Joe Helble:
Welcome everyone to the 10th community conversation, addressing planning, response, and operations in the time of COVID-19. I’m Joe Helble, the provost of Dartmouth College joining you today from Dartmouth’s campus.
And I started today’s community conversation wearing a mask to make a point about something that’s going to be a very important component of today’s conversation. This simple step of wearing masks and what a centrally important role it’s going to play in enabling us to bring students back to campus this fall and do everything we can to ensure a successful start and a successful completion to a residential fall term.
I’m joined today as always by Justin Anderson, our vice president for communications who’s with us from another studio on campus. And today we are joined by two guests once again by Dr. Lisa Adams of the Geisel School of Medicine, the associate dean for global health, a professor and a specialist in the care and treatment of infectious diseases, including infectious tuberculosis, and as many of you know, co-chair of Dartmouth’s campus wide COVID-19 task force.
We’re also joined today by a distinguished alumnus from the healthcare sphere, Dr. Marty Cetron, MD, a member of the Dartmouth Class of 1981. Marty is the current director for the Division of Global Migration and Quarantine at the CDC the U.S. Centers for Disease Control and Prevention. In addition to his 28 years with the CDC, Dr. Citron holds faculty appointments in the division of infectious disease at the Emory University School of Medicine, and in the Department of Epidemiology at the Roland School of Public Health. Marty is here in his capacity as an alumnus and as a member of the Dickey Center board and is not officially representing CDC.
Following our normal format today with the campus update, live Q and A moderated by Justin, we’ll have a conversation with campus leaders and an opportunity for them to answer your questions directly from the audience as well.
Now, today, in our update I’d like to briefly discuss some of the recent news that we’ve rolled out and some of the decisions that we’ve made, including updates on fall term residential housing assignments for undergraduate students, testing protocols and the transition period, and the importance of those first 14 days when students return to campus. That’s an area where things like masks again become critically important. And we’ll also speak a bit about the on-campus opportunities this fall, as we anticipate them based on information that we have available today.
So let me start immediately with the discussion of term assignments, which is something that has been very much on the minds of our undergraduate student community over the past few weeks. As our undergraduate students know over the past several days, Dean Lively has sent out several important updates to the Dartmouth community regarding student term assignments. What I’d like to do is just briefly review those for the broader Dartmouth community listening today, who may not be aware of some of the details of the plan. And then comment briefly on some of the questions that have arisen.
Dean Lively herself will be joining us for the next community conversation on Aug. 19. And we’ll use that time with her to speak in much more detail about some of the questions that we know are on your minds, particularly questions that we’ve been hearing from returning students and from parents. So please join us on Aug. 19 for a more detailed discussion of those topics now at a high level.
Over the course of spring term, as we considered our options for fall term and for the upcoming academic year, both President Hanlon and I, as I have said often, frequently noted our goal of supporting the maximum number of students that we could return to campus, guided first and foremost by the application of appropriate public health standards. And all along decisions were informed by input and recommendation from federal guidance and state of New Hampshire guidance, by the progression of the pandemic itself, both locally and also across the country and the world, and the work of our task force and several working groups that we’ve described in these sessions before, looking at operational health and academic questions. And in fact, we’ve had many of the leaders of those efforts with us in prior community conversations.
The plan we announced on June 29, as you all know, was by intention, an integrated full year solution carrying us through summer term of 2021. It’s a solution that gives all undergraduate students the chance to be here residentially for part of their education, but not all at the same time.
As promised first year, students will be treated as a cohort and thus have the same residential terms with one another in the fall and the spring of this academic year. The ’21s, ’22s, and ’23s were each given priority for one specific academic term, which means that students in those class years expressing a preference for that term will in fact, be given priority over all other class years for the term.
That plan gave us the ability to give guarantee every student right now at least one specific residential term and gave every student the opportunity to express a preference for their second residential term. Structured this way it allows us to de-densify the campus, an important consideration in managing collective community health, with approximately 50% of our undergraduate student community and residents at any one time assuming current conditions continue over the course of fall term.
So where are we today? As Dean Lively announced in her recent emails over the course of the past week, we received responses from the vast majority of our undergraduates. And in fact, 96% of them submitted the information we had requested, which is worthy of noting both as a thank you to our students for being so responsive and submitting the information and to our colleagues in student affairs and in the office of institutional research for creating and managing a complicated process in an extraordinarily tight timeframe.
So, where did that bring us? Where did we all land? For the fall term this year all students in the classes of ’22, and ’24, in other words, all of the entering first year students and all of the juniors, plus all incoming transfer students who confirmed their interest in fall term were in fact approved to be here for in-person education this fall. All other continuing students from other classes who also listed fall as their first choice have been approved for fall term residential accommodation.
All told with this plan, we expect to have 2,300 undergraduate students on campus this fall, a number of the de-densifies our residential communities in ways that help support social distancing and provide buffering capacity in the system if students need to be quarantined or isolated because of illness during the fall term. This residential and operating plan was designed with this buffering capacity intentionally as a way of increasing the probability that we can navigate the fall term successfully for all.
But doing so navigating the fall term successfully means that we are asking for the engagement and support of all members of our residential community. And that means students, faculty, and staff alike, to enable us to launch and navigate the term successfully and to completion and to launch the fall term as a community that truly looks out for one another.
That means we’re going to be asking our community to join us in taking actions that depart from our normal way of operating in a normal year. For example, that means we’re going to stagger arrival times over a six-day period the week before classes begin. Students will receive information on assigned arrival time, along with housing assignments and important health and facilities information the week of Aug. 16. That also means we’re asking our students to travel the campus without family or friends, if that is at all possible. Or to be simply dropped off by family or friends, if they must accompany you without them getting out with you and walking the campus.
I know and we all know that this is a particularly difficult request to make of our new students whose families may be visiting the Upper Valley for the first time. And if you must be accompanied by a family member or friend, we ask, in fact, we insist that you observe proper social distancing, wear face protection at all times while on campus and remain outdoors. These steps while they may sound significant and unusual are absolutely essential to supporting and promoting community health and enabling us once again, to get the fall term off to a successful start for all.
In terms of the remainder of the academic year, all those students who listed winter as their first choice have in fact been approved for winter term residency. Some students, but not all, who listed winter as a second-choice preference have already been accommodated. For spring term all first-year students in the Class of ’24s and all seniors, all ’21s, who requested on campus enrollment for spring term have in fact been granted it. And finally, all rising sophomores, the members of the class of ’23, who requested summer term have in fact been approved. In addition, all ’22s and others who requested summer as their first have also been approved.
Now we’ve already received questions from some of those students who received confirmation for one term, but not two. As we said at the beginning and as I’ve said frequently, it was our intention to offer all students to have the opportunity to be on campus for two terms this academic year. This remains our intention. Nothing has changed.
So, you may ask why not simply assign all students to terms now, regardless of their preferences. The answer is that we are in fact trying to accommodate preferences as best as we can and trying to address the challenges of supply and demand. Students have the flexibility to decline an assignment for fall term, which may open some spaces to a wait list process as Dean Lively has indicated. In addition, the visa situation for many of our international students remains challenging and, in some ways, more uncertain than it did when we devised this plan just two months ago and we’d like to retain some flexibility to accommodate they and other students with particular and challenging needs.
The number of students who wish to be here during spring nearly exceeds the number of spaces right now. Again, this is a question of supply and demand. And summer like winter was not heavily requested and yet offers the highest probability for a potential return to normal operations, which means we could potentially accommodate a larger number of students in that term at that time.
For that reason, I hope you can understand why we are taking a little bit more time to work through the assignments of second terms for those students who have not yet received them. Simply put we’re asking for your patience.
We’ll have more information about fall term capacity in the coming week. And we may be able to accommodate more students at that time. We’ll have a better picture of our international student situation in about a month. And with that information early in fall term, we anticipate finalizing assignments for winter term, and then subsequently during winter break finalizing plans for spring.
Now, would we like to do this sooner? Absolutely. Do we know the lack of specificity is difficult? Yes, absolutely. But I hope we’ve all seen the impossibility of forecasting conditions two months out in the progression of this disease, never mind six or nine months ahead. And for that reason, as we have done all along, we are making our decisions and making these assignments thoughtfully, doing as much as we can to accommodate student preferences and reflect changing information on the ground to support student choice.
I’d also like to take a few minutes to speak about our plan testing protocols in quarantine planning, or more specifically the plan that we have developed and are putting in place for the first 14 days of arrival for students when they come back to campus this fall. A related question on the minds of many is the plan for testing. And that’s something that perhaps one or both of our guests can comment on in more detail in just a few minutes later in this conversation.
Now for our student community, we’re developing plans for pre and post arrival testing for undergraduate students returning to campus, and those graduate students who are not yet here and will be arriving on or after Sept. 1. First, we’ll be asking all of our returning domestic students to undergo pre-arrival testing, which Dartmouth will arrange and coordinate. This pre-arrival testing will help identify any students who may be ill prior to travel, prior to return to Dartmouth, enabling them to isolate at home and helping the community by reducing the baseline level of positive tests upon arrival.
An email with specific instructions will be sent to each returning student living domestically regarding these arrangements in the plan several weeks before their expected arrival date back on campus and it will provide the details. Now it’s understood, of course that international students will be unable to participate in this process due to logistics. And those students living outside of the U.S. will be exempt from this requirement before returning to campus.
Now like many of our peer institutions, Dartmouth will also be testing students frequently once they arrive on campus. We’ve partnered with the Broad Institute to test students on days zero, day three and day seven of their return to campus. Test samples will be collected at Dick’s House in a coordinated fashion and more information on the specific plan approach and expectations will be forthcoming for those students enrolled in fall term later in the month of August.
Once students arrive on campus, they’ll begin what I am calling the initial 14-day period, which is effectively a type of self-quarantine. During this time, particularly during the first 48 hours, we will be asking our students to remain self-quarantined in their rooms. If they receive a negative first test, they will then be permitted to go pick food up at DDS during specified times and spend some time outside alone on the Hanover campus. After students receive a subsequent negative test on their third day on campus, they will have more flexibility and freedom, and be able to participate in some organized group outdoor activities. Those activities will expand dramatically after a third consecutive negative test on day seven. After day 14, assuming a student has not developed any symptoms, the initial 14 day transition period will end, and students will have the ability to join organized small group gatherings, have access to all facilities that are open on campus, with the important caveat that this has to be done again with masks, with appropriate social distancing protocols being followed even outdoors.
I cannot stress enough to our entire community, and particularly to our students, that this initial two-week period is essential to giving all of our community confidence that we can manage this together. It is essential to permitting a full term that allows those students here in residence to enjoy the full residential experience that we can offer under these constrained circumstances. It is essential to assuring our community, including the greater Hanover community, that we are prepared for and can manage through successive terms here in Hanover until a vaccine is developed and deployed.
In addition to this initial testing, Dartmouth will continue to partner with the Dartmouth-Hitchcock Medical Center to conduct tests of any students exhibiting COVID-19-related systems, and we’ll be also partnering with them on some additional surveillance testing throughout the fall term. Finally, to ensure the safety of the entire Dartmouth community, as students begin returning to campus, all employees who are student-facing and working on-site, or approved to return to work on-site, will also be required to undergo testing. Details on this will be announced later this month.
Remember that a lower undertaking of comprehensive testing program, we are asking students, faculty, and staff alike to adhere to all other policies regarding the reduction of COVID-19 transmission, such as but not limited to: hand washing, again the importance of face coverings, completion of the daily screening for employees, and physical distancing.
Let me just take a few minutes in closing to speak about the academic program for those of you who will be here on campus this fall. As many of you know, the fall course selection process opened on Monday and will run to Tuesday, Aug. 11. Dartmouth will be offering a range of courses that stand from the sciences, to the social sciences, to the humanities, both in person and with more courses being hybrid and having in-person options for those students who will be present on campus. As we have stated previously, the majority of courses this fall term, this first term in hybrid operation, will in fact be offered by a remote learning, whether students are physically present here in Hanover, or learning by distance from another geographic location.
In total, Dartmouth is offering 828 course selections this coming term. Of those, counting independent study courses, if all were to have an in-person component, the caveat being that we know students who are not on campus will also register for independent study, the number in the catalog with on-campus elements is 139, a little under 20%. If we combine this number with other courses where faculty have said that if the term gets off to a successful start, and again this comes back to the importance of our collaboratively and collectively navigating that critical first 14-day period together, successfully as a community, faculty have said they anticipate offering things like office hours outdoors or in large room, or meeting on the green in small groups, or gathering small groups for a discussion over a cup of coffee. Adding those in, approximately 30% of our courses may have some in-person component.
While I cannot promise, knowing our faculty, I do believe that their commitment to our students is such that if we move through September successfully, and if our community truly adheres to the protocols we put in place to protect community health, the opportunities for our faculty to engage in person with students who are here will only grow. There is so much more on this than I can say. Over the course of the past month, I’ve engaged with the directors of our interdisciplinary centers and institutes and asked them for their plans to engage students outside the classroom in both remote intellectual and educational experiences, and in in-person educational experiences. The responses that I have gotten from the center and institute directors is spectacular.
In the interest of time, I can only mention a few, and I hope I’ll be able to come back to this in a more full way in two weeks when we meet again. But from the Hood Museum, which is developing plans to offer guided, self-guided or activity-driven visits to the galleries, or even to single rooms, for small groups of friends, teams, class or classes; to the Hop, which is building a small screen fun series exploring the craft of filmmaking through live virtual conversations with guest artists and students, some of them having an in-person discussion component, and including notable alumni, like CNN anchor, Jake Tapper, and filmmakers, Phil Lord and Chris Miller.
Or for the Magnuson Center for Entrepreneurship, initiating a program called Stand with Small Business, where student teams will provide rapid support and creative ideas to impacted small businesses in the Hanover area. Or the Rockefeller Center, and their tradition in a traditional presidential election year, to host gatherings to watch the results come in live. This year, Rocky plans to host several small in-person gatherings that will be live streamed to the greater Dartmouth community.
Or the Rassias Center for the Study of Language, which is planning Tent Talks, gathering small groups of students on the Green to watch movies. Or pop-up activities in sustainability and energy, coordinated between the Irving Institute for Energy and Society, and our Sustainability Center. These are just a small sampling of the exciting opportunities that will be present for those students here on campus this fall. More to follow on this as the start of term approaches and details develop.
Let me simply end now in the interest of time, as I often have in these conversations, by truly saying thank you to the members of this community. From how we work with one another, to how we spend our spare time, to how we communicate, this is not how I nor any of us envisioned our lives this year. When I think back on the conversation in February that I had with Josh Keniston and Lisa Adams, a conversation that led to the formal structuring of our COVID-19 Task Force, and what we anticipated as their work at that time and think about where we are today, there are no adequate adjectives to describe it.
Unprecedented seems trite, but it is so incredibly accurate. Against that backdrop, as I look around at this community as the faculty and staff collaborate, as I look at the town of Hanover and Dartmouth-Hitchcock Medical Center, both of whom working with us in partnership to find a path forward. As I see our students and their passion and energy around their education, and the desire to be in Hanover, it is absolutely nothing short of stunning and inspiring.
Thank you to all of you for continuing to engage as we approach the start of fall term and make this the start of a new year unlike any other. With that, I’ll turn it over to Justin. I’d be happy to take just a few questions, and then I’d like to turn it to our two distinguished guests for a discussion of some of the testing, and sampling, and surveillance protocols that we described. Justin?
Justin Anderson:
Thank you, Joe. Truly very nice to see you today. We’ve got a bunch of questions that have already come in. I think I’m going to start with a question that is, just as you started, wearing a mask. This is a question about masks. How is Dartmouth going to enforce COVID-19 safety precautions among students, specifically the wearing of masks and physical distancing?
Joe Helble:
Right. A general answer, Justin, and that’s a really good question, and that’s one that some members of the greater Hanover and Norwich communities have asked me. We are going to be asking our students to sign essentially a community compact, a statement of community expectations, that affirms their willingness to adhere to the community standards, which include social distancing, and the wearing of masks in public settings. The town of Hanover has partnered with us in this. The town of Hanover, as those you here in the community have noticed, has put up signs all around the green and downtown saying that the wearing of masks is expected in this part of the community.
We are going to be working our students and working with our student advisory group to find the most effective way to encourage that, and also to address questions where we see individuals who may not be adhering to the mask expectation, the mask policy, in ways that we need them to. This really is a matter of community health. This really is a matter of protecting one another. As I think our guests later can tell us, there are also signs and emerging studies that wearing a mask protects not just the “other” but protects the wearer as well. As an aerosol scientist, that makes perfect sense to me, and I’m thrilled to see the research coming out in support of that.
Let’s take that question again when we have Marty and Lisa with us. But I will say that part of our expectation for our student community is that they will adhere to these community standards, to enable us to navigate the full term successfully, to enable us to remain open, and enable their fellow students to complete their education, and to ensure that we can in fact open the way we hope and intend to in the winter term.
Anderson:
Joe, during your introductory remarks when you were discussing the testing that we will do, you mentioned testing on day zero, three and seven. A viewer writes in to ask, will the results of tests be made publicly available? And then, does Dartmouth have a threshold number of cases that would cause us to re-evaluate our residential plans?
Helble:
Right. Let me take both of those questions briefly, Justin. Then I say hereto, these would be good questions to put to Lisa Adams in particular as well. We do have plans to monitor over the course of the fall. We do have plans to share aggregated data with the community in some way. How exactly that data will be shared has not been finalized, but I think Lisa might have a thing or two more that she can say on that. That will certainly be clear by the time the term starts. In terms of a threshold, we do not have a strict numerical threshold because it depends upon so many things, Justin.
It depends on what’s happening in the broader community around us. It depends on what’s happening nationally. It depends upon whether we have the capacity to treat all the students who need to be treated in Dick’s House, or in Dartmouth-Hitchcock Medical Center at the time that we are seeing infection. It depends upon whether we have adequate space for quarantine, and we can act quickly to isolate the number of cases in presumed immediate contacts. There is not a number per se, but we will be monitoring and modeling throughout the course of the fall time, recognizing that there may come a point where if things are pointing in a certain direction, we may need to make a decision to cease operations residentially and send students home.
This is the scenario that no college or university wants to encounter. Here, I will say particularly to those who ask why we weren’t more aggressive in developing an opening plan for the fall and bringing more students back, we very intentionally made a plan to de-densify the campus, and keep our student residential population at 50% to maximize the chances that we can navigate the fall term successfully, and handle some cases, some incidents and disease on campus without needing to shut down.
Anderson:
Joe, this is something that I know we’ve talked about before. It’s a good question, so I’m going to put it to you today. If the vast majority of students will be learning remotely in the fall, even those on campus, what are the advantages of having students and residents? How do those outweigh the high risk of introducing the virus to a vulnerable Upper Valley community that has thus far been quite successful or lucky at avoiding outbreaks?
Helble:
Luck is always involved, Justin, but I also firmly believe that we have been successful. When you look at the steps that Dartmouth-Hitchcock has taken, when you look at the education that’s happened here in the community locally, when you look at the steps that the governors of New Hampshire and Vermont have taken, when you look at the strong encouragement from the beginning to wear a mask, socially distance, restrictions on travel that were put in place by the governors of both states, and the idea that certain businesses would be shut down, including many dining establishments and bars beyond the point where they were shut down in other communities, all of those things helped tremendously in stemming the increase in the disease.
If you look at per capita rates in the country, we along with Maine and other parts of northern New England, are among the lowest incidents, regions for disease on a per capita basis in the country. We are asking our students to recognize this as they move back. We are asking them to be parts of this broader Upper Valley community. We are asking them, and in fact expecting them, and have protocols in place to take them to task if they do not adhere to the community expectations that we put in place. We don’t want it to be a punitive and disciplinary process. We do have sanctions for violating the terms. But we are really asking them to recognize that failure to adhere to these protocols, which would lead to an increase in incidents and disease, jeopardizes everything for the rest of their classmates throughout the course of the fall and into the winter and beyond.
We are being as careful and as thoughtful as we can. Again, operating with a lower student residential population on campus is something that gives us more confidence in being able to navigate successfully, but this has really got to be a collaborative community effort if we’re going to be able to succeed.
Anderson:
Joe, we have time for one more question before we go to our distinguished guests today. This question is sort of related to where you just ended that last question, and it’s about what a couple of different viewers have written in to say as the expectation that there’s going to be many more undergraduate students living off campus this year. There’s a number of questions about how we will be testing and monitoring the behavior that we are expecting for on-campus students, how that’s going to translate to what’s expected to be a larger number of students living off campus this fall.
Helble:
Our plans, Justin, and this would be a very good question to discuss in detail when Kathryn Lively’s with us in two weeks, but at a high level our plan for students on campus this fall anticipates a certain number of students who will be living in off-campus housing. I want to distinguish between those who are authorized for a residential term and those who will be living in residential housing. To be here this fall, and participate in residential education on campus, and to use the campus facilities, students have to be approved for residential education this fall. They are not required to live in on-campus housing, but if they live in off-campus housing they are expected to undergo the same testing and protocols and follow all the same standards of those students who have chosen to live in residential housing. So, the community expectations are the same. You need to be approved for a residential term, whether or not you are living physically on campus, to be able to participate in residential education. Again, it is a direct request to the student community to work with us. It is more important now than ever.
So, one of the things that Kathryn Lively, Dean Lively, has been working with a student advisory board that she’s set up, how can we most effectively communicate that information and importance to and collaborate with students and student leaders to make this successful? So, it is in our hands. I am so confident that the Dartmouth community has the will, the desire, the maturity, and the intellect to make this happen. But we have to make it a priority if we’re going to be successful.
So, thanks for that question, and certainly more to continue on that point, particularly when Kathryn’s with us in two weeks. So thank you all for those questions, and what I’d like to do, as Justin indicated, is now bring our two guests into the conversation to join us, Dr. Marty Cetron, a member of the Dartmouth Class of 1981, member of the Dickey Center Board of Advisors for many years, and an expert in global infectious disease here in his capacity as an alumnus, and Dr. Lisa Adams, who’s joined us a few times before, co-chair of our COVID-19 task force and also an infectious disease specialist. So, Marty, Lisa, good to see you onscreen, and thanks so much for joining us.
So, Marty, if you don’t mind, I’d like to start with you, and it’s a big picture question that I think certainly would be of interest to me and many of our viewers. If we think back to mid-March, when states were just starting to impose work at home restrictions and colleges and universities like Dartmouth were beginning to make decisions to send students home, I looked at the numbers, and I know the numbers well. The total number of confirmed cases in the U.S. was roughly 10,000 at that time, and that really seems like the innocent days of the past in comparison. Here we are not five months later, and we’ve pushed past 4.75 million cases in the United States. What have we learned about containing this outbreak, what do we know now that we didn’t know at the start of the year, and how can we utilize that to plan accordingly and appropriately for what lies ahead?
Marty Cetron:
Thanks. First, thanks for having me, but thanks for giving me an opportunity to weigh in on such a critical question. As an infectious disease specialist and public health practitioner, we think about these types of outbreaks along three dimensions, the dimension of the pathogen, the dimension of the host, or the people that are infected, and the milieu, or the social context in which the epidemic is occurring. So, let me just say a few things about each of those and what we know now that was not quite clear at the beginning.
With regard to the pathogen, some things are very strikingly apparent now. One is that this is not influenza. In fact, it’s not even a traditional respiratory-type infection, in that the infection really attaches to the receptors on blood vessels, and blood vessels serve all the organs of the body. So, we’re seeing all sorts of different manifestations of the infection. It’s much more serious than influenza, and we don’t have the kinds of countermeasures in antivirals or in a preventative vaccine.
But there was a lot of talk about how this compared to flu, seasonal flu or even a pandemic strain of flu. Even though it’s called SARS-CoV-2 and the genetics put it in the SARS family, this pathogen is behaving very differently than SARS-1, which had just a several month duration and capped itself at a much smaller number of cases globally, 800 or so, or 8,000 with 800 deaths. I think SARS-CoV is fundamentally different in a lot of ways that have become much more clear.
The Achilles heel for this pathogen, in my perspective, is the fact that there is a lot of asymptomatic and pre-symptomatic infection, where people don’t even know they’re sick or infected and thus don’t have the benefit of taking the kinds of precautions that we recommend, which is stay home when you’re sick and contact trace and find the contacts. It’s estimated that up to 40% and in some settings more of the infections are [inaudible]. So, this is an insidious virus, where we can’t see it. It’s invisible, and it’s problematic because we don’t know who’s infected and who’s not.
Another thing we’ve learned is not only can there be asymptomatic and pre-symptomatic infection, but the viral loads at the very beginning in this phase are among the highest. So, people are most contagious in this asymptomatic, pre-symptomatic, and maybe the first few days afterwards. This is in contrast to other infections which become more contagious as people progress in their illness and get sicker. Ebola is an obvious example, which means that while you don’t even know you have it, you might be the most likely at a time when you’re spreading. So, the viral load being very high early and contagious, people being high before they recognize they’re sick, if they ever get sick at all, is really something we’ve learned.
The other Achilles heel, I would say, is the appreciation of fast math, what exponential growth really means in terms of spread, and that is if you don’t stay in front of it and act early and chase the virus at its early indications of its presence in your community, the virus will always be chasing you in overwhelming numbers with unbelievable doubling times in the community so that it’s very difficult to control and get ahead of it once it’s escaped your reach. So fast math means people have to act early. Insidious virus means you have to be looking at something you can’t see with very effective tools, whether they’re tests or other means that we’re going to figure out where the viral is. But we need to know and be able to see the virus in different, untraditional ways.
In terms of the host, we have two different challenges. We have the vulnerability to infection and then the vulnerability to bad outcomes, severe disease. We have learned a lot more about who’s most at risk for severe disease, whether it’s by age or underlying health, but the vulnerability to infection and who’s transmitting is still something that we’re beginning to tease out. The transmitters may not necessarily be the ones that are most obviously sick and late. In fact, most spread from person to person is occurring before people are even really diagnosed.
Finally, we’ve learned more and more about the way in which it’s spread and the ability, the potential ability for small aerosols to actually create super spreading events in that regard. Witness the asymptomatic choir singer who comes to a practice with others in the choir and is able to spread efficiently over a long distance simply by singing. We’ve learned now that the act of speaking and singing, and you don’t have to be sick and coughing in order to spread these viral particles.
This is what led to our understanding about the importance of the role of face masks as source control. It protects me from spreading the virus to somebody else. It’s an act of civic responsibility. But it also has some level of protection for me from the particles that other people may be spreading, and if everybody’s wearing it, we get a very powerful collective impact. So, our understanding of the potential role of face masks in curbing transmission has really evolved over the course of the outbreak.
Finally, the milieu or the context, we clearly know that there are super spreading events, perhaps even more than super spreading people, but closed indoor spaces tend to be the highest risk. Sort of my algorithm is thinking about four axises, time and space, person and place, and each of those four things will allow you to estimate your risk in a setting. But we’ve really learned how important being outdoors, allowing for the UV light and the virus to dissipate, rather than be concentrating in small areas.
So those are some of the things that we’ve seen now, and we’ve learned these lessons repeatedly not just across the United States, but also across the globe as we’ve watched how quickly this virus can spread and really be both insidious, fast math, and have high consequence for multiple different severe morbidity and mortality, even outside of the respiratory tract, strokes and clotting disorders and kidney problems, et cetera. So, we’ve learned a lot, and we’ve been humbled quite a bit. Even though it was a virus which genetically looked like something we’ve seen before, it’s behaved in a very different way.
Which is what makes your work so fascinating and means every new infection, every new viral agent is going to present its own set of challenges, no matter how much it looks like the ones before. I have to say before I turn to Lisa with a question, one of my very first graduate students ever after living in the US for many years returned to his native China, and he and I were in touch in late January, early February, just talking about progression of the disease there. I remember so clearly, he sent me an email saying, “Joe, you need to get everyone to wear masks.” He said, “This is going to be so culturally difficult for the U.S., but when they were mandated in China and we implemented them by edict across the board, you saw the infection rates plummet. So, I worry for you, because I know how hard this is going to be in the United States.” That was certainly a prescient comment.
So, Lisa, let me turn to you now and build on what Marty just said. Marty gave us a good sense of the big picture and how the disease is progressing, the challenges associated with it. How do you and the task force and you, an infectious disease expert, think about translating that to decisions that we need to make here on campus or recommendations you need to make to me for decisions on campus? We’ve come up with a testing protocol that now has pre-arrival testing and tests three times in the first week, plus surveillance testing over the term. Why?
Lisa Adams:
Well, thanks, Joe. I’m happy to provide some updates on testing. This remains a rapidly evolving space as testing availability, test features, and information from our modeling continues to emerge. You’ve already talked about the pre-arrival, so I’m going to focus on the on-campus testing that we will do.
First let me share the good news that our college health services has begun testing our newly arriving graduate professional students. They began last week with some newly arriving Geisel students and then this week with newly arriving Tuck and some current Guarini students, and they now have tested over 200 students. So far, no one has tested positive.
So, let me explain why our testing schedule is so rigorous at the start of the term. It really builds on a lot of what Marty was saying and things that you’ve highlighted as well. As we know, we’re in a low-risk area. At this point, we have essentially limited or no community transmission in the area, and we know that travel is a recognized risk factor associated with COVID transmission. So that highest risk period for the virus to be introduced into our community is when there are newly arriving in groups, in this case, our students into the Upper Valley community.
So being able to identify and act quickly and early to identify anyone who may have been infected, either in their home community before they left or during their travel to campus, is really critical. It’s based on the two factors that Marty just pointed out, that people are most infectious early in their infection, those initial days after they become infected, and that real Achilles heel, that insidious feature of the virus, meaning that there’s asymptomatic and pre-symptomatic transmission and that high rate, up to 40%, of disease being asymptomatic.
So, our rationale for day zero, three in testing is based on the fact that those first couple of weeks are so critical. So, day zero testing will allow us to capture anyone who may have been incubating the virus before they left their home destination and they come to campus. The day three testing’s important because it allows us to capture anyone who is still incubating virus on day zero when they were tested because they were either infected right before they departed or maybe at the beginning of their travel. The day seven testing allows us to capture those who may be on the later side of incubating the disease, potentially infected, again, during their travel to campus. So, this rigorous schedule allows us to quickly isolate someone if they convert to a positive test, which is important for halting further transmission.
I just want to point out one or two other things, and that is that isolation, although it sounds like a harsh term, it’s not meant to be a punishment. People may be infected not due to any fault of their own, but due to exposure with someone who perhaps wasn’t as careful or fastidious as they were. So, I want to kind of remove that stigma from the term at the start. Isolation really allows the ill person to get the attention that they need and, in this case, to make sure they have access here on campus to a single room and private use bathroom and, of course, for us to be able to protect those around them.
That initial two-week period will be so important. As you mentioned, we’ll have increasing outdoor time in place. If someone is able to move from negative testings at day zero, day three, and day seven, but recall that the New Hampshire Health Department Guidance doesn’t allow testing to actually end that quarantine, that early monitoring period early, and that people still can be incubating. The incubation period is 14 days, so people still can be incubating as late as 7 to 14 days, but with each successive negative test, there is greater reassurance that someone is uninfected.
Helble:
Great. So, Lisa, let me just ask you a couple of quick follow-up questions about logistics. Then I want to turn to Marty for one last question before we open it up with Justin. What can you tell us about the mechanics? So, I know details are still being finalized, but something that’s on the minds of a lot of people, can you tell us the method of sample collection?
Adams:
Sure, and this is another area within diagnostic testing that’s quickly moving. The good news that I can share here is that we will be using a technique to collect and are using a technique to collect samples from the anterior nares, the front part of the nose, and not using that very deep and uncomfortable nasopharyngeal swab. Anybody out there who’s had it done knows it is not a pleasant experience. But the anterior nares specimen collection now has FDA emergency approval, so that’s a great step forward to making testing more accessible and acceptable.
The other good news is that we are hopeful that by the time we are testing our undergraduates who are arriving that self-collection of specimens, where a student swabs their own nose, will have that FDA emergency approval and something that we can do for the day three and day seven testing.
Now, our partner, Dartmouth-Hitchcock Medical Center, is using the nasopharyngeal swab collection. But, as I said, this is a quickly evolving space, and we are certainly committed to using, whenever possible, the least invasive method for specimen collection that is scientifically validated and proven and available in our community.
Helble:
That’s great. I’m sure the students will appreciate that. I can say personally I think many members of the faculty and staff will appreciate that. So, one last question, Lisa, and then I want to turn back to Marty. What does happen if someone tests positive? How do the students get their results, and what do we do with them?
Adams:
Yeah. So, a great question. So, if a student tests negative, they will be contacted by email from our testing vendor, the Broad Institute that you mentioned, to be able to access their result via a secure patient portal. Now, if a student tests positive, our college health services, which for our students is the ordering clinical provider, they’ll receive that information. In that case, the student will get a phone call from a clinician to talk about the test results and next steps, with the focus on how to ensure that they can safely isolate themselves, whether that involves moving onto a separate on-campus designated space or whether they can do so safely in their off campus residence. In addition, whenever anyone tests positive, the New Hampshire Health Department will also be in touch with the student as part of their state lead contact investigation process. And our college health services has been doing a great job of following up to check in with students on a regular basis, to see how they’re doing during the time that they have to be isolated. So, I want to emphasize that this is a very hands on process. And I want to remind everyone that following up on individuals who have an infectious disease and preventing spread in the community, is a long-standing public health practice.
This is something I was closely involved with for individuals diagnosed with tuberculosis when I was the director of surveillance for the TB Control Bureau in New York City. And so, this is well within a health department’s area of expertise and really part of their usual activities. So, I think it’s important to remember while this is a new disease, the work of following those who have infection, and who are in isolation, and those who are identified as close contacts, is a very familiar practice for our public health system.
Helble:
Great. Thank you, Lisa. So Marty, let me turn back to you and I’m going to ask you in the interest of time if you can answer a big question with a very short answer, so we can turn to the audience who wants to speak with both of you. And it’s probably too early to ask this question, but I’m going to ask it anyway. So, what have we learned that should enable us to respond differently with more alacrity to the next pandemic?
Cetron:
Mm-hmm (affirmative), great question. I’m always cautious about using the term lessons learned, I know it’s quite popular, I prefer to say, lessons observed. History will tell us whether we’ve learned these lessons. Because in fact, some historical work about the 1918 pandemic at the turn of the century, revealed many of the lessons that we’re experiencing right now. It’s also quite clear that those lessons haven’t necessarily been learned a century later. We go back in the archives, they were studied, they were reported, in fact, the framework for response is based on some lessons observed from history learned, I think we have to wait for the test of time. But I will say some that are quite clear. One is, that we need to have tremendous amount of humility and respect for the power of Mother Nature in evolving pathogens. These pathogens emerge and as soon as we genetically identify them and characterize them, we put them in a box, and we think we understand them.
But remember, this virus has probably only been on the planet in humans certainly less than a year to our knowledge, and it doesn’t behave like we might expect. And in combination with the tremendous power of denial, in terms of looking for the more favorable explanation of events, which is quite common, we have to work very hard to keep our denial blinders off and keep our minds open to the uncertainty. We need to be much more flexible and recognize that there’s a lot of uncertainty and there’s a lot to learn. And imprecision and uncertainty does not necessarily mean the counterfactual is true, it just means that we have to be open. And so, another lesson observed, I think, is the importance of dispelling the myths of false truths, or in today’s lexicon, fake news, and that we have to be very careful.
Technical expertise is necessary, but insufficient to control an epidemic of this magnitude. And we really are at the mercy of the viral numbers and the human brain and ingenuity. And what we need is a unified effort that ... This sort of diamond of the interest and perspective in the lens of science and public health, which is absolutely critical, it can’t be dismissed. The appreciation of the economic lens of the virus and how it’s affecting society is also critical. The importance of political leadership. And the absolute importance of regular community engagement to test understanding. And all of this successful control of a virus like this, a global pandemic, requires a full bank account of trust in all of these institutions, in all these ways, an alignment of messaging.
Helble:
[cross-talk]
Cetron:
And if there’s a bankruptcy of trust, it can be really tough. So, I would say, to end with Stephen Hawking’s quote here, that the enemy of knowledge is not ignorance, it’s in fact, the illusion of knowledge, this pandemic has made that crystal clear in spades.
Helble:
All right. Thank you, Marty, that’s a thoughtful observation. And one of the things I would add as I’ve watched this and how we’ve developed as a country over the past six months, clear, consistent, and coordinated, communication is something that we can arguably have opportunity to do better the next time around. And it’s absolutely essential in managing this and getting everyone on the same page and trusting one another, as you pointed out, trusting the scientific information. We have about five to seven minutes left; I want to make sure we give our viewers chances to ask at least a few questions to the two of you. So, Justin, I’m going to turn it back to you. And in the interest of time, Lisa and Marty, I’ll ask you to be really concise in the answers so we can get to more than one or two questions.
Anderson:
Thanks, Joe. And I’d like to start with you, Marty. A questioner asks, it’s actually a based on an observation with outbreaks raging across the country right now and what seems like increasingly long wait time for test results, how does Dartmouth not risk bringing the infection into the Upper Valley as students return? Now, that’s obviously a Dartmouth specific question, but I suspect that’s the same question that colleges and universities across the country are asking right now.
Helble:
Yeah. The Dartmouth strategy is very well thought out. It includes all three really critical pillars, prevention, detection, and response. I think that prevention and the three W’s that we mentioned, wear a mask, watch your distance, and wash your hands, that’s going to go a long way. Detection, having a vigorous surveillance and testing program, so that you can know where the virus is at the moment it emerges on campus. We are starting at a very low point in the Upper Valley, and in fact, in New England in general, probably some of the best places to be right now in the country in that regard. And having a response plan that is thoughtful, not only to take the early surveillance but to have a very effective means for isolating those cases, contact tracing quickly, having a place to conduct that and snuff it out.
The strategy involves pre-arrival activities, date of arrival activities, essentially to create a safe bubble. And then throughout the semester, this type of vigilance in understanding what’s going on and having a number of contingency plans. I think it’s a really good strategy, the questioner is right to say, “There’s a lot of virus all over the country right now,” but these are exactly the kind of tools that would be needed to try to give this a good chance of success. Ultimately, it will totally depend on the civic responsibility and the cohesiveness of a community, to recognize that what we do as individuals is an absolutely essential component to protecting the beautiful space and this sort of bubble of low virus transmission on campus and in the Upper Valley.
Anderson:
Lisa, we’ve talked a lot today about testing particularly on days zero, three, and seven. Questionnaires are asking, number one, what happens if there is not just one or two or three positive tests during that period but if there’s actually an outbreak, how is Dartmouth going to respond to that? And then, another question about testing, we’ve talked a lot about zero, three, and seven, but what comes next? What about after the initial 14 days, what’s the testing plan into the term?
Adams:
Oh, great question. So, we will certainly follow our sort of outbreak response plan, if we were to have more cases than just a few that we could sort of easily handle. We have reserved enough isolation and quarantine space, I think you heard over... Around 400 rooms, so we feel like we have that capacity to be able to move people into safe isolation and quarantine spaces. We’ll be working quite closely with our medical partner, Dartmouth-Hitchcock Medical Center. But it’s something that we are really going to be tracking early on and frequently with daily symptomatic checking, recognizing that that’s not going to capture everyone, of course, but also with some routine infection surveillance testing, that sort of leads into that.
But I will say just around the outbreak response, we will have sort of thresholds and criteria triggers that would cause us to take different actions if necessary. And I can say more about that at a later date. But just to get to the, sort of, the infection surveillance testing, we are planning to have ongoing testing for a representative sample of students, and I didn’t mention, but for also our employees, the student facing employees will also be included in our testing protocol. And so, it will be at a frequency of about testing everybody once a month, so that we will have some also wastewater management tests assessments that we will be doing. So, we have a couple of different ways in which we think we can have some early triggers, early warning signs for capturing any introduction of virus into our community.
Anderson:
Marty, we have time for just one more question unfortunately. And this one is about ... It’s about vaccine or vaccines, and the questioner points out that there seems to be a wide discrepancy among experts about how long it’s going to be before there is or maybe, a vaccine. Some experts say three, four years. Actually, earlier this week, Dr. Fauci participated in a webcast with D-H doctors and others, and he said he was cautiously optimistic that there could be a vaccine by the end of this year or the beginning of next year. So, why the discrepancy? Why some think three or four years, others think really a matter of months?
Cetron:
Great question. I would say as Joe opened in the beginning; things are unprecedented here. Normally it can take years, and sometimes the challenge of a safe, effective, vaccine, can take a decade, and for some diseases it’s still elusive. So, historically there’s a wide range of experience. We have an unprecedented threat and is being met with an unprecedented global effort at moving and advancing vaccine science quickly, Operation Warp Speed, you might have heard. Things ... Investments are being made in multiple companies to move things along, not a wait for the winner to then begin to scale up. But I do want to remind people, that some of the confusion may come in as to when is there a vaccine versus when do we get to control the epidemic with vaccination.
Cetron:
Vaccines in themselves don’t save the lives or prevent infections unless a vaccination program is happening, and we achieve high coverage rates to reach that herd immunity goal where the transmission pressure goes down. So, it’s not only when the vaccine arrives and to be assured that it’s safe and effective, but it’s also the vaccination program itself. We’re talking about needing to have very high coverage rates, upwards of 60% uptake, in order to achieve that level of vaccine induced immunity. That also is part of this challenge of controlling a pandemic with a vaccination program.
Anderson:
Thank you very much for that, Marty. And thank you and Lisa, both, for joining us today for an incredibly informative conversation. We’ll be back in two weeks, and I’m going to go back to Joe now to say a little bit more about that and wrap things up for the day.
Helble:
So, thanks Justin. And let me add my thanks to you, Lisa, for joining us once again, and Marty for not only joining us today but for the conversations I know you’ve had here and there with the taskforce to help us think about some very challenging questions as we develop our plans for operation in the fall and beyond, so thanks so much for that on behalf of Dartmouth. So that’s all for today, we’ll be back in two weeks with our next community conversation. As I said earlier, although we will provide a broad update, there will be a particular focus on issues of interest to students and to their parents given the impending transition to the start of fall term and student arrival.
We’ll be joined by Dean of the College Kathryn Lively, and one or two academic leaders to discuss the academic side as well as the student logistics side. And finally, let me note that given the interest in continuing updates, we will be continuing these community conversations at least into and through the month of September. So, we look forward to continuing to provide you with updates on operations as we exist in this interesting hybrid, and in some cases, significantly remote mode of presenting Dartmouth. Thanks everyone for your interest, engagement, support, and questions. As always, stay connected, stay well, and stay safe. Look forward to seeing you in two weeks. Thank you everyone.
