the university released data specific to each house but never any of its own dorms.
That testing data was aggregated and analyzed by Cole Beeler, IU’s director of symptomatic testing, along with the rest of IU’s Medical Response Team. Beeler handles most of the 16 metrics IU considers when making decisions. But the school does not publicly release all of its data.
The MRT analyzes testing data and contact tracing interviews. They look for themes where positive cases are occurring and make recommendations when they think a house needs to be shut down.
They have a direct line of communication to IU President Michael McRobbie when a larger decision has to be made, such as purchasing necessary materials for building up on-campus labs and facilitating arrival and departure testing.
But slowly, toward the end of September and into October, houses came off IU’s quarantine list. By sectioning off the highest infected population from the rest of campus, the spread was contained, and new cases began to decline in the houses.
Only one house is currently quarantined, Beta Sigma Psi — which is in its second quarantine period.
Ashton dropped below 10% occupancy. Positivity rates in greek houses dipped below 2%. IU’s overall positivity rate dropped too as students spent more time in Bloomington. IU only reported one student hospitalization — an IUPUI student Carroll only heard about after they were discharged.
IU’s weekly positivity rate hasn’t gone above 2% since the week of Sept. 20.
The MRT was pleased. It believed its plans were working.
“We’ve been able to ring fence it and prevent it from taking down the rest of campus,” said Adrian Gardner, IU’s director of contact tracing.
But positivity rates are rising again right before Thanksgiving, especially in greek houses. IU’s 1.72% positivity rate in the final week of mitigation testing before Thanksgiving is the highest since the Sept. 8 update. Eight houses were given cease-and-desist orders — nearly all for hosting large gatherings, especially Halloween parties — and two were shut down for the academic year.
In the spring semester, Carroll and the MRT expect more students in greek life wanting to move back into their homes. It’s unclear if the homes will be allowed to open in the spring. House directors want them open. Only the individual housing corproations and Monroe County itself can close the houses. IU has no control.
“The people who were going to get exposed were going to get exposed no matter what,” Beeler said.
Even in the supposed haven of his office, Carroll is not insulated from the pandemic and its skyrocketing cases. Carroll’s family had its own scare with COVID-19 in early November when his daughter exhibited symptoms. She was not allowed to return to school until her test result came back, nor was her brother, who would have been a close contact. Carroll has always been focused on limiting his close contacts, but he can’t distance from his family.
Ultimately, her test came back negative.
Carroll still argues with his daughter, telling her why she can’t go to sleepovers. He tells her if restrictions are loosened in some areas, like allowing her to attend high school in person, they have to be tightened in others.
It’s a new dynamic on the classic parent-teenager arguments on freedoms and allowances, especially when that means “Dad” becomes “Dr. Carroll.”
The MRT members all said the pressure of their jobs can be overwhelming. There is barely enough time in the work day to eat lunch. Every decision is criticized. Calls and emails come in daily telling the leaders they are not doing enough. Others say they are doing too much.
The studies Beeler reads every day often conflict. Carroll said in an Oct. 15 webinar schools are making things up as they go with information changing so rapidly. It’s hard to make decisions at times when there still is so much unknown about the pandemic. Students, staff and parents alike want solid answers, and the MRT can’t always provide that.
“I’ve gone through phases where I’m like, ‘What am I doing,’” Beeler said. “It’s so disheartening.”
The hours are not healthy. All the MRT members have their normal jobs that haven’t gone away, but the responsibility of responding to a pandemic that has killed over 250,000 Americans is now on top of it. They all have families, but family consistently gets sacrificed for work.
McKeen’s 15-month-old daughter pushes the door open and barges into his office during meetings. She’s just learning to walk, and McKeen doesn’t get to play with her as much as he’d like.
“You feel like less of a parent or you’re not parenting enough,” McKeen said.
“You feel like less of a parent or you’re not parenting enough.”
— Graham McKeen, assistant university director for public and environmental health
Gardner moved back to the United States from Kenya in late March because of the pandemic. He stayed with his family in Boston before renting an RV to drive to Indiana. He, his wife and three kids lived in an Airbnb for months before closing on a house they never toured.
His kids have to enter new schools and make new friends in an environment not conducive to meeting people, just like college freshmen.
“Indiana’s terrible, we can’t go hang out with friends,” Gardner’s kids say.
“That’s not an Indiana thing, that’s a COVID thing,” Gardner replies.
When Beeler gets home, he crashes. He called himself a vegetable. He can’t eat. His eyes burn from looking at screens.
Beeler goes to bed at 8:30 every day to make sure he has some amount of energy to get up at 4 the next morning. When he can, he tries to read his young children bedtime stories.
But he doesn’t think he’s doing his job as a husband. He doesn’t think he’s doing his job as a father. He doesn’t work from home, and in getting up before the sun rises and going to bed as it sets, he barely sees his family at all during the day. Even for the fleeting moments he’s physically with them, he’s not there mentally.
“I’m very mindful of the fact that I'm probably letting my family down constantly,” Beeler said.
Carroll always smiles when he’s asked when IU will shut down. He doesn’t understand why the question is “when.” And as Thanksgiving break begins, he’s proud IU withstood every spike in cases, never closing or going fully online.
“I think we’ve constructed a very robust response to the pandemic that I would put up against any other school in the country,” Carroll said. “And I still think we’re doing pretty well.”
While Indiana entered Stage 5 of its reopening, new single-day case increase records began occurring ever more frequently. After averaging 825 new cases daily when Stage 5 began, Indiana is now averaging more than 6,500 new cases every day.
Even as the nation faces its worst wave of the pandemic, Carroll still believes he and the MRT have a working plan to combat the pandemic.
Now, instead of quarantining greek houses, the MRT is now focused on parties, cold weather and COVID-fatigue leading to spread, as well as how it will safely bring students back this coming February.
“I would love to loosen restrictions, but our surrounding environment is on fire,” Carroll said in a Nov. 4 webinar. “We’ve created a reasonable bubble at Indiana University.”
That bubble, however, has been endangered with multiple IU fraternities throwing big, unmasked Halloween parties in the fall. Delta Upsilon was shut down by Monroe County. Some students were suspended for celebrating historic IU football wins on Kirkwood Avenue or outside Memorial Stadium.
Many students have asked why the school brought them back in the first place if they were going to punish them for acting like college kids.
But the MRT believes students are less at risk to the coronavirus on campus than in the community. IU’s positivity rate — albeit rising — is still far lower than the rest of the state. Carroll has said all semester his goal was to make it safer to be a part of the IU community than not.
Carroll has said he doesn’t see many more in-person classes happening in the spring. He said classroom settings are only safe because of the current protocols, and opening more would be a detriment to that. When in-person classes begin in February, Carroll plans on-arrival testing and administering significantly more total tests every week.
And as cold weather and flu season begin and a third wave continues in Indiana, IU’s plan for the future isn’t totally clear.
Carroll has seen his own life open up this fall. In a Nov. 4 webinar, he has taken walks distanced from neighbors and had friends over in his backyard. He bought space heaters so they could sit outside safely. He was in the stands as IU’s resurgent football team defeated Michigan for the first time since the Reagan administration.
Carroll admits he doesn’t always know the right thing to do because he doesn’t always know what’s coming. It’s hard to tell parents there isn’t concrete evidence on what will work, but after completing the first trial of its experiment, IU believes it has a working plan. IU thinks it is doing the best it can.
Carroll thinks he’s doing the best he can, too.
Whether the plan will continue to work remains unclear. Such is the nature of the pandemic. It’s all an experiment.
Thanksgiving will be Carroll’s first chance for a break in months. He won’t see his relatives as they mourn his father’s death thousands of miles apart.
Instead, Carroll hopes to get the PlayStation 5, start the new Spiderman game and geek out where, at least for a little while, he can try to think about something other than new coronavirus cases.
“Schools are making this up as we go,” Carroll said in an Oct. 15 webinar. “We’re all in the veil of ignorance.”