The Maximal Expected Benefit of SARS-CoV-2 Interventions Among University Students: A Simulation Study Using Latent Class Analysis

Non-pharmaceutical public health measures (PHMs) were central to pre-vaccination efforts to reduce Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) exposure risk; heterogeneity in adherence placed bounds on their potential effectiveness, and correlation in their adoption makes assessing the impact attributable to an individual PHM difficult. During the Fall 2020 semester, we used a longitudinal cohort design in a university student population to conduct a behavioral survey of intention to adhere to PHMs, paired with an IgG serosurvey to quantify SARS-CoV-2 exposure at the end of the semester. Using Latent Class Analysis on behavioral survey responses, we identified three distinct groups among the 673 students with IgG samples: 256 (38.04%) students were in the most adherent group, intending to follow all guidelines, 306 (46.21%) in the moderately-adherent group, and 111 (15.75%) in the least-adherent group, rarely intending to follow any measure, with adherence negatively correlated with seropositivity of 25.4%, 32.2% and 37.7%, respectively. Moving all individuals in an SIR model into the most adherent group resulted in a 76-93% reduction in seroprevalence, dependent on assumed assortativity. The potential impact of increasing PHM adherence was limited by the substantial exposure risk in the large proportion of students already following all PHMs.