Joseph Helble:
Good afternoon, everyone. Welcome to our 27th Community Conversation, addressing planning, response, and operations in the time of COVID-19. I’m Joe Helble, the provost of Dartmouth College, joining you from the Starr Instructional Studio in Berry Library on Wednesday afternoon, April 28, 2021.
I’m joined as always by Justin Anderson, our vice president for communications, from another studio here on campus. Justin and I are joined today by two guests who’ve been with us many times, including on our very first Community Conversation of April 29 of last year, Lisa Adams, M.D., a professor in the Geisel School of Medicine, the co-chair of Dartmouth’s COVID-19 Task Force and a specialist in the care and treatment of infectious disease. And Josh Keniston, our VP of campus services, VP for institutional projects and co-chair of Dartmouth’s campus wide COVID-19 Task Force.
We’ll follow our regular format with a brief campus update, live Q&A moderated by Justin, a conversation with Lisa and Josh about campus operations and also about the state of vaccinations, and then ending with an opportunity for them to answer your questions directly.
Today, I have several operational updates to provide on vaccinations, research protocols, and anticipated changes for summer. But let me start, as I do most weeks, with our regular update on testing and case counts as we near the end of week five. Hard to imagine that we’re already here, the end of week five, the halfway point of the term for undergraduate, Thayer, and Guarini students.
Now, when we gathered two weeks ago, I acknowledged that there had been lines at the testing center at the start of the term. I mentioned the steps we had taken to address them and I indicated that I was confident that these steps were addressing the issue. The quick update is they have. Things have been running smoothly at Leverone testing center the past two weeks, and so I’d like to just pause and thank our students once again for their patience, thank our staff for quickly working the problem, and thank our partners at Axiom Medical for their collaboration and their support in fixing things and making it work smoothly once again for our community.
In terms of the results of our surveillance testing, at Dartmouth these past two weeks we’ve seen a continuing decrease in positive tests relative to the end of winter term. In fact, we’ve returned to the very low positive test levels we saw during much of fall term. Over the past two weeks, we’ve conducted 17,537 tests and had a total of 10 positives, for a positivity of 0.06% in that period. Over the past 12 days in the student community, we’ve had a total of four new cases and in fact, we had eight days with zero new student cases reported, again, bringing us back to the kinds of levels that we saw in much of fall term.
For calendar 2021, our overall positivity for students and employees combined, meaning all of our testing, is therefore down to 0.24%. And since the very start of testing on July 1, 2020, we have now passed the 200,000-test level—a staggering number that was hard to imagine when we began this back in July. We’ve conducted 200,915 tests as of yesterday, and as reported on our dashboard, with a total of 393 positives and an overall positivity of 0.20%. Now, these are very, very positive trends and I’m hopeful that with the spring weather that started to arrive and our ability to spend more time outdoors still masked, still avoiding large gatherings, still distancing in accordance with campus and town rules, the downward trend will continue.
Now, in terms of trends on other college campuses these past two weeks, for our Ivy peers reporting data, the downward trend continues on their campuses as well. For the year 2021, all of our peers in the Ivy league now lie between 0.13 and 0.66% positive test level. Our NESCAC peers are currently reporting positivity ranges from 0.04 to 0.29% for calendar 2021, roughly the same level that they were at two weeks ago. And our local state university peers, the University of Vermont and the University of New Hampshire are at 0.32 and 0.57% respectively for 2021, also down from their levels two weeks ago.
The states of New Hampshire and Vermont are among the national leaders in percentage of the population that have received at least one dose of the vaccine, both states now above 50% and in fact, New Hampshire at 60%. Perhaps not surprisingly, the number of new cases in each of our two states has fallen sharply the past two weeks, a very encouraging sign for the local community and for our region as we move towards opening up greater access to our campus and campus activities over the course of summer term.
Moving out of vaccinations, as we announced late last week, Dartmouth has partnered with the state of New Hampshire to offer onsite, and by this, I mean at Dartmouth, vaccination clinics. These clinics are now open to all Dartmouth students currently in the Hanover area and to all Dartmouth employees. And as announced yesterday afternoon by our Task Force co-chairs, Josh Keniston and Lisa Adams, these clinics are also now open to all dependents, partners and household members of Dartmouth student, staff and faculty who are 18 or older, regardless of residency. Clinics will be held on Wednesday, May 5, and Thursday, May 6 ,from 8:30 a.m. to 7:30 p.m. in Thompson Arena.
In addition to providing flexibility for our community, the state will be providing both the two-dose Pfizer BioNTech vaccine and the single-dose J&J Janssen vaccine. The first dose of Pfizer will be offered to any appointments scheduled between 8:30 a.m. and 5:30 p.m. on both dates and the clinic will then offer the J&J shot from 5:30 to 7:30 p.m.
Now, I need to stress, appointments are required. There will not be walk-in opportunity. Registering is simple and straightforward, but appointments are required. This is important because the number of doses we receive from the state of New Hampshire is based on the number of appointments scheduled. Everyone who gets the two-dose vaccine will be able to get the second dose here on campus at our clinic before the spring term ends.
Now, as Josh and Lisa indicated in their email yesterday afternoon, if you have already scheduled an appointment then you’re automatically signed up for a Pfizer BioNTech spot. If you would instead like to receive the J&J single-dose vaccine, you must reschedule by canceling your current appointment and then select a new appointment time. You can do this by visiting https://health-clinics.dartmouth.edu. Details, again, were in Josh and Lisa’s email of yesterday afternoon.
Again, a reminder, you must sign up to be able to receive the vaccine at Dartmouth on these dates next week. The number of doses, as I said, is based on the number of appointments scheduled. The deadline to sign up for students, employees and dependents and partners alike is 11:59 p.m. ET tomorrow, Thursday, April 29. Dartmouth student, staff and faculty can sign up by going to http://dartgo.org/vaxappt. That’s V-A-X-A-P-P-T. Dependents, partners and household members can sign up at http://dartgo.org/vaxregfam, or V-A-X-R-E-G-F-A-M, single word. Again, that was contained in Josh and Lisa’s email of yesterday afternoon.
Once vaccinated, we do need students and employees to upload their vaccination information as soon as possible. Students are asked to submit proof of vaccination through Dick’s House with information available on the Dick’s House website. Employees are asked to provide proof to Dartmouth’s occupational medicine partner, Axiom, and provide consent to Dartmouth’s limited use of this information by completing the form at http://dartgo.org/vax or V-A-X.
Now, we know that students and employees alike have been getting vaccinated and yet the percentage of the undergraduate student community that thus far has confirmed that they had been vaccinated is 12% overall and 17% for those who are on campus who are here in the Upper Valley. And not that this is a competition, but I will note to all of our students that two of our professional schools are already well beyond the 30% level. And not to name names, Tuck and Geisel, but it’s great to see you progressing at such a rapid rate. And I hope you will drive us to the 70 to 90% level we need to achieve herd immunity in your communities and set an example for the rest of the campus.
A reminder to all of us that while this is a strong start overall, we still have quite a ways to go to reach this overall 70 to 90% goal and achieve herd immunity. Now, I’m pointing this out for two reasons, first as a reminder to register for the on-campus clinic if you haven’t already. And also because over the past week, we’ve been receiving many messages from students and parents alike asking for more in-person activity this summer because of the general observation that nationally, vaccination is progressing rapidly. While that is true nationally and in fact, it is true in our region, the numbers that I just cited show that we are not yet there on our campus.
Broad Dartmouth campus community vaccination is an important step in our considering more in-person opportunities and activities and engagement with faculty this summer. I cannot stress that enough. Broad Dartmouth campus community vaccination, again, reaching herd immunity is essential for us to return to a planned, normal campus experience this fall, which means residential education in the classrooms, in the laboratories, in the studios, and on the stages and a broad range of co-curricular activities.
So, for students and families who are asking, what does fall term look like? Fall term looks like residential operation in the classroom and in co-curricular activities, but we need you to partner with us to get vaccinated in a timely fashion so that we can see well before the start of fall term, that we are on the necessary trajectory to achieve herd immunity by the start of the term.
To students who are here this term and to our employees, we therefore encourage you to begin the vaccination process as soon as possible. And I’ll say again, and for the last time, including next week through one of the Dartmouth clinics, and we ask you to upload your records as soon as you have received your final dose.
Just a note to our employees, a reminder that all employees are eligible to take time off to receive their vaccine. And remember for all of you who have gotten vaccinated and uploaded your confirmation information, you’ll be able to begin a reduced surveillance testing regimen of only one time per week.
Now, looking ahead to the end of spring term, I know that there are many questions regarding commencement. First, for our students who will be marching either in their investiture ceremony or in commencement, or both, just a reminder that if you are not presently in the Hanover area and are planning to return to campus for commencement, if you’ve been fully vaccinated in the United States, you must submit proof of vaccination to Dick’s House as soon as possible and no later than at least seven days before your arrival on campus. If you’re not fully vaccinated and will not be fully vaccinated by the time of your travel back to Hanover, then our travel policies apply with different rules depending upon whether you are coming from elsewhere within New England or outside of New England. All require a negative PCR test, generally 72 hours in advance of your first ceremony. Details will be conveyed by the individual schools in the coming weeks with dates specific to their ceremonies and also posted more generally in early May.
Second, I know from the many emails I’ve received from Dartmouth families, and I know as a parent myself, that there is special significance of the commencement moment for many. I know that it feels different without family present in the stands, and this is perhaps the only moment in my many years at Dartmouth where I have wished we had a stadium that seated tens of thousands of spectators so that we could easily and safely accommodate guests for every graduate as we do in normal times with people packed closely together on the Green. But we all know that we do not have a stadium that accommodates and seats tens of thousands of individuals. We are, however, encouraged by trends these past two weeks in case counts, nationally and regionally, where we have seen a steep decline in positive test levels and we are exploring ways in which we could allow students to bring up to two guests, ticketed, to investiture or to commencement, and do so in a way that is consistent with campus rules and local community rules, which are expected to be in place at that time.
Now, I had hoped to be able to provide more detail today, but we are continuing to explore options, again, with the goal of allowing every student who is currently planning to march in our ceremonies to invite two guests. And these would be ticketed events with specific assigned seats. We anticipate saying more on this in roughly the next week. And I know that my simply saying today that we’re pushing hard to find a way to make this happen is going to elicit many questions about details which we cannot yet answer.
I am telling you this today because it has been our commitment in these conversations from the beginning to be open and transparent about issues that we’re working to and working through and the timeframe over which we hope to be able to bring them to resolution. I’m doing that here, and I therefore need to ask for your patience as we try to finalize what will be feasible within local and state guidance and guidelines and to the maximum extent equitable and fair for all of our schools, all of our programs, and all of our graduates. Again, we’re being transparent in saying we would like to make this happen, but we cannot yet promise that it will be possible. Once more I ask for your patience and we anticipate saying more on this within roughly the next week.
Now, let me offer a few thoughts on summer session as we also have gotten many questions over the past week, particularly from parents asking why we are not yet requiring that all classes be taught in-person during summer term. Last June 29, when President Hanlon and I announced Dartmouth’s operating plan for the year, we presented a plan that was a full year integrated plan that offered approximately 50% of our undergraduate student community the chance to be in residence in any given term, offered students some agency or some choice in expressing preference for particular terms, and stressed two key foundational principles—supporting and prioritizing the health and safety of the community, meaning students, employees, and the local community alike, and ensuring the continuity of educational opportunity for all of our students.
When we articulated this integrated plan for the year, we stressed that we were providing opportunity for all students to access most of our available curriculum through this term, this summer term, which is the fourth term in our four-term plan. This summer, for a variety of reasons, approximately 20% of our undergraduate student community will be studying remotely and will not be able to be here with us in Hanover. Those students need to have access to a broad set of curricular offerings as well and that is why we are not requiring all classes to be taught in-person this summer. In addition, although guidance, including masking guidance, is changing rapidly, we are not remotely close to herd immunity, as I said earlier in my remarks, and we will not be there by the start of summer term. That is our intended and stated goal for the fall term.
Finally, our commitment to the faculty in asking them to pivot overnight last spring to online learning was to give them the choice and to trust them as our colleagues, as our students’ teachers, as the individuals who know best, how to teach a class of mixed learners, the flexibility to decide how best to engage students in challenging and engaged learning in their subjects and in their classrooms. We are standing by that commitment to our faculty.
We are still in a pandemic and I know that all of us are so, so tired of this and the slopes of the trend lines are positive, but that doesn’t change the fact that we are, in fact, still in a pandemic. There will be more in-person classes this summer. I recognize it’s not as many as all would like, but I am confident that this summer is going to be a significant step forward from the spring and I am confident that if vaccination levels rise as we approach summer term more of our faculty will be open to adding in-person elements or having in-person conversations with students, office hours, and one-on-one meetings as summer term approaches. Let me just end this by saying once more, our goal and our intention is for all or nearly all of our classes and labs and studios and stages to be in-person this fall.
Now, let me end with just a minute or two of quick updates on some spring term items. First, in terms of access to research facilities, Vice Provost for Research Dean Madden announced earlier today some additional flexibility for laboratory research, which takes effect on Monday, May 10. On May 10, we will move to phase three of our research ramp in plan and protocols, which will remove restrictions on hours of operations in research buildings, reduce but not eliminate physical distancing requirements in some laboratory settings, and make adjustments to disinfection protocols for shared equipment. All of this should allow for some expansion of the level of research activity, starting immediately on May 10.
Second, in terms of community activities, yesterday, we held our first Tuesdays Together gathering, where Lou’s donuts and cookies, and thank you very much to those who planned this, were handed out around campus. It was a chance for me to speak with a few students and see a few colleagues in-person, many of them for the first time in more than a year. Thanks to all who helped out. Thanks to all who came out. And I look forward to seeing all of you at the next one on May 10, or perhaps shortly thereafter that week. Details to be announced as the date approaches.
I’m also happy to announce that “Live at Collis” will launch this weekend, as long as the weather permits, with live performances. This week will feature a senior showcase with six seniors performing, and I believe this is outdoors. We’ll also be starting a weekly outdoor movie night on Saturday nights. The first showing is on Saturday, May 8, with details to be provided next week. This is a collaboration between the Office of Student Life and Hop Film, and it will show a mixture of new releases and some fan favorites. So come out, be outdoors, see a few members of the Dartmouth community in-person, and take in a film. Screenings will take place on the Kemeny Courtyard behind the library.
And finally, as of today, tents located at Cutter Shabazz, Blunt, Hitchcock, Moore Plateau Street, and Wheeler will be open from 10 a.m. to 10 p.m., Sunday through Thursday and 10 a.m. to 11 p.m. Friday and Saturday. The tent located at ’53 Commons will be open for dining from noon to 7:30 p.m., seven days a week. It will also be open for informal gatherings from 7:30 to 10 p.m. Sunday to Thursday, and 7:30 to 11 p.m. Friday and Saturday. All events must be scheduled in the VEMS Event Management System, where the daily schedule will be posted for each tent, and if a tent is not scheduled, it is available for informal use gatherings at any time of up to nine people.
Tents are self-serve, which means you need to prepare and provide all aspects of your event support. But each tent has a base setup, which must be restored by the user after the event. Again, details are available through the VEMS Event Management System website.
So, with that, let me bring my remarks to a close. I look forward to an engaging spring term, the balance of spring term, and I am confident that given the significant progress we’ve seen in case counts and positivity rates, the improving weather and the commitment of the Dartmouth community to get vaccinated, and I am counting on you for a commitment to upload your records, we can make significant progress and begin to see and engage more of our community outdoors or under the tents in the second half of spring term starting today. Justin, over to you.
Justin Anderson:
Thanks, Joe, and so nice as always to be with you on this dreary, unfortunately, Wednesday afternoon. I just want to echo what you acknowledged in your opening remarks about the flood of questions that we are receiving about summer term and whether there will be in-person instruction. And you addressed a number of the reasons why that is a challenge. One thing that you didn’t address, which I’d like to bring up, again, because it is filling up my inbox rather quickly is an observation that a number of correspondents have made about the Hanover schools, and people have observed that Hanover, the elementary school, the middle school, and the high school have had in-person instruction all year, and Dartmouth hasn’t. How come they can do it and Dartmouth cannot?
Helble:
Well, so it’s a good question, Justin. First, I have to correct you. It is not a dreary day in Hanover. It is never a dreary day in Hanover. There is a refreshing gray mist settling upon the plain that will green and brighten everything we see in the morning. In terms of your question about the comparison to the high schools, it’s an important point, but in many ways, it’s an apples and oranges comparison. So first, you have to look at the physical facilities and ask what kind of ventilation system you have in the room and whether that is sufficient to enable people to remain in close proximity to one another for longer periods of time. Second, the students are living in a congregate living situation, which raises the level of risk relative to them all dispersing to their home communities at the end of the day.
Third, we are very attentive to the broad mix of activities that happen here in campus, where students are not just popping into a classroom for 30 or 40 minutes, but are spending long periods of time, potentially in study sections together, working in design studios together, working in research laboratories together. And it is all of this collectively that we need to manage to support and promote the health of our community. And so I know that it’s not a satisfactory answer for everyone, but the truth is, every institution, every college and university, is different. Comparing a college or university to a high school where you’re comparing resident congregate living to students coming in and out over the course of the day are very, very different situations.
Anderson:
Thank you for that, Joe, and thank you for correcting me when I said that it was dreary. What I should have said is that it’s just not quite as sunny as it was yesterday.
Helble:
There you go.
Anderson:
Joe, you have stated repeatedly during Community Conversations over the last year that Dartmouth will follow the science in terms of how it is evaluating the situation and the decisions that will be made. How does science justify the limits on commencement attendance, the in-class instruction, and the visitor policy given all of those great positivity rates that you cited earlier, as well as the number of tests that we’re doing, and all of the numbers that are rather impressive and paint a positive picture, or at least a positive snapshot of what’s happening at Dartmouth at the moment? So, if we are following the science, a number of people have asked, then why aren’t we opened up?
Helble:
All right. Well, again, Justin, there are several different considerations here. And I think, in part, when we talk about following the science, we have to be careful not to focus only on the best-case situation and say, “That is what immediately applies here.” What do I mean by that? For a commencement event, we are going to be bringing large numbers of people into town who are from outside of our community. We have no way of insisting that they are vaccinated coming into town. We can ask it they’re vaccinated. We have no way of insisting and managing that vaccination individual health information for people who are not part of our community.
Second of all, there are pinch points in the process where people are in close proximity moving into a stadium, moving out of a stadium, that require us in an abundance of caution to keep people reasonably separated from one another in the event.
Third, we have to think about just the challenges of the mix of population that we have in town, the different ages of population, and the risk that this may pose to individuals who are older and again may not be vaccinated in a stadium setting.
And then fourth, we are not prepared to have people in close proximity packed together just as outdoor sports arenas are not having individuals packed together in proximity close together. And we are substantially limited by the size of our stadium. As I said earlier, if we had a 40,000-seat stadium, the one time in my life I wish we had that it would make things so much simpler. The capacity of our stadium is actually under 10,000 for a configuration for graduation, and just the way the seats are aligned, it makes it extraordinarily difficult to maintain the recommended distance between people in what is a large event, this is not a small gathering, but a large event, keeping them safe and a distance from one another.
And in terms of the classroom piece, just the last thing I’ll say, there was a paper that was published just yesterday in the proceedings of the National Academy of Sciences by some MIT scientists commenting on scenarios under which you can show that even with 6 feet of separation there is risk of infection through aerosolization to other individuals in the classroom. It depends upon the mechanical ventilation of the room. It depends upon how well mixed the air is. It depends upon how effective the masks are. And so, again, there are indications that we will be able to move in a very positive direction over the course of the summer. We have to make decisions today about whether or not we can manage large crowds two months from now. That’s what’s limiting our ability to commit to saying to everyone, “Yes, commencement is open and you can bring two guests and we’ll be able to make it work in the stadium with the crowd that, that would entail.”
Anderson:
Joe, we have time for just one more question before we bring in Josh and Lisa. A viewer asks, “What will Dartmouth do with the vaccination information that goes to Axiom? And I guess what will Axiom do with it as well?” So, what happens to those medical records?
Helble:
Right. Actually, Justin, I think that question is best put to Lisa, but right now we are using it to track aggregate levels of vaccination within our communities. Full stop. That’s the end. That’s the end of my answer. Maybe I will turn and put that question to Josh and Lisa as a starting point. Justin, if you don’t have a follow-up, why don’t we welcome Josh and Lisa to the screen and begin, if you don’t mind Justin, by my turning and putting that question that you just put to me to Lisa and Josh. What is it that happens with the vaccination information after employees upload it?
Lisa Adams:
I’m happy to help us get started with that one. The information is stored on a secure server, it’s entered through their secure portal. Really, what we are using that information for is, as we have said, to provide some additional freedoms to people, a decrease in testing frequency. We know, too, that individuals who are fully vaccinated will also have greater travel freedoms, but really the main purpose for keeping it in a system by Axiom right now is so that it can be fed into the test screening testing system, the reminder system, the system that says if individuals are in or out of compliance with their testing requirements. That’s the main purpose for which it is being used right now. Josh, I don’t know if you have anything you want to add.
Josh Keniston:
No, I think you’ve covered it, Lisa.
Helble:
All right, thanks. Thank you for clarifying and adding to that.
Let’s turn now to another vaccination related question and Lisa, here I want to start with you although I’ve got questions for both of you. The J & J vaccine is again approved under emergency use authorization for use and administration within the US. In some locations, including as I announced earlier, at Dartmouth individuals going through our clinic will have a choice. Our choice is Pfizer BioNTech or J&J Janssen. What questions should someone consider in making the decision about which vaccine to choose?
Adams:
I think it’s just great. We are fortunate to be getting to a point in our vaccine rollout such that ample availability now allows individuals to make a choice about which vaccine they receive. This is good news. As a clinician myself, I certainly support informed choice and patient empowerment when it comes to medical decision-making.
Obviously, the J&J Janssen vaccine has the benefit of being a single dose. We see a lot of people expressing preference for this vaccine because of that, because they want the convenience of a single vaccine appointment, because they want to be fully vaccinated on a shorter timeframe, two weeks versus five and six weeks from start to finish with the two dose vaccines, and because they’re worried about the undesirable local and systemic reactions, the fever, chills, aches that more occur after a second dose. This is actually a great option for individuals who have those preferences and now they can make that choice. I really do see it in many ways as an individual preference here.
I will say just a few words about resuming administration of the J&J Janssen vaccine. I listened very intently to the livestream of the ACIP meeting last Friday, where they discussed and eventually voted to reinstate its use. Now all sites, including our Dartmouth site next week, are providing this vaccine in accordance with the guidance that everyone is appropriately informed of the very low risks for serious adverse events, including that rare blood clotting syndrome called thrombosis and thrombocytopenia syndrome. This updated warning has language that is directed at women under 50, who appear to be the ones at increased risk for this rare but serious disorder. After reviewing the data, it became very clear to the ACIP and CDC, but the potential benefits of preventing hundreds, thousands of hospitalizations and deaths far outweighed the risks with reinstating this vaccine.
Lastly, I think it’s important to add that the pause in administering the J&J Janssen vaccine should be seen as a positive. It was an example of the FDA and CDC’s extensive safety monitoring system, working as it was designed to work, identifying even these very small numbers of cases. I see that as reassuring, that vaccine safety is being taken very seriously.
Helble:
Great. Thank you, Lisa. That’s hugely helpful, I think, to many of us who were thinking about the choice between the two options in front of us.
Josh, let me turn to you now with a vaccination question as well. This is on the logistics side. What can you tell us about the clinics that will be held next week? Again, appointments will be required and there’s one more day to sign up, but where will they be, who will manage them and how’s the process going to work?
Keniston:
Yeah. I think as you’ve mentioned, Joe, a couple of times and really important to emphasize, we do need everyone to sign up by tomorrow evening because we need to submit to the state the number of appointments that we have so that they can then issue us the right number of doses. That piece is really important. It’s going to be in Thompson Arena, which we actually had a clinic today. It was a second dose clinic. Everyone will recall we earlier, or a couple of months ago, had partnered with the state for some of our employees to get a first dose, and we actually ran a second dose clinic today. The system is working well. What people can expect when they show up is it’s largely going to be staffed by Axiom Medical, which is our same partner for testing. We also have partners from the state and local levels, including the town of Hanover and Dartmouth EMS, helping to staff it.
When you arrive, there will be some initial screening questions. These are the same questions you would get at any vaccine appointment, making sure that there’s not a risk factor that they need to be aware of. Then there will be a registration process. One of the nice things about being able to do this on campus is for our employees, our students, we actually have most of the information in our systems, so it’s a really quick registration process. For those who are household members or dependents, there will be a separate table. We’ll need a little bit more information from them, and then you’ll move on your way, get your shot, and then there’ll be a brief 15-minute observation period, just to make sure that everything went well. What we’re encouraging folks to do is while they’re waiting, use your smartphone and upload your records. Do it right there when you’re done, when you’ve had your second shot, go ahead, and take a picture of that and upload it.
It’s a pretty smooth process and it has the benefit of being right on campus, which most people, if they’re here, can walk to. We’re excited about it.
Helble:
Great, great, great. Thanks Josh to you and your team and to everyone who was involved in setting that up. That convenience is extraordinary, and I’m really excited that we’re able to offer that to the Dartmouth community, including family members.
Lisa, let me come back to you with a question. I want to ask about the breakthrough cases that we’ve been hearing about in the news. I checked this last night, as of yesterday there were 52 reported breakthrough cases in New Hampshire, and 7,157 nationwide. Breakthrough means someone who’s been fully vaccinated then tests positive subsequently for COVID-19 infection.
The numbers sound large, but for context, there’ve been over 87 million individuals vaccinated thus far in the United States, which means fewer than 0.01% or one in 10,000 vaccinated individuals have shown breakthrough. For me, as I listened to the rhetoric around breakthrough in the media, it suggests it’s a concern, but this is actually from my perspective, a sign that the system and the vaccine are working exactly as intended. You’re a physician and a scientist, what might you say to someone who’s concerned about breakthrough and maybe even sees this as a reason to delay vaccination?
Adams:
I would say that breakthrough cases should come as no surprise to any of us. We know that none of our three COVID vaccines, and in fact no vaccine in use today, is 100% effective. What we do know is that these vaccines are very effective at protecting against severe disease, hospital admission, and death. Really, that was clear from my earlier comments as well. We know we are and will see some breakthrough infections in individuals who are vaccinated, at least until we get to a point where there’s very little virus circulating. The vast majority of these are going to be mild or even asymptomatic infection.
I can’t emphasize enough that the risks for an adverse outcome are much, much lower if you are vaccinated. I also hope that seeing individuals develop these very mild breakthrough infections will actually help the vaccination cause as we consider that it was likely their vaccine that led to their infection being very mild or even inconsequential. This really should be considered a pro-vaccine moment in my mind.
Of course, we’re collecting information on the spectrum of disease and transmission of dynamics of breakthrough infections as more people are vaccinated. Of course, we hope that as disease prevalence decreases, really such breakthrough infections will become truly rare events.
Helble:
Great. Thank you, Lisa. Building off that, I want to turn back to you, Josh. This is a question not about vaccination, but about operations. Vaccination is certainly improving the state of health of the local and campus communities, and we are seeing case counts come down. In accordance with this, I know the taskforce is working through recommendations for me to review related to the easing of some of our operating restrictions for summer term. Can you remind everyone of the color-coded levels of operation and just talk a bit about where we are now and where we hope to get some time in June, perhaps, and what that means for operations this summer?
Keniston:
Yeah, absolutely. Everyone, if you are a regular viewer, you will recall we had defined five levels that started at essential access only and progressed to full access. Currently we are at the middle level, which is called, limited access. Earlier in the pandemic, some of the things we were looking for to move to the next level were things like access to testing. We’ve always looked at how are we able to safely move to these next levels. I think as we are looking at where we are with the vaccine rollout, that’s one of the key levers that’s going to allow us to move to the next level, which is a dark green, less limited access.
Really, what we’re looking for there is we’re still going to be asking for people to try and help de-densify campus and to do things virtually or remote when they can. If they do need to come to campus, it’s going to be a little bit easier, that we’re going to be able to increase capacity in some of our indoor spaces, that we’re going to make it easier for visitors to come to campus.
I think as we move toward June and start to see these high levels of vaccination among our community, I think we’re optimistic that we’ll be able to roll out these relaxed guidelines, with the plan, as you’ve said, Joe, to ultimately get to that full access level by the fall.
Helble:
Thanks. Just let me just ask you one related follow-up question. I’ll ask for a quick answer and then Lisa, I want to put one last question to you before we turn to Justin and the outside questions. I mentioned earlier that tents are now up and around campus and they’ve been approved and permitted for use. Can you just tell us, really briefly, about capacity, potential uses, and what your thoughts are on tents potentially being available again this summer?
Keniston:
Yeah. The tents are really designed as a great opportunity for folks to get outside and be able to hold their events. It follows our events guidelines. If it’s an organized, scheduled event, that can be up to 25 individuals in most of the tents.
Then if the tents aren’t scheduled, people are free to go use them. Those can be groups of up to nine. I think we’re going to watch them during the spring and see if they get a lot of use and if they do, I think we’ll continue them into the summer.
Helble:
Great. Thank you. Lisa, let me give you the last question and then we’ll turn to Justin. I want to ask you a breaking news question. As I’m sure you know, the CDC just yesterday indicated that outdoor masking requirements can be lifted under certain circumstances. What were your reactions to the release of these new guidelines?
Adams:
I found this new guidance very encouraging. For me, it reinforced a few key principles about viral transmission dynamics and infection control practices that we have been tracking and recognizing as important.
First, I would say it reinforced that the outdoors is safest. In one systematic review, I know that less than 10% of cases globally have been attributed to outdoor transmission. In those cases where it does occur, we really believe that it’s due to prolonged close contact without masks. We know that the outdoors is the perfect environment to reduce transmission. Fresh air rapidly disperses and dilutes the virus, and then sunlight also helps kill the virus. Recognizing the benefits of being outdoors is really part of the Dartmouth ethos and so, not surprisingly, has been part of our approach and a part of our policies all along. I think we can think of the outdoor ice rinks, the fire pits, the Tuesdays Together on the Green and now the outdoor concerts and other events that are being scheduled for being outdoors. Again, all this is very reassuring and where I think we should be spending as much time as possible, once it gets to be more sunny in Hanover.
Secondly, this policy, in my mind, is about giving privileges to vaccinated people because being vaccinated makes you safer. Not completely safe of course, but safer. It also serves to incentivize people to get vaccinated. Of course, we’re doing the same with changes to our policies for those who are vaccinated. As we mentioned, the less frequent testing requirements, and greater travel freedom, and exemptions from quarantines, et cetera. Again, trying to find ways to really encourage people who maybe had been hesitating or putting it off for now, really encouraging them to get vaccinated. Now is the time. You can get it done. You can get it done at Dartmouth. You can get it done locally near you. That’s all great news.
Lastly, I will mention that the announcement of this new guidance actually came during my health EPI meeting. We actually quickly pivoted to look at the guidance and are now thinking together about how we can adapt it to our spaces, recognizing that we’re still bound by town guidance, including Hanover’s mask mandate, which I understand is still in place, but it’s certainly exciting to see another incremental move towards that new normal that we are all so desperately craving right now.
Helble:
Thanks Lisa. Thanks very much. That’s helpful insight as we think about it and also respond to questions about why Dartmouth is not adjusting some policies immediately as the CDC issues new guidance. It’s one of many factors that we have to be looking at as we make these decisions.
Justin, back to you to see what’s coming in from our audience.
Anderson:
Thank you, Joe. And Lisa, if I could stay with you for the first question and it’s regarding the Jansen & Jansen vaccine, and the fact that we’re going to be getting J&J doses now that they’ve been cleared for use. How do you think that bringing J&J back online will affect our community and its ability to have greater levels of vaccination by the summer? And does this mean that we’ll have more students vaccinated by the summer and, as you just observed, perhaps more privileges because of it?
Adams:
I certainly think so. Again, we know as people are registering for the vaccine clinic that we’re going to be holding next week, we see some people preferentially choosing the J&J vaccine. Again, I think it’s very nice as many of our students are in motion at different times, to be able to not have to think about how and when to time and schedule a second dose. Again, I think it just provides that convenience, that freedom. And I think it will lead to more of our students being vaccinated, maybe more of our employees as well. But I do think having it as an option is going to provide greater flexibility to people. And I think, in some cases, greater acceptance in getting all of us, the Dartmouth community, the local community, the state, nationally towards better vaccine coverage. And that’s, as we know, herd immunity the 70 to 90% target is really what we’re aiming for.
Anderson:
Josh, if I could go to you with sort of a related question, and it is about whether or not there would be different levels of access to different buildings or resources on campus for students or faculty or staff who are vaccinated. In other words, will their ability to travel more freely on campus once they’re vaccinated increase, or is it something that is going to depend on the status of the whole, as opposed to the status of the individual?
Keniston:
Yeah. We’re really using the status of the whole to determine our campus operations. I think as both Lisa and Joe have mentioned, the way that we’re collecting this data with Axiom tracking it or Dick’s House for the students, it really is about having that information for making decisions at the aggregate level and first helping with some of our testing cadences. But we really aren’t in a position, we’re not going to link that data to a key card and whether or not you are vaccinated will indicate whether or not you have access on that key card. That’s something that technically is difficult to do. And I don’t think, from a philosophical perspective, we think that’s the right direction to go either.
And so really what we’re advocating for is the more people that get vaccinated, the quicker that people go get those appointments and then upload those records, the quicker we can move through these phases and that we can open up different aspects of campus to everyone that wants to get access.
Anderson:
Lisa, back to you with a question about vaccinations. A viewer writes in to ask if they have a mild response to a shot, whether it’s the first or the second, and we’re all hearing these stories that the second dose of the vaccine can really knock you out. A viewer writes in to ask if they don’t have a severe or acute response to the first or second shot, does that mean that it’s not working or that they got a bad dose? How should people think about that?
Adams:
No, that’s a great question. I’m so glad that somebody asked that. Because yes, everybody who’s getting vaccinated is sharing their stories about how flat out they were after their second dose. And some people feel like if they didn’t have a bad reaction, something went wrong. And that is not the case. So let me be as reassuring as I can to say that not having a bad reaction after your first or your second dose, does not indicate anything about vaccine efficacy. When the trials were done, certain percentage of people had these intense local and systemic reactions after the vaccines and some didn’t, and all have the same level of protection provided.
So, it’s really not a measure that the vaccine failed or your immune system failed in responding to it. It really is not correlated in that way at all. So, there are reasons why some people’s immune system may react in a different way and make them feel more sick than others, related to age and sex and other pre-existing conditions. But really, we don’t think there’s any reason to believe that if you didn’t react that your vaccine didn’t take or that your immune system didn’t respond. I say, you just got lucky.
Anderson:
Josh, as we think about the coming months and particularly as we look to the fall and what we expect to be all returning to campus, how is the task force thinking about, how are you thinking about the return of employees? Do you think it’s going to be staggered? Do you think it’s going to be staggered by function, by a building location? How are you thinking about how we bring employees back to campus?
Keniston:
Yeah, it’s definitely going to be a transition period. Joe and Rick Mills, I think, had earlier talked about Sept. 1 is kind of the date we put out there for when most people can expect to start transitioning back. We think there will be some transition that happens during the summer out of necessity as we open more facilities up, as we get to higher level of vaccination, we will just need more people on campus to support our operations.
And that will be a good test for us. That will be a good experience to have some small numbers come back, make sure that we’re all used to the kind of systems that we used to just take for granted in terms of how they operate. And that will build throughout the summer. I think we will see in August another kind of uptick, there’s a lot of work that goes into preparing for students to arrive in the fall. And so, I think there will be another step we take there with some more folks coming back and then really that Sept.1 date, encouraging more folks to come back.
I’ll also just note that Rick Mills, I think in his town hall, noted, there’s also some conversations about those who maybe can continue to work from home. So, this isn’t kind of a flip the light switch approach. There’s definitely going to be steps we take along the way, and it will be responsive to what we need on campus. And also some one-on-one conversations that need to happen in certain areas as people rethink things that may be a little different in kind of a post-pandemic world.
Anderson:
Lisa, you in talking about the change in the guidance from the CDC on wearing a mask outdoors, you mentioned that Hanover, the town of Hanover has not modified its position on masking. So, a viewer writes in to ask, how do you reconcile all the various guidance, whether it’s from the CDC, or the state, or the town, how do you factor all those in to say, OK, yes, we’re going to change our guidance on wearing a mask outside, despite the fact that the state of New Hampshire says it’s OK, but Hanover, the town of Hanover, says please continue to wear masks. So how does the task force reconcile something like that, certainly in this instance, but I suspect this kind of thing is going to be happening a lot as we move forward over the course of the coming weeks and months.
Adams:
Absolutely. It already has happened a lot. And it’s been an issue that we have been trying to track and figure out which guidance we need to be holding to. We have always said that we will be looking towards national guidance, state guidance, local guidance, and we may choose to be more conservative, more restrictive given our congregate living setting.
So, we have always been balancing and trying to align. And, as you point out, state, federal, town guidance, don’t always align. So we have to take that into consideration as well. We certainly have good lines of communication and communication channels with the town of Hanover. And in general, our outdoor spaces, I think we are really beholden to what the town of Hanover mandates. So that’s sort of, I think, that’s a relatively easy one. And we work with the town of Hanover when there are instances where we think we might want to have a momentary deviation or an exception made because of a particular event such as graduation, that we’re going to be holding on campus.
So, I think what we try to do is look at the guidance coming out from the different sources. Again, we can never be more permissive than our state guidance, which is typically aligned with our town guidance. And then see if in fact we need to be more restrictive in some cases. And when guidance changes, we look to see how that, again, how that impacts, how do we apply that to our setting? So, it’s constantly, it’s really a large part of the work that we do when we’re setting a health and EPI policy.
Anderson:
Lisa, I’m going to stick with you for the last question. And it’s the last question because we are running out of time and because I have to get over to Thompson to get my second dose of the vaccine. So, we’re going to really have to be out of here by 4:30. The last question is about boosters. So, I’m getting my second dose today, which is fabulous. I’m grateful for that.
What are the chances that we’re all going to be needing booster shots six months from now, or four months or now, and will Dartmouth be able to provide booster shots just like they provide flu shots annually, and just like they’re providing, not just the tests, but also the vaccinations?
Adams:
Yeah. That’s another great question that I hear a lot. I would say at this point, we think that booster doses are likely in our future. The CEOs of both Pfizer and Moderna have stated that they anticipate boosters will be needed for their respective vaccines, but perhaps more importantly, our main authority on COVID, Dr. Tony Fauci, has also said this is likely to be the case. And I’ve heard it actually put this way that the question isn’t if we’ll need another shot, but when.
So, at this point, we do have good data to suggest that our vaccines provide at least six months of protection. And I stress the at least because we only have data going out that far. It’s probably likely that it’s going to be beyond six months, but we just haven’t been able to tell you due to the clinical trials to follow people for beyond six months and collect the data and do the analysis.
So, I think if we think about the flu shot is an annual vaccine that we’re used to getting on an annual basis, but then look at the other end of the spectrum where we see the tetanus shot, right? That’s something that you should get every 10 years. So, I think the COVID vaccine might fall somewhere in between there. It may be something that we get every year, every two or three years. And I certainly hope by over the summer, by the fall that we will be learning more about when booster shots might be needed.
I do know that the pharmaceutical companies are working on developing booster vaccines right now. And they’re actually trying to figure out if the best booster is the one that you got initially, or maybe combining, like the different platforms, maybe that’s going to be the way to provide optimal protection. So, there’s just a lot more information here as this very hot topic continues to evolve. And I do know that we hope that we will be able to provide COVID vaccines much in the way that we provide flu vaccines currently.
Anderson:
Thank you so much for that, Lisa. That was really helpful. And thank you and Josh for joining us again, on what I think Joe said was the 27th Community Conversations. Joe, I’m going to toss it back to you so that I can head over to Thompson.
And I’ll just leave you with, if you email me tonight or tomorrow morning, I might not respond as quickly as I usually do.
Helble:
You’re going to have a mild reaction, Justin, I can tell. And enjoy the second dose. So, Justin, thank you. Lisa and Josh, thanks as always for joining us. And I just want to end by commenting on something you said, Josh, just now in the Q&A, that struck me. You spoke about our decision-making process being focused on the status of the whole to define the state of campus operations. And I can’t stress enough as we make these decisions, we are really looking at the status of the community health. What we can do, not to preference individuals who may have had vaccination and can operate a little bit more freely but provide an environment that allows every student and employee to access activities and access their education in a comfortable and safe way.
The more we approach herd immunity, the more members of our community who are vaccinated and upload that information so that we can track the data, the more quickly we can move to reducing restrictions on operations for all.
So please, if you haven’t heard it enough in this hour, let me end by saying, I strongly encourage you to sign up for one of the Dartmouth vaccination clinics, get vaccinated next week, employee, student, or student family member alike. Upload the information and help us move much more quickly to a more open and engaging in-person summer session this year. Thanks very much. Stay healthy and stay safe, everyone. And I look forward to seeing you in two weeks.
