Joseph Helble:
Welcome, everyone to our 21st Community Conversation, addressing planning, response, and operations in the time of COVID-19. I’m Joe Helble joining you from the Starr Instructional Studio in Berry Library on Wednesday afternoon, Feb. 3, 2021. I’m joined by Justin Anderson from another studio on campus.
We’re joined today by two guests. Benjamin Chan MD, the state epidemiologist for the New Hampshire Department of Health and Human Services where he’s worked since 2014. Dr. Chan is also a clinical assistant professor at the Geisel School of Medicine, part of the division of Infectious Disease and International Health at Dartmouth-Hitchcock Medical Center. He was named the New Hampshire Union Leader’s New Hampshire Citizen of the Year for last year, 2020.
Dr. Chan will be joined by Duane Compton PhD, professor of biochemistry and since 2014, the dean of Dartmouth’s Geisel School of Medicine. Duane has been member of faculty for 28 years and, as dean, continues to oversee a research program that explores how cells acquire abnormal chromosome numbers and how those changes, in turn, affect the growth of cancerous cells.
We’ll follow our regular format this afternoon, with a brief campus update, live Q&A moderated by Justin, a conversation with Ben and Duane about their work, as it pertains to COVID and ending with an opportunity for them to answer your questions directly.
Tomorrow, Feb. 4, marks the start of week five of classes for most of our students, meaning hard as it is to believe, we’re already nearly to the midpoint of winter term and thus far, the term has progressed pretty much as we anticipated it would and that’s a wonderful thing for me to say to you today.
Graduate and professional school students continue their work in their labs, on their projects, and in their classes. Undergraduate students, who are resident this term, are back on campus, arrival quarantine period has ended and even in the midst of winter, even in the midst of subzero temperatures this weekend and major snowfall yesterday, students are outdoors and just as we had hoped, are embracing winter.
The skating rinks on the Green, which opened to students in the Dartmouth campus community a little over a week ago have been fully utilized. And anecdotally, there’ve been more than a few students venturing out onto the ice for the first time in their lives. I ran into one of my own advisees out next to the rink a week ago, after it opened and I could tell even behind a mask, he had a huge smile on his face and was fully embracing the opportunity to experience something new at Dartmouth.
Capacity on the rinks is limited and I’m told they’ve been busy, but not full. And I know from those days when I’m on campus looking at the Green, even on days like today, that our facilitates crew is doing an outstanding job keeping them open. I saw them out there this morning, clearing yesterday’s foot of snow from the ice and students were skating as I walked past on my way to the library a half hour ago.
The golf course has been busy, and I suspect that yesterday’s snow will encourage more students to head out and give sledding, snowshoeing, or cross-country skiing a try. The expanded indoor spaces we made available this term are being utilized. Staffing of those spaces is going well overall. With the term fully underway, surveillance testing is fully operational and now, in its second week in Thompson Arena, where it will remain for the balance of winter term.
As I said in our last Community Conversation, testing, along with masking, distancing, handwashing, limits on group size, and other measures is such an integral part of our plan and an important part of our effort to keep the community healthy. I appreciate the efforts that employees and students are making to get to Thompson Arena and get tested. I cannot stress how important this is. We need everyone, who is expected to participate in our testing protocol, both local students, and everyone who has campus access privileges, employees, and students alike, to participate, as scheduled, in regular surveillance testing.
To supervisors on the Dartmouth campus, if you receive a message that indicates one of your employees may have missed a test, please follow up with them directly and check in, and encourage them to get tested as soon as possible.
To our students, we know, and I know that weather conditions will pose a challenge and we appreciate you recognizing the necessity of persevering and getting tested, regardless of conditions. Overall, I’m greatly appreciative of the compliance by our community thus far this term. And I’m counting on it continuing through winter as it did through the fall. Our ability to navigate this term, and the next term, successfully, depend upon it.
In terms of an update on the status of this testing thus far, as of yesterday, we’ve conducted more than 96,000 tests with 18,000 of them occurring just over the past two weeks alone. Now, this level, not surprisingly, is the largest number of tests we’ve conducted in a two-week period since testing began early last summer. This is roughly the level we expect to continue for the balance of the term.
In that stretch, there’ve been a total of 22 positive tests, inclusive of students and employees, a positivity of 0.12%. That’s a level that is held steady over the past two weeks. That is a level that is 1/2 of the level we saw in early January. And that is a level that is comparable to the overall level we have seen since testing began last summer. This level continues to remain very low, relative to the surrounding area and the surrounding area continues to remain low, relative to the rest of the region and relative to much of the country.
It’s worth noting that positive case counts have continued to decline for New Hampshire, for New England, and for the United States as a whole. While we have a long way to go, as absolute numbers remain very high, with more than seven-day average of just over 140,000 new cases nationally each day, it’s a substantial improvement over what we were seeing in early January and for me, a very encouraging sign.
In terms of trends on other college campuses, as I mentioned here two weeks ago, most of our NESCAC peers have delayed student return until early February and remain a few weeks away from having meaningful testing data for us to review.
Most of our Ivy peers have undergraduate students back on campus. For those that are reporting cumulative data on a public dashboard, all lie between 0.1 and 1.4% with four Ivy universities clustered in the 0.1 to 0.25% range and it is in this lower part of the range where Dartmouth continues to reside. Along with testing, comes of course, the question of vaccination. And specifically, the question of testing and travel guidance. Both for individuals who have been vaccinated and for individuals who have previously tested positive.
The New Hampshire Department of Health and Human Services has changed its quarantine guidance for those who were within 90 days of a positive COVID-19 test and for those who are two weeks from their second dose of the COVID vaccine. The Dartmouth COVID-19 task force has been determining how to apply these changes to policies for our students and for our employees.
Some of these changes at Dartmouth that’ll be announced later this week include all Dartmouth students and employees who have tested positive for COVID-19 in the last 90 days, will no longer need to observe travel quarantine if they have to travel outside of their allowed area and return to campus. For undergraduates residing in New Hampshire, this allowed area is the states of New Hampshire and Vermont and for others residing in New Hampshire, the allowed area is New England.
Individuals who have tested positive for COVID-19 in the last 90 days will continue to be exempt from regular surveillance testing. Similarly, those who are two weeks beyond the second dose of the COVID-19 vaccine are also exempt from travel quarantine outside of New Hampshire, Vermont, or New England. However, those who have been vaccinated are still expected to participate in surveillance testing here on campus. Because we do not yet know if the vaccine, itself, prevents asymptomatic infection and potential for transmission of the virus.
Out of an abundance of caution and the desire, again, as I’ve said so many times in these conversations, to protect the health of the broader community, we are expecting those who have been vaccinated to continue to participate in surveillance testing for the time being. For everyone in both of these groups, the need to quarantine after being in contact with someone with COVID-19, will be determined by a discussion with a clinician from either Dick’s House or Axiom Medical. Individuals in either group may require testing symptoms following evaluation by a health care provider.
Further details regarding these policies which I realize I’ve walked through fairly quickly and are fairly complex, in a written summary of what I outlined above, will be shared in a community message from the taskforce co-chairs later this week. Now, let me end today with just a few updates and announcements related to winter term, spring term, and general operations. First, around winter term.
With the academic term fully underway for all, and those students who are in a residential term in all programs and schools, now back in residence, our facilities are now open as planned. As I mentioned earlier, skating, skiing, tubing, sledding, and fire pits scattered around campus are all operational and have all been well-utilized over the past week. The Dartmouth Skiway remains open with the Winslow lift open today and all the fresh snow we received yesterday, I learned this morning, the Holtz lift and Holtz side trails will be opening tomorrow, Thursday, Feb. 4, and will remain open throughout this weekend.
Also, this weekend, winter carnival is gearing up. And with a theme of “Level Up, Carnival Rebooted,” it’ll run for three consecutive weekends starting this Friday and will include multiple ice sculpture contests, three separate smaller snow sculptures, and a gaming theme that will allow all students to participate, whether they are resident in Hanover or studying remotely this term. Details can be found on the students.Dartmouth.edu Collis website.
Facilities, including those that I mentioned in our last Community Conversation are now open for student use, with details available via the office of student life website at dartgo.org/winter and then following the link for meetings and study spaces. In addition to academic spaces open in the evenings for student use, the Collis Center is now open until 2 a.m. every night, Baker-Berry Library is open until 10 p.m. Sunday-Thursday, and 6 p.m. Friday-Saturday, and parts of Alumni Gym and the fitness center, including the treadmills and ellipticals are open by reservation until 11:30 p.m. every day.
We remain interested in hearing additional thoughts and ideas for additional things we might also consider for winter term. The dedicated e-mail address, wintertermsuggestions2021@Dartmouth.edu continues to be monitored. That’s all one word.
And even as we prepare for winter carnival weekends and participate in winter term activities, our deans and staff and student affairs are beginning to think about spring term and will be seeking input and ideas and suggestions on this as well.
Feel free to send along any early spring term thoughts and suggestions to the winter term suggestions e-mail address and they’ll be reviewed as part of our early plan.
Now, in terms of spring term, some have asked whether the spring term undergraduate calendar will remain as posted on the registrar’s webpage, given the winter term final examination period now ends several days later on Wednesday, March 17. The short answer is yes. I can confirm that no change is being made to the start of spring term. Spring term classes will indeed begin as scheduled on Monday, March 29 as indicated in the spring term calendar on the registrar’s website.
Now, let me wrap up with just a couple brief notes on budget process update, and also, finally, an update on admissions in this challenging COVID year. As I mentioned last time, two weeks ago, here in this conversation, we’ve gotten some questions about the timing of remaining steps needed for budget planning for FY22, the fiscal year that begins July 1, 2021. The usual budget cycle remains in place. Final budget targets were received by division leaders late last week, prior to the end of January and we, therefore, remain on track for finalization of the FY22 budget with review and approval by the board of trustees in early March.
Turning now to admissions, the 2020-2021 academic year has seen a complete change in many of the fundamental elements of our admissions processes. For undergraduate students as well as for graduate and professional school students; with faculty and staff working remotely increasingly restrictive travel recommendations being put in place; and with increasing restricting travel recommendations being put in place and closure of campus to most visitors for most of the past 10 months, the campus visit and tour that becomes such an important part of seeing and experiencing Dartmouth and Hanover, seeing our facilities and meeting faculty and students and staff in person were no longer possible. Last summer, when we made these adjustments, quite honestly, we didn’t know what to expect in terms of applications to Dartmouth in the middle of a global pandemic.
In December, we released the news that undergraduate early decision applications had increased by nearly 29%, a very positive early sign. Earlier today, we completed that story by releasing the news that the overall applicant pool exceeded 28,000 applications for the first time in Dartmouth’s history, an increase of more than 32% over last year. And across Dartmouth, it’s worth noting that masters and PhD applications also increased substantially this year.
Although the changes vary by department and program, overall, as of yesterday, applications for graduate admission were up 16% over last year, more or less. What this means is that our admissions team, working virtually, has a lot of work to do these next two months. This means our faculty graduate admissions committees working virtually have a lot of work to do these next two months.
And what this means is that this fall, where we still may be masked, but hopefully, if trends continue, we’ll, again, be fully open as a residential community, there’ll be another talented, diverse, and global community of new students for us all to welcome to Hanover. I know we all look forward to that moment.
Thank you for your attention and interest and let me turn now to Justin who will take your questions before we return to our guests. Justin?
Justin Anderson:
Thanks, Joe and great to be with you, as always. There are a number of questions that, they’re slightly different from one another, but all sort of premised on the same idea. Which is around allowing access on campus to more people. One writer asks, specifically: Will we bring back more students for spring term, given our proven ability to keep numbers low? And then, another strain of questions is about commencements and whether we might allow say, family members and parents to attend commencement if they can prove they’ve been vaccinated? So, there’s other questions, too, they’re all sort of about like, how is it that Dartmouth will decide that more students, family members, visitors, can come on to campus? What do we need to see in order to make that happen?
Helble:
So, what we need to see, Justin, are several things. So, let me answer that, the broader question collectively. What we need to see, first and foremost is significant decrease in infection rates across the country. Not just across the region. Not just across the state of New Hampshire, but across the country. Our visitors and our students are coming from all over the country, all over the world. We would need to see clear indication that disease transmission is diminishing.
We’d need to see clear indication that despite the new variants, which many believe are more infectious than the strain we’ve been fighting for the past ten months are not significantly increasing rates of transmission of the disease.
We’d need to see significant penetration of the vaccine in our community and we would need to be confident we can operate our facilitates with guidance from the state, and guidance from the federal government, and guidance from the Centers for Disease Control, and what we’re seeing reported in the scientific community, that we can operate in a more-dense capacity than we are presently and still keep our community safe.
Having said all that, given where we are, early February, Feb. 3, given that spring term begins in late March and given that decisions on populating the residence halls in classrooms for spring term will have to be made fairly soon, it is quite likely that the plan we articulated last June and have been following consistently for this year with our residential and on campus facilities occupied at roughly the 50% level will remaining intact through the spring term.
Of course, that’s subject to revision as new information becomes available. As of today, all indications are that we will be operating, once again, at 50% capacity for spring term. In terms of commencement, as President Hanlon’s announcement said, we felt that given everything we know today, the availability of the vaccine, the distribution of the vaccine, and the difficulty of gathering a large group in a confined space, right? As I think Dr. Chan will tell us, even as the vaccination rates increase, it is critically important that we maintain masking and distancing for a fairly significant period of time in the future. We simply don’t have a facility large enough to spread out students and the family members and keep them at appropriate distance for one another through a commencement ceremony.
Could that change in the next few months? Yes, and we’ll be continuing to evaluate information as it comes in. We felt it was important, right now, to let families know the likelihood is that it will be virtual participation by families with the students, themselves, able to gather. That was also an important message we wanted to send to our graduating seniors and graduate students. You will have the opportunity to gather, masked and a safe distance from one another, as part of your final.
Anderson:
In your answer just then, you referenced the different variants of the virus that we are seeing across the globe and an audience member writes in and asked whether or not Dartmouth has found any of those variants, whether it’s the one that we’ve read in the news, in the U.K. or South Africa. Those are the ones that seem to have people sort of most exercised. Have we seen those variants on campus and then, if we did, would that trigger a different kind of reaction, perhaps, in scale than we have here to fore been exercising?
Helble:
The direct answer to your first question is no, we have not. But we are also, like most campuses, not extensively screening and testing for the specific variants. This is something that’s under discussion right now. It’s something we may consider doing, moving forward, but we have not yet put in place the capability to screen for the specific variants. That’s the case, based on conversations I have with my peers weekly, conversations that Lisa Adams, the co-chair of our task force has with her peers weekly.
The situation is similar at most colleges and universities. We’re beginning to explore the mechanics and feasibility. If we do, and if we discover that there is a significant shift in the dominant strain, and if it is more infectious, then of course, we will be revisiting our protocols and procedures and making decisions on how best to operate that may affect the facilities that are open, indoor facilities first. That may affect the group size limits. I don’t want to speculate much beyond that, other than to say if we see that levels of transmission are increasing, we will, of course, convene the task force and ask whether additional protective measures are needed. This is something, why, I have to say, as optimistic I am around the falling case rates, it all comes with the caveat that modeling suggests new strains won’t become pervasive and perhaps, dominant until late March or slightly later. We’re watching it closely.
Anderson:
Joe, a question, sort of similar to that, although kind of the flipside of it, there are obviously, variants of the virus. There are also different vaccines with different levels of efficacy. Based on the clinical trials and so, how does—how is Dartmouth thinking about the vaccination of our community, depending upon which vaccine we get? Or whether or not we’ve got some of the AstraZeneca vaccine, you know, and some of the Pfizer vaccine or some of the Moderna. Like, as far as Dartmouth is concerned, are sort of all vaccines equal as we think about what it means for how we are going to manage the density on campus?
Helble:
I’ll give you my answer, but I suggest we pose that question to Ben Chan, who is with us. My answer is all vaccines are equal. In the sense that if there’s a difference where one vaccine has 92% efficacy and one has 94% efficacy, those differences are so small as to be insignificant. If you can get the vaccine that has 92% efficacy today, versus waiting a week or two to get the vaccine with 94% efficacy, you are much better off getting vaccinated as soon as you can. That’ll have a bigger impact on reducing your risk and because it reduces your risk, reducing the risk of those around you. The vaccines have all been, I have to say, as a scientist and engineer, to me, exceedingly, impressively efficacious and my advice would be the one that’s available first is the one we should get. Let’s ask Ben Chan his view on that as well.
Anderson:
A couple of viewers have keyed in on a number you quoted a couple answers ago, about the 50% on campus residency. And a couple people have written in to point out that, that they suspect, and these people may be among this group, that seniors will be living off campus, perhaps in large numbers. And the question is whether or not that would open up, sort, housing stock, that had sort of been earmarked for them and it might allow for more students to come back to Dartmouth because of that.
Helble:
I want to be careful how I answer this. The answer is yes, but our commitment, first and foremost is to bring back all seniors who want to be here and all first-year students who want to be here. That was the promising commitment we made in the beginning when President Hanlon and I outlined the terms and preferences protocol back in June of last year. We anticipate that some seniors, not all seniors, but some seniors will choose to live off campus. It’s a matter of how many students will be here locally, how many first years will be here, locally in residence and it’s not a question of how many residence hall rooms they need, but what number of them—there’s also the campus facilities occupancy question. De-densification isn’t just about de-densifying the residence halls, it’s about de-densifying the dining hall, the gym, de-densifying the library, and classroom and laboratory spaces to the levels we feel are appropriate, where we can comfortably support and maintain and protect public health.
So, that’s a long way of saying, it’s not an obvious swap where if one senior gives up a space in a residence hall to live off campus, we can immediately bring in another student. It depends upon campus occupancy, but this is something the task force is looking at. This is something we’re talking about. We haven’t made any decisions, it’s not a promise that there’ll be a wait list process, but it’s not absolutely certain there won’t be. All I can say is stay tuned.
Anderson:
We have time for one more question before we move on to our guests. I saved this one specifically for your last question though it was the second question that was submitted today. And this person wants to know whether or not you have strapped on skates and been out on one of the skating rinks yourself?
Helble:
I have not. I’ve walked around the skating rink and chatted with the staff, I’ve sat in one of the chairs at the fire pit and talked to students, but I haven’t yet gotten out on the ice. I suspect that I need to, and I’d like to before winter is over. Thank you for making me make that pledge on air. I won’t forget it.
Let’s turn to our guests now. I’m pleased to have with us today, Dr. Benjamin Chan MD, who is the state epidemiologist for the New Hampshire Department of Health and Human Services, and who is also an individual affiliated with the Geisel School of Medicine and DHMC. Ben, wonderful to have you with us.
We’re joined by Duane Compton, PhD., professor of biochemistry, who’s been at Dartmouth 28 years, running a successful NIH-funded basic research program. Since 2014, he’s been in the dean’s office as the Dean of Dartmouth’s Geisel School of Medicine. Duane, wonderful to have you.
I’d like to start with a few questions for Ben and then switch to Duane, I’m going to move it back and forth before we open it to our audience. There are different, but related questions that I know our audience would benefit in hearing addressed from both of you. Ben, my questions for you are going to focus on your role as a public health official. I’d like to start by asking you, at a high level, very briefly, help our audience understand what it is that your role as state epidemiologist entails, particularly when we aren’t in the middle of a global pandemic.
Benjamin Chan:
It’s a great question. I think the term epidemiologist typically confuses people. An epidemiologist is somebody that studies the distribution of diseases in a population and the risk factors for diseases and tries to figure out ways to prevent disease and protect health. You know, it seems like, since I started in public health back in 2014, there’s been an endless stream of infectious disease threats that have come down the pipeline.
Back in 2014, it was the West African Ebola outbreak, followed by Zika, and we’ve been dealing with drinking water, environmental health contamination issues and cancer concerns, you know, the Hepatitis A outbreak. There’s never a shortage of public health threats that we’re not responding to, but when we’re not dealing with an outbreak or pandemic. A lot of our focus is trying to figure out how to work with our local health care and public health partners to address the local population health issues and the chronic diseases in the state.
And so, a lot of public health is working with local communities and local health partners to build relationships and build connections to address the real, on the ground, health issues, health disparities, health inequities that are present in communities around the state. Certainly, I’m, my training and you know, continue to practice clinical medicine in the area of infectious diseases. That’s where I spend a lot of my time, but you know, I provide medical and epidemiology support to all areas of public health, including environmental health issues and chronic disease problems as they come up throughout the state.
Helble:
Given that, if I can ask a quick follow-up, do you find yourself in non-pandemic times, traveling around the state a fair bit in your role connecting with public health officials on a regular basis?
Chan:
A lot of what we do is try to build partnerships with local health care providers and local public health partners. A lot of times that’ll require traveling. If there’s an issue or concern in a certain area of the state. We spend a lot of time working on communication and engagement with local communities and so, it really depends on what the issue is. There’s a lot of travel involved in different areas of the state. The other thing that we focus on is building connections, not just within the state, but nationally as well. Working with partners on calls, talking with the U.S. Centers for Disease Control and Prevention and trying to help coordinate the response to something like this pandemic, at a national level as well, and getting input from what’s needed at the local or state level.
Helble:
That’s really helpful background and context. I want to pivot and ask you about COVID in the COVID response. If you heard the questions that were being posed to me, so much of the focus now with the availability of not just a vaccine, but several vaccines are on the efficacy of different vaccines, the availability of different vaccines and decisions that people need to make as their number gets called, as they become available. I’d like to start by talking in general or asking you in general about the rollout. So, New Hampshire’s currently in Phase IB of the vaccination rollout. Based on numbers I looked up yesterday, 7.6% of New Hampshire’s population has received at least the first dose of the vaccine, according to yesterday afternoon. This is roughly comparable to the national average. What can you tell us about how the first phase is going? Can you speculate or tell us when you expect to see New Hampshire reach Phase II and potentially Phase III?
Chan:
We’re in the first phase of vaccination and because vaccine supply is limited, we have created, New Hampshire has created, and other states have created these different phases of vaccination in an attempt to prioritize who gets the vaccine first. And New Hampshire’s approach and many other states approach to this has been to target the up front, limited vaccine supply, to people that are most at-risk for severe disease from COVID-19 or complications of COVID-19 like hospitalization and even death. We’ve also targeted the vaccine up front to our frontline health workers, recognizing the need to maintain health system capacity.
Currently, we’re in Phase 1B of the vaccination. And we expect to be vaccinating individuals in Phase 1B probably through the month of February and into March. A lot of this really depends on vaccine supply. The limiting factor in our ability to put needles into arms, so to speak is really the supply of the vaccine. I know the federal government is working on ways to increase vaccine supply to states. Right now, we have two vaccines that are coming to us on a weekly basis. The Pfizer-BioNTec vaccine and Moderna. Both are similar in terms of makeup and effectiveness.
We do expect that over the next several weeks to month, even, that there may be a third vaccine coming to us. This is a vaccine from Johnson & Johnson and there are a couple other vaccines in the pipeline that are still being studied and we’re waiting for data on.
As more vaccine becomes available, we will be able to vaccinate more people. But, just to give you an idea, Phase 2A and Phase 2B include probably about 1/3 of the population of New Hampshire. And so, from when vaccine became available, mid-December through January, February, and through March, we hope to try and make vaccine available and vaccinate, probably close to 1/3 of the population given the supply we have. Obviously, we can, we can ramp that up as more supply becomes available.
Helble:
One last follow-up question and then I want to turn to Duane. The northern New England states, at least, are similar, somewhat, geographically, similar in terms of population base. Has there been any discussion or consideration given to taking a pooled approach? I don’t know whether the federal government has ever made that an option, but rather, have 50 states do it independently. Could northern New England engage as an effective region?
Chan:
We’re always looking for ways to coordinate nationally and regionally. And so, you know, we’re constantly in communication with our public health partners in other states. The difficulty is that, when it comes to the vaccine, each state is getting a certain allotment of vaccine on a weekly basis. And that allotment is based on the population of the state. And so, certainly there, are ways we’re trying to coordinate, but as we’ve seen in many areas of this pandemic, each state and each public health jurisdiction has a slightly different approach to how they’re approaching the challenges of the pandemic and that includes the challenges of vaccine rollout.
So, for right now, it continues to be a state-by-state approach. Each state has a different, probably a slightly different prioritization scheme for how vaccine is being prioritized. One of the things we agree on is the need to vaccinate up front, our health care workforce and people at highest risk for severe illness from COVID-19 or complications of COVID-19. That’s something I think, when you look state by state—you’re going to see a consistent approach across different states.
Helble:
That’s been, in reading I’ve done, very clear, states prioritizing those workers and those populations. So, thank you. Duane, let me turn to you for a few questions and I’ll come back to Ben and you for one last question before we open it up to the audience. And I want to ask you, first, a fairly general question, about Geisel, before we ask more COVID-focused questions. I think much of the Dartmouth community, truly, despite of history of Geisel, doesn’t know the scope and depth and breadth—many of our colleagues don’t recognize that more than 2/3 of the externally sponsored, funded research that takes place at Dartmouth takes place at the Geisel School of Medicine. Can you tell us about the scope of the work? Two or three major areas of emphasis that Geisel and Geisel faculty are known for before we move to the COVID questions.
Duane Compton:
Sure, a good question and then thank you for the opportunity to be here with you to join this conversation. You know our core missions are for education and research, and our research programs span virtually the entire spectrum of biomedical science. What I mean by that, we have investigators who are doing experiments to understand behaviors of single molecules, we have investigators looking at how tissues and organs function. And investigators looking at whole organisms and how physiology works there, all the way to populations and how things work in populations. And, within those programs, they span everything from investigators trying to figure out the basic mechanism for how something works in the biological system, all the way out to very highly applied questions.
And when we’re talking about applied, we’re talking about understanding mechanisms of biology that lead you to understand the nature of cancer and how to better treat it. We have cancer biologists and thinking about therapeutic strategies. They’re thinking about cystic fibrosis and things—how it affects both the lung biology there, and also other effects of cystic fibrosis, such as the onset of diabetes. Children’s health, questions about how to—how environmental exposure is—create lifelong challenges. Behavioral health, how do we create the right ways to, to help individuals who have challenges in behavioral health and all the way out to the study and analysis and study of how health systems, themselves, operate. And how we can make them more efficient to create better patient outcomes. It’s a broad spectrum of science.
Helble:
In that universe, I have to ask, is there COVID-related work being conducted at Geisel?
Compton:
There’s quite a lot going on. This is where I have to really tip my hat to the Geisel faculty. I think they recognized the gravity of the situation, immediately and utilizing their current expertise and what they were doing, they launched efforts in, essentially, every area that we think we should be working on.
What I mean by that, we had investigators begin working on how to create better, more efficient and faster testing modalities. We had investigators working on vaccine strategies. We had investigators working on therapy strategies, so, once you’re infected, how to treat people effectively. And we had investigators looking at patient data and data records to understand things of like, comorbidities and how they really affect the individual’s outcome once they’re infected. So, our investigators really stepped up and started looking at it from all different facets.
Helble:
I understand there was a group a few years ago that did foundational work related to stabilization of the spike protein that’s playing a major role in the development of the vaccine therapies that are being rolled out. So, Geisel, one can argue; directly connected to the development of these vaccines.
Compton:
Yeah, with respect to the Pfizer vaccine, the methodology that was developed in order to allow for that protein to be expressed in a stable fashion, so the immune system would have persistent exposure and mount a response to it, that the foundations of that was created by an investigator at Geisel.
Helble:
Ben, I’ll turn to you with a question about the variants that was put to me briefly, just ask whether the state—what the state of New Hampshire is doing, if anything, at this point in time, to monitor the potential for the new strains to spread. And also ask you to tell us more about your sense of the efficacy of the various vaccines against these emerging strains.
Chan:
I think the variants will be the next big challenge in our response to this pandemic. And there are three, right now, that we’re keeping an eye on. There’s a strain out of the United Kingdom, we call it the U.K. variant. There’s a strain out of South Africa and then there’s another strain out of Brazil and it appears that these variants are likely more infectious or more easily spread person-to-person. On the order of 50% more infectious.
At the same time, there’s new data emerging—even in the last few weeks, that prior infection with an earlier strain of the virus or vaccination, even, with the currently available vaccines may not provide as much protection as, against, the original, you know, circulating wild type strain of the virus. Now, this is an area of active study. And there are some differences between the strains.
The U.K. variant, V117 variant, appears to still be susceptible to protection and immunity from the currently available vaccines, but the South Africa variant and Brazil variant appear less so. So, you know, this raises concern, obviously... for the ability to control the virus spread if and when some of these variants are introduced into a population there are efforts, not only in New Hampshire, but nationally to increase the type of genetic sequencing requires to identify these variants.
We’re looking at identifying higher risk people who test positive and trying to do the genetic sequencing locally on certain individuals that might have traveled, for example. While state and local public health is doing that at a federal level, the CDC is also increasing the number of specimens they’re doing genetic sequencing on. They’re working with some of the national reference labs to do sort of random testing, random sequencing on positive specimens at a national level in order to get a better idea of how widespread these variants may be.
We have identified these variants in the U.S., but not New Hampshire. The one that appears to be most prevalent in the United States is the U.K. variant, that V117 variant, I think there’s over last count, over 500 cases from 33 different states. The other two variants, the South Africa variant, and the Brazil variant, still appear to be limited in terms of the numbers identified throughout the United States. But this is something we’re keeping a very close eye on. There are efforts in New Hampshire and nationally to increase surveillance to try to detect these. But if they are more infectious, that means there needs to be a higher level of vaccination, and a higher attention, higher compliance with the other mitigation measures like social distancing and face mask use.
Helble:
Duane, let me turn to you for just a quick final question and then turn it back to Justin for questions from the viewers. I’ve been asking you a bit about research, but of course, the other major effort of the Geisel School of Medicine is training the next generation of physicians. COVID turned everything on our campus upside down, overnight, back in March. Medical education has significant hands-on components for upper year medical students. What kind of adjustments have you had to make to the teaching of medical students? Can you give us an example or two of things you’re able to continue to do in person, versus things you had to do remotely?
Compton:
Really good question. I think you hit the nail on the head. Everything got turned upside down when COVID struck. We have, in our different programs, the MPH program went entirely remote learning at that time. Our students pursuing PhDs in laboratories, we had to carefully manage the personnel density in those laboratories that’s been affected and continues to be affected in that way. In the MD curriculum—I think that’s what you’re asking about—we moved the component of the curriculum involves classroom instruction, and we moved a lot of that to remote learning. Some of that is coming back now under controlled conditions to ensure social distancing in small group settings.
With students that are in the clinical environments, those students were actually, because of the nature of the clinical systems, they were actually asked not to come into the clinics for a long time. That was, actually happening nationally with all students and all medical schools. Wasn’t unique to us.
And as the health systems began to gain better understanding and better control over their patient populations, they started allowing students back into the environment. I think in many respects, because the prevalence had been low here, we had our students back in DHMC, our primary clinical partner. We had them back in that environment earlier than other medical schools were able to. The last thing I’ll add, is that our students are actually classified as, in groups 1A, as part of the state’s inoculation program. So all of our students, I believe all of our students, at this time, who are in clinical clerkships right now, have been vaccinated or are beginning to be in that first injection phase. And then, many of our students who are currently in the classroom section, are actively volunteering in clinical spaces so they’re also being vaccinated. So, because of the nature of what our students are doing, clinically, they’re high on the vaccination list.
Helble:
Great to hear. This is for students not just who are doing clinical rotations locally at DH, but for any students of Geisel, who are doing clinical rotations, those in programs elsewhere in the country, still fall under that vaccination.
Compton:
Yes, that is true.
Helble:
Thank you, Ben, thank you, Duane, Justin, over to you.
Anderson:
I’d like to stick with Duane. Someone wrote in a follow-up to the question he just answered. And it’s about being the dean of a medical school, during a pandemic. And whether or not the students look at this as like the ultimate medical school experience. You know, you hear stories that doctors get excited about unusual procedures they get to perform. So, is a global pandemic viewed similarly from students? Do they think like what an interesting, great time to be in medical school?
Compton:
Oh, absolutely. It’s such a good question, that our students have very strong sense of empathy and desire to participate in health care and so, they’re just anxious to get in and help in any way they can. They were pretty frustrated when they got moved out of the clinical environments and so, we found lots of different ways to get them back in the system.
I’d say, at a higher level and I think Dr. Chan, you’ll relate to this, I believe, but one of the things that’s really important is the way in which this public health crisis, that has shown how medicine in public health intersect. We, it’s just so clear that things happening outside the health system, with the pandemic, are really affecting the medical outcomes of people after they contract that. So, you know, the idea that public health in medicine are two separate disciplines is just not true. And this is really showing how medicine and public health are just two sides of the exact same coin. Our students embrace that, I think they understand the nature of that and practice that in their daily lives and look forward to doing that in their professional lives.
Chan:
If I can quickly chime in, I absolutely agree. That’s one of the areas of interest of mine personally, as a clinician, trying to build those bridges, between the individual clinician and what happens at a state level, whether it’s responding to a pandemic or dealing with health policy issues, in a legislature, or responding to community concerns. It’s no longer just about the doctor-patient relationship, or clinician-patient relationship. We’re really looking more at how do we look out for the health of an entire community and entire population and there’s absolutely a role for individual clinicians to be involved in that.
Anderson:
Well Dr. Chan, if I can stay with you, sort of along those lines of all of us becoming more engaged and more aware of these issues, a viewer writes in to ask about you know, what is the latest trend, double masking? And whether or not that’s something that we should be doing? And frankly, you know, we’ve gone through this evolution, where at the beginning, the American icon, Dr. Fauci, was suggesting that we didn’t need to wear masks and now we’ve gotten to the point where it’s like, oh no, you should double mask. Can you explain a little bit—how that happened and whether or not we should be wearing double masks? And if double, why not triple? It’s confusing.
Chan:
Yeah, the question is like where does it end? If two masks are better than one, what about three or four masks? Throughout the course of this pandemic, what people have seen is our response has changed and our recommendations have changed because our understanding of this new virus has changed. So, I think when we started to realize, early on in the pandemic, thinking, you know, late winter, early spring, that there were—we believe—a significant proportion of people with COVID-19 that were asymptomatic, meaning without symptoms, but still able to spread it, spread the infection, that the role of masks became more central and more prominent of an issue. What you’re seeing now is an evolution of our understanding of this virus.
The question is, do people need two masks? Is that a public health recommendation? No. What we heard Dr. Fauci say, if people want to wear two masks? Could they do so? Sure. People can choose to wear two masks, but that’s not a core public health recommendation and I think we’ve always tried to take a multi-layered approach to mitigation, a multilayered approach to preventing this virus from spreading. It’s not just all about testing, it’s not all about social distancing and all about face mask use—it’s all of it combined.
The first goal is to get people to wear masks in the first place and if people are already wearing masks, and they’re concerned, wear a better mask. If you’re wearing a single-layer gator, for example, you know, upgrade to a two or a three-layer mask. I don’t think we all need to go to double masking and I don’t think we need to all go to N95 masks in the community as you know, some people have been talking about. I think we just simply need to use masks and use better masks, better-fitted masks, masks with multiple layers and use that in conjunction with the physical distancing and limiting of social gatherings and group gatherings.
Anderson:
Duane, I want to go back to you. You mentioned how your Geisel students have been vaccinated and are, in many cases, on the front lines. A viewer writes in to ask, on the front lines, how, what are the Geisel students doing that puts them, that puts them on the front lines?
Compton:
So, part of their curriculum is to have practical encounters patients and how to learn how to be a practicing physician. That puts them at risk because the patients don’t always come in being pre-tested. There’s an unknown about each patient encounter. So, that’s the risk element there. I’ll add one other component to this too. Which is, our students are quite active in the community. They conducted the influenza vaccination program, for our Upper Valley community here. They’re also going to participate in the COVID vaccination program for, for the community. So they’re actually interacting with the public and helping to vaccinate everyone.
Anderson:
Dr. Chan, we’re unfortunately running out of time. We have a lot of questions, but I think we have time for just one more. And a viewer writes in, wondering whether or not Dartmouth, as an educational institution, will have priority in terms of getting the vaccine. And the person makes the argument that if Dartmouth were to get the vaccine, then faculty could be vaccinated which would mean students could come back quickly which would have downstream consequences in terms of the local economies and so doesn’t it make sense for New Hampshire to prioritize educational institutions because of all of those positive affects? I guess the question is whether or not Dartmouth will be prioritized.
Chan:
It’s a great question. I wish we had enough vaccine to administer or offer the vaccine to everybody. The reality is that especially up front we have very limited supply and so, we’re in this position of having to prioritize who gets the vaccine and the first phase is focused on giving it to the people at highest risk of severe disease and risk of dying from their infection.
When we move into Phase IIA, we’re prioritizing school staff and schoolteachers, because we recognize the importance of education, you know, getting kids back to school, maintaining school operations, whether that’s K-12 schools or colleges and universities. So we are attempting to prioritize, you know, vaccination for schoolteachers, school staff, so we can maintain educational operations in our state. For the first phase, it’s really focused on getting the vaccine to those at highest risk who might be hospitalized or die from infection.
Anderson:
Thank you for that, for that response and thank you for all that you’re doing for the Dartmouth community, for the state of New Hampshire. It’s obviously, greatly appreciated and thank you, not least of all, for joining us today on Community Conversations. Duane, thank you, too. We appreciate it. With, that I’ll go back to Joe.
Helble:
Thank you, Justin and let me add my thanks to you, Duane, and Ben for joining us today. For an interesting and illuminating conversation. You can tell there, are a lot of questions in the community, both on how we are managing on campus, our operations, our research and how things are progressing and what the development and availability of these vaccines means for us and for what everyone so desperately hopes for, for return to life, as usual, at some point in the foreseeable future—whether that’s summer or fall, somewhere on the horizon in 2021, is what people are hoping to see.
We have many more topics to discuss in Community Conversations as we go forward over the course of this year. A big one being the finalization of the FY22 budget with FY21 having been impacted significantly by COVID and its effects on operations, both revenue and on the expense side.
We’ll have a bit more to say about that in two weeks and we’ll also be turning our attention to planning for spring term and providing a bit more detail on some of the questions that you asked today.
So, until then, everyone, stay well, stay healthy, embrace winter and go out and enjoy these wonderful outdoor conditions on the Skiway with Holt’s Ledge now open on the skating rink or walking around town. I look forward to seeing you on campus and look forward to seeing you all at the next communication conversations in two weeks.
Thank you and have a good afternoon.
