Joseph Helble:
Good afternoon, everyone. And welcome to our 15th Community Conversation, addressing planning, response, and operations in the time of COVID-19. I’m Joe Helble, the provost in the Star Instructional Studio in Berry Library on this Wednesday afternoon, Oct. 14. I’m joined today by Justin Anderson, my VP for communications here at Dartmouth, from another studio on campus. And Justin and I will be joined for a conversation focused on the current progression of COVID-19 in our community.
Joined by Lisa Adams, a frequent visitor to Community Conversations who is in her 18th year as a faculty member in the Geisel School of Medicine, who is the co-chair of Dartmouth’s COVID-19 Task Force, and a specialist in the care and treatment of infectious TB. Antonia Altomare, in her seventh year as a physician at Dartmouth-Hitchcock Medical Center, also an infectious disease physician, and until recently DHMC hospital epidemiologist. And Julia Griffin, town manager of Hanover, N.H., a position she has held for the past 24 years, coming to Hanover in 1996 after serving as the city manager of Concord, N.H.
Before we begin, I’d just like to apologize briefly for the short delay we had in getting started. We had some technical difficulties. But we are ready now to move forward. We’ll follow our usual format today with a campus update, live Q&A moderated by Justin, a conversation with Lisa, Antonia, and Julia, and finally a chance for them to answer your questions directly.
Today, I’d like to provide an update on fall term operations and also discuss an early look at winter term planning. Let’s start with the fall term and the status of our testing, which is updated daily on our COVID-19 Dartmouth Together dashboard. Testing continues daily in the Leverone Field House for employees and students alike and is now also operational one day per week in Williamson for those working in the Lebanon medical research campus.
By all accounts, operations continue to go smoothly at both facilities. Waiting times generally remain small. And if my morning test last week was any indication, adding up each stage of the process, I can’t have been waiting more than one or two minutes in Leverone at most. In most cases, results are being received the day after the sample is taken, consistent with our plan.
So, I’d just like to say thanks again to all of those who arranged the facility, the process, and the planning and staffing. It truly is going smoothly. As of yesterday, Dartmouth had conducted more than 20,500 student tests with a total of eight positives, a positive test rate of 0.039%. Counting employees, more than 25,000 tests have been conducted for some 7,950 unique individuals. And as planned, we will continue to test this population at the same frequency through the end of fall term. Now, as many of you know, in addition to monitoring our own data, we monitor the publicly reported testing data of our peers as an indication of how other campuses are managing, paying particular attention to those in similar non-urban environments with comparable regular surveillance testing protocols that look much like the protocol that we have and have had in place at Dartmouth.
Most of our NESCAC peers with their smaller student populations remain in the 0.01 to 0.04% positive range, with two campuses slightly higher in the 0.1 to 0.3% positive range. UNH and UVM, our state research university peers, have far larger student populations, but have also seen rates remaining low at 0.14% and 0.03% respectively. Now in comparison, many of you will have seen numbers in the news from private and public universities in other parts of the country that are approximately 15 to 50 times higher, meaning positive test results in the 0.5 to 1.5% range or even above.
Now in comparison, while our numbers and those of our NESCAC, UVM and UNH peers remain very encouraging, we need to remind ourselves that all of this is happening against a backdrop where case counts are rising nationally, reversing a late summer decline, as well as regionally. New Hampshire and Vermont in fact have both seen their positive case count double over the past two weeks. In New Hampshire, this represents approximately 1,000 new confirmed positive cases in the most recent two-week period. While overall case counts in our region remain low relative to most of the rest of the US, all of this, the national trend, the regional doubling, is a reminder danger that we need to continue to remain vigilant, particularly as we enter the Northern New England cold weather season.
Our announcement just two days ago of our first cluster also serves as a reminder that the Dartmouth community is not immune. As taskforce co-chairs, Lisa Adams and Josh Keniston indicated in their Monday afternoon message, the state of New Hampshire defines a cluster as a group of three or more people having active COVID-19 who were linked. Even with overall numbers remaining small, the emergence of such a cluster is a vivid reminder that we are dealing with an infectious pathogen where transmission can and in fact does occur asymptomatically. We are therefore continuing our campus operations at the limited access level as defined on our Dartmouth Together COVID-19 site. And it is an indication that those employees whose work enables them to work remotely should continue to do so for the foreseeable future.
Looking ahead to winter term, first and foremost, operationally, we expect winter term to function almost identically to fall term. We anticipate offering the opportunity for residential education to approximately one half of our undergraduate student body, same as fall term and consistent with the integrated full year operational plan that President Hanlon and I announced on June 29. Pre-arrival screening, which is pre-travel screening, will be conducted for all students, same as for the fall term. Arrival week testing, which we currently anticipate occurring on days zero, three and seven, will also occur, same as the fall term. Quarantine in residence halls will be required. And present guidelines indicate that it will be for 14 days, again same as the fall term. Substantial capacity for quarantine and isolation space will be maintained in our residence halls. And all indoor spaces, including indoor dining, will have capacity limits at any one time. Group size for activities will be limited. And campus facilities like the library and the gym will be open, but at reduced capacity with rules on masking and distancing, and only for those approved for residential education.
Finally, classes will be primarily offered by distance or by hybrid modalities with some in-person opponents, with Dartmouth departments currently working on finalizing their slate of offerings in more modalities for winter term. Now, I say all of this so that you know that in other words, students, faculty and staff alike should anticipate that winter term will operate exactly like fall term, albeit with slightly different weather conditions and no outdoor tents. Now we are looking for ways to provide more opportunity for our students to gather in small groups both indoors and outdoors. We have heard you, members of the student community and their families, who have expressed appreciation for the opportunities that Dartmouth has put forth in the fall term from quarantine to the present state of the term, and ask for more, more opportunities that could engage more students in more structured activities.
Many teams from the dean of the College area are working on this. And I will soon be appointing a committee of individuals who will work with them and expand on these efforts, looking for ways for Dartmouth to offer more, including outdoor activities in the winter, and to offer opportunities not just for our students, but for our faculty and staff to engage in the community as well. I’ll have more on this as we get closer to the start of winter term. Now for undergraduate students, an important question is who will be resident during winter term?
As Dean Lively indicated in a note sent to undergraduate students yesterday afternoon, after surveying those students who had been approved for winter term residential education, we confirmed that the plans of some had changed, and we are now able to offer winter term residential opportunity to additional students, students in the Class of ’23 and above through a wait-list process.
Students interested in being considered for winter term on campus residential education have this week, until 5 p.m. Eastern daylight time this Friday, to add their name to the wait list through a simple one-step process, by emailing dean.of.the.college@dartmouth.edu with wait-list in the subject line and confirming interest by providing their student Dartmouth ID number in the message. That’s all it takes. As Dean Lively’s email yesterday indicated, no additional information is required. Priority in additional winter term approvals for rooms in College residence halls or Greek organization facilities, both college-owned and privately-owned, will be assigned randomly to those students who were only approved for on-campus enrollment for the ’21 summer term. This group being primarily our current sophomores, the members of the Class of 2023. This will enable those students to have an earlier opportunity to return to campus, as otherwise many of them will have waited more than a year to be offered a residential term opportunity.
After this process has been completed, if there is space remaining, we will prioritize those students on the wait-list who have thus far been only approved for one term of on-campus enrollment, with that prior approved term being either fall or spring. All students participating in the wait list process will be notified of the outcome of the process, and therefore whether they’ve been approved for winter term on-campus enrollment, by next Wednesday, Oct. 21. Dean Lively and her colleagues in Student Affairs who are managing this process have received several questions from student athletes asking about the status of winter and spring term competitions to help them decide whether to participate in the wait-list process.
Decisions on athletic seasons have not been made. These decisions will be made later this year by the Ivy League presidents as a group in consultation with their athletic directors. Decisions may not in fact be made until late in the year to give each of our Ivy League universities the time to see how the pandemic evolves as we enter colder weather conditions, and enabling us all to make decisions that prioritize the health and safety of our student athletes. What this unfortunately means is these student athletes will need to make decisions about participating in the wait-list process well before the competition question has been answered.
Dean Lively and her colleagues have also received many thoughtful comments suggesting alternative selection processes or offering reasons as to why other individuals or other groups of students should receive priority. We recognize that there are many ways a selection process could be run. We recognize that each process by prioritizing one group will seem appropriate to some and unfair to others. Unfortunately, conditions have not changed, and data from different regions, different cities, even different campuses have shown that steps that increase population density in smaller spaces and reduce masking and distancing requirements increase the likelihood of disease transmission. From the beginning, in these forums, I have said that we at Dartmouth remain determined to follow a plan that allows the maximum number of students to navigate any term successfully.
What this means is not increasing student numbers at this time, which unfortunately means that there will be disappointed students and families. I do ask that all members of the Dartmouth community understand why we are taking these steps. This truly is an extraordinary and unprecedented time for higher education and for us all. For those who will be resident during winter term, we will be staggering arrival dates as we did for fall term. We ask that students not make travel plans at this time, as arrival and testing dates have not yet been determined. Students will receive housing and assigned arrival dates in November and should defer travel planning until that time.
Now in addition, after consultation with the COVID-19 Task Force, the Academic Working Group and faculty leadership, including the deans and associate deans of arts and sciences, Thayer, and the Guarini School of Graduate and Advanced Studies, we also anticipate delaying the start of winter term by a few days, most likely to Thursday, Jan. 7, for undergraduate, Thayer, and graduate students only.
Tuck and Geisel winter term programs will not be affected and will open on the currently scheduled dates. Now, why are we considering this? A delay of a few days in the start of winter term classes for undergraduate Thayer and Guarani students, with an associated delay of a few days in the end of winter term, would enable all of these students to travel back to campus after the holidays, would avoid having large numbers of students in residence halls in quarantine over the New Year’s holiday, and would enable us to have the necessary staffing on campus to manage comprehensive arrival week testing that I described a few moments ago. Delaying the start of winter term by a few days would also delay the conclusion of winter term by a few days. The remaining questions that we are exploring before finalizing the calendar for winter term are focused on the need to transition our residential facilities between winter term and spring term residents.
Many universities have substantially reduced the length of their spring term break because it’s a mid-semester break, not a between-semesters break. Students in those universities returned to their same rooms. For us, the quarter system means that there will be substantial undergraduate student turnover with first-year students returning to campus during that break week, and we need to ensure that we have the staffing and sufficient time to make the transitions work. I anticipate announcement of the details in the next two weeks, no later than our next community conversation on Oct. 28.
Now, let me end with just a few thoughts on the challenge we’re facing and how we are doing. As I’ve often said in this forum, there is absolutely no question that this is hard. We’re asking everyone, students and employees alike, to sacrifice some personal freedom in support of the community good. I understand how challenging this is, and I know we are all tired of living this separated, and at times quarantined, existence. I understand well the parents and students who express some frustration with restrictions on group size or indoor gatherings or travel.
And I understand the frequent references to Hanover as a bubble. Despite the increase in cases in New Hampshire and Vermont these past two weeks, the extent of the disease in this region is low relative to much of the rest of the country. But this is not a true bubble, not an environment that’s fully contained. New disease counts in the state and in our region are not zero and are in fact increasing. New disease counts in our Dartmouth community are exceedingly low, but they are not zero. And yesterday’s pause in two major clinical trials reminds us that we cannot count on a global vaccine being delivered and available tomorrow. This is not a time to step back from the measures that have helped us navigate this pandemic, this global pandemic, this well this far. It’s worth remembering for all of us that this disease truly can be devastating.
To put it in context nationally, we’ve already lost in nine months of COVID more than half the number of people that we lost in all of World War II. We’ve already lost more than we did as a nation through the entirety of World War I, the Vietnam War, 9/11, and operations Enduring Freedom and Iraqi Freedom combined. I don’t say this to paint a bleak picture. I say this to ask all of us to summon our resolve. We have had cases in our community, and we do now. And thus far, there is no indication of widespread contact, no need for widespread quarantine. The actions we have been taking as a community collectively are working. I wish I could promise that winter term would be more flexible. If there is the ability to make it so supported by public health data and guidance, we will do so. But if not, I am going to be sitting here and asking for continuing sacrifice for the good of the whole from this community.
So I ask you, in addition to participating in regular surveillance testing, please complete the temperature and self-assessment, or TSA, screening every day if you’re working or living on site. Maintain 6-foot social distancing. Avoid large group gatherings. Follow travel restrictions. We will get through this, and we will be better for it having done so as a community. Wear those masks. I so look forward to celebrating that moment with all of you when this is behind us, but until then, we do have work to do. Thank you all for everything you are doing to engage our students and work as part of a community and keep this community safe. Justin, over to you. I look forward to hearing a few of the questions that might be on people’s minds. Thank you.
Justin Anderson:
Thank you Joe, and nice to see you today. A lot of questions have come in so far, a lot of really good questions. And just as a preview, I should mention there’s a lot of questions here for Julia Griffin. So a lot of people are eager to hear from Julia. So we will definitely look forward to what you have to ask her, and rest assured that I’ll be able to chime in as well.
I’d like to start with a questioner who submitted this question before you referenced the fact that we don’t live in a bubble. This questionnaire asks: It seems that Dartmouth has built nearly a perfect bubble. And, why not close the bubble and allow normal activity within that bubble, and not let students out? Not let students go out to Quechee or to Lebanon, or to wherever else. Just close it up, and essentially have what the questioner refers to as like a normal term in the bubble.
Helble:
Now that’s an interesting question, Justin, and it’s something that we actually did talk about with the task force in the very early stages of designing our summer plan. And we asked ourselves: Is it truly feasible? Could we truly build an impermeable membrane barrier effectively around the campus and keep our students in and keep the surrounding community out? For a variety of reasons Justin, that just didn’t feel right. It didn’t feel right to who we are as a university. It wasn’t reasonable to imagine how that would work with faculty and staff who needed to access campus. As soon as you allow that, you have pores in the membrane. You don’t have a perfect bubble. We thought about the ability or the desirability of keeping students restricted and confined to the campus. What about the students who just want to get out and experience the fresh air, and go for a long run on their own, or get out and stretch their legs and go for a hike?
And so what we tried to develop is a set of rules that we thought were reasonable and achievable for most. Asked everyone to be vigilant, but didn’t pretend that we could truly put up an impermeable barrier around the campus, particularly with faculty and staff needing to come in and out to be able to do their jobs and interact with students. And so it’s an interesting idea. As I’ve said often, I’m an engineer and I like the idea of thinking about process and theoretical constructs, and then applying a filter that says, “How realistic is this to achieve, and what would be the impact if we were able to achieve it?” And we made the decision that in the interest of community health and student mental health and giving some flexibility and freedom, the operating model that we have was the right way to go. But it’s an intriguing idea.
Anderson:
Joe, I should also say that in addition to a steady stream of questions that have come in since the beginning of the webcast today, I also received separately a lot of email from parents with questions, which is great. I encourage parents and whomever to send questions, because that’s a great way to reach me, and for you and I to be able to address those questions. Of the parents I heard from, I think that it’s safe to say that the most asked question was about students who have been asked to leave campus this fall. How many students have been asked to leave campus this fall? Broadly speaking, why? This information is important because it helps guide our students on how to conduct themselves. There are simply too many rumors around this, and it is creating fear and uncertainty that might not be necessary and could be better guided.
Why is there not more transparency? So I think, Joe, I’ll take this one and then you can certainly add to it if you think that’s appropriate. From sort of a 30,000 foot view on this, Dartmouth has never announced when students are asked to leave campus, and that number is not quantified at the end of the term or the end of the year. I mean, simply put, it would be a violation of our student’s privacy, and it can lead to targeting and it can lead to people trying to figure out who has been asked to leave campus and why. And just generally speaking, we try to avoid that because we truly think that it would be unfair to the privacy and confidentiality of the students who have been asked to leave.
Now, I recognize that we have a balance that we have to strike between transparency and privacy. And in this particular instance, we think that privacy is what is truly wins the day. I think also on this issue, I think context matters. It’s extremely important when the event that would lead to someone being asked happened. There is, as I think everyone knows, an ever-evolving public health situation. And what is happening on any given day, week, or period of time is going to determine sort of how we respond, how we respond to what are brought to us as potential violations. Also important to know that the dean of the College takes those reports very seriously, and evaluates them as fairly and rigorously as they can. No one relishes the duty of having to ask a student to leave. It’s not something that anyone wants us to do.
I will say, just sort of to wrap it up, that a good rule of thumb is that if you follow sort of the basic tenants of wearing a mask where specified, maintaining physical distance, filling out the TSA, and importantly avoid gathering in groups larger than 9, or 25 if it’s a campus-sponsored event, you should be just fine. So, we understand that this is on people’s minds. We understand that folks would like to hear more, but we are coming down on the side of the importance of privacy and maintaining the privacy of our students. Joe, do you want to add anything to that?
Helble:
No, I think you’ve summarized it well, Justin. That’s exactly right. Privacy first and foremost. We want to respect the privacy of these students, and we also recognize that for some, perhaps for many, it was an accident, it was a misstep, it was not thinking. So we don’t relish asking students to head home, but we are thinking first and foremost of the collective health of the community. And that’s why it’s important that we adhere to these rules. It’s all the measures together that it takes to keep the community safe. It’s all these measures together that have enabled us to navigate it as well as we have so far.
Anderson:
Another question that is coming up a lot from the parents is really about the rules on campus as they relate to interaction with one another and activities, and why there aren’t more opportunities. You mentioned in your opening that we are looking to create more opportunities. I guess what might be helpful for a lot of these questioners is perhaps explaining why these restrictions are in place. It seems as if some people think that perhaps they are arbitrary, or certainly too draconian. So I guess if you could try to explain to people why they are in place, and why we made the decisions that we made, perhaps that would be helpful.
Helble:
I mean at a high level, Justin, we’re following federal and state guidance, and we’re looking at best practices as recommended to us by federal and state authorities. And so this has to do with keeping group size small, keeping people masked and distancing, and keeping people separated and preferably in outdoor environments to reduce the spread of a disease, which can be spread, we now understand, by aerosol transmission. And this is something that was speculated on six months ago, but the data have only become more convincing in the past three to four weeks. And so it is taking the appropriate steps we can take to keep the community safe and operating under what we consider an appropriate margin of caution. We would like to be able to assemble larger groups. We would like to be able to offer more opportunity, and we hope to be able to explore those in the winter term.
But as I said, fall term, we are taking our guidance from best practices, from recommendations from the federal and state government, from what our epidemiologists are telling us. And also in terms of indoor gatherings that may seem innocent, if several students want to get together in a room, we’ve mapped our facilities. And we know a fair bit about air flow and circulation and turnover rate of the indoor environment in these different rooms and the frequency with which surfaces are or are not disinfected. All of this has gone into our determining a set of rules that govern the amount of time that students can get together and the numbers that they can assemble in an indoor space. They might seem arbitrary. They might seem even silly in some cases. They were all designed with understanding of the environment, of understanding of how the transmits as best as we can and doing our best to keep students outside of that disease transmission threshold, again, to protect the health of the community.
Anderson:
Joe, we have time for one more question, and then I’d love for you to be able to get to our guests. This question is about health safety and refers to something that Dean Lively said. For every policy we made about residence halls, the primary consideration was public health. And certainly you, I, others have talked about the public health being our top priority as we’re making our decisions. This person goes on to ask: How does mental health figure into that statement, or physical wellness, or academic success? What responsibility does the college have to serve the whole student and every student?
Helble
So, I’ll just be brief Justin, in the interest of time, but we take that very, very seriously. And in fact, if you look at Dean Lively’s email to the students yesterday, even though it was focused on winter term. In the wait-list process, she took time to comment on ways to get engaged with activities, ways to support students in their physical and mental health, and ways to give them access to counselors, deans, and resources that could help them talk through, for first-year students who transition to college, which is difficult under the best of circumstances for some students and certainly doing so in this time of pandemic and restricted freedom. We are in the process of hiring additional mental health counselors.
And as I said, we are looking very hard and carefully at additional activities that we can offer to our students group and structured and organized, including ones that would be open to members of the faculty and staff, to build community in more extensive and intentional ways in the winter term, when it’s particularly hard given the fact that as many may know, it’s dark longer in New England in January than it is in the summer. It’s colder and snowier. But if you’re dressed right and you’re engaged in the right activity, it can be a beautiful new way to explore a different part of the environment, a different part of the world. We’re working on putting those opportunities together exactly for these reasons, to give the whole student, the whole person, a chance to engage. Thanks to whoever wrote in with that question. I appreciate it, and it is very much top of mind.
With that, Justin, thank you for the questions. Thanks to all. I apologize we couldn’t get to more of them because of our delays and some technical issues at the beginning. I’d like to turn now to our guests, Lisa Adams, from the Geisel School of Medicine and our task force co-chair’ Antonia Altomare, a physician at Dartmouth-Hitchcock and infectious disease specialist and recently the DHMC hospital epidemiologist, and Julia Griffin, Hanover town manager for nearly a quarter century.
Welcome, and thanks to all of you for joining us. I’m going to move quickly through these questions so we have time to bring in questions from the outside. And Lisa, I’d like to start with you, if I may. Your note to the campus on Monday announced our first cluster, confirmed three new positive cases identified within the off-campus student community. Even with these positives, our overall rate of confirmed infection remains very low. I think we now have eight positives and some 20,000 student tests. But students testing positive are placed in what we call isolation. What does that mean specifically for our students, and how is it different if they’re on campus or off campus? How are we supporting them?
Lisa Adams:
Great. I’m happy to explain more about our isolation process. Just as a reminder, isolation is the public health practice of separating someone who is ill with a contagious disease from those who are not ill. And again, just to point out that individuals who have symptoms consistent with COVID must also isolate while they’re awaiting their test result. Isolation for our students generally means moving into one of our dorm spaces reserved for this purpose, the main features being access to a single bedroom, a single use bathroom. We also arrange for meal delivery, which students can actually order from dining services using their dining app.
Now, students who are living off campus may be able to safely isolate in their off-campus home. But if not, all off-campus students, whether they’re an undergraduate, a graduate or professional student are offered the option to isolate on campus. Whether they can safely isolate off campus or not is determined through a discussion with our college health services team. And of course, the same guidelines would apply. They need to have access to a single bedroom, a single use bathroom, and a way to get meals or food delivered.
Now, once in isolation, our College health nurses are in touch with all students, whether they’re on or off campus, daily to check in and see what they might need and see if they need perhaps a higher level of care. And if they’re on campus in isolation our Dick’s House providers can actually make house calls to see them if that’s needed.
And in relation to the mental health concerns and sort of the whole student wellness, to combat the social isolation that can accompany the physical isolation, we do offer counseling services to everyone as an additional sort of supportive service. Now, I will say, we know isolation can be challenging, especially when someone is not feeling very ill, and our students, like most young people with COVID, typically have very mild symptoms, or in some cases, no symptoms at all. So I have to emphasize that we really have appreciated our students’ good spirits and compliance with the strict isolation practices as part of their commitment to protecting their roommates, their floor mates, and the broader Dartmouth and local communities.
Helble:
Great. That’s great, Lisa. Thanks. And thanks also for the comment on supporting the students’ mental health. It ties in nicely with the last question that a listener had asked of me. Antonia, I’d like to turn to you now, and I’ve got a question or two about spread of disease in the Upper Valley. But before turning to that, this is your first time with us on Community Conversations. So if you don’t mind, I’d like to ask you just about your recent role at Dartmouth-Hitchcock Medical Center. What does it mean to be the hospital epidemiologist?
Antonia Altomare:
Sure, so, in general, epidemiology is a branch of medical science that deals with incidence, distribution, and control of diseases in a population. But specifically to the hospital, the utmost priority is really the health and safety of the patients, as well as the staff and employees that work there. Tracking infections that one would acquire because they came to the hospital, but not the reason they came to the hospital, so trying to really lessen the impact of any of these unintended harmful consequences of being in the hospital. That’s on the patient side, and of course, then on the employee side, it’s preventing exposures to the employees and infections that could happen in our staff.
Helble:
All right. That’s great. And it’s gone extraordinarily well, as I understand. We had Joanne Conroy with us as a guest a few months ago, and she was quite proud in saying that the rate of transmission within the hospital has been essentially zero, which is extraordinary given the number of patients that you’ve seen over the past six months. So if you’re responsible, well done. Turning to the spread of disease in the Upper Valley over the course of the pandemic, what can you tell us? What trends are you seeing in the geographic areas that D-H supports, and what indicators are you paying attention to?
Altomare:
Yeah, so I think everyone has noticed recently, like most of the other states in the United States, that case rates, numbers are going up. And in fact, the majority of our cases throughout this pandemic really have been in our southern region, really the more populated areas like Manchester, Nashua, and the larger counties where we just have more dense population.
Some of the things that we track really are the number of cases, cases by population. That way we can get a rate and standardize it and be able to compare across states. We look at hospitalizations because that’s certainly a surrogate for severity of infection and rising cases. And then we look at our percent positivity rate of all tests being done, and this has been very helpful for two reasons. One, are we actually doing enough testing, and do we really know our prevalence in our community? And two, when we start seeing that rate go up, and we think we are doing enough testing, it really means there are more cases. And we have always been in the 1% range, and if you get down into more granular details, we are actually increasing, and the most recent percentage is 1.3%. Although that doesn’t seem like a lot, that 0.3% more in a state our size actually means a lot. Our rate is certainly going up, and those are kind of the big three things we look at.
Helble:
Great. Thank you. Lisa. I’m sorry, Julia, I’d like to turn to you now, and think a little bit more locally and think very specifically about the Hanover community or the Hanover core of the Upper Valley. I won’t ask you about specifics for any students, but certainly we all know from reading the Valley News recently and hearing reports from colleagues in town that there have recently been cases reported in the Hanover and also in the Lebanon schools. Can you tell us how these cases came to light, to the extent that you can, and how the system, the schools, the town, and the local healthcare community have responded? How are we addressing these?
Julia Griffin:
These cases began to crop up about a week ago, Joe. We previously had two cases in the Hartford, Vt., school district right across the river, about three weeks ago. And then, within the last week, we had two cases that showed up in the Lebanon school district. Then last Friday, we had our first case at the Ray School, Hanover’s elementary school, then a case in the middle school, Richmond Middle School in Hanover, and now, a third case in the Ray School has cropped up. We also have one case in the Marion Cross Elementary School in Norwich, so that’s a total of four cases in our public school system, two cases in our neighbor, Lebanon, to the south, previous two cases across the river in Hartford, Vt.
There’s very, very close coordination in this region, across the school district superintendents’ offices, school principals, school nurses, our health officers. We all work very closely together, and we also work closely with both state departments of public health, both in the reporting and the contact tracing work that’s going on, and particularly in Hanover coordinating very closely with our school principals and school staff, administration staff, and decisions regarding isolation, quarantine, what classrooms perhaps should be quarantining, and what notification procedures we need to implement.
Helble:
OK, great. Thanks. Let me step back to, I have another question or two for you, Julia. Let me step back to Antonia, and in some ways build from that response. And Antonia, you touched on this a bit in your last answer, but although the totals in the schools and in the region remain relatively low, the number of confirmed cases, as I said earlier, in my remarks has doubled over the past two weeks in both New Hampshire and Vermont. What do you attribute this to, at a high level? And are there any additional measures that you would like to see the state or the region take in response?
Altomare:
As a result of the state’s investigation of these cases, we know that the majority of these cases are actually happening in small clusters. These are people that are either within families or close contacts of families, and they think it’s attributable to increasing small gatherings that are happening. People have been really good about avoiding large gatherings, but as a result, now people are gathering in their own homes with maybe a few more people. And as more people gather with more people, you start having this exponential increase in exposure opportunities. So there’s that.
And then there’s just known contacts with other cases that seems to be importing it in. I think a lot of our increase is probably due to the slow, the feel of what happens when we started opening back up. Restaurants going from 25% capacity to 50% to now full-capacity. The fact that people are just downright tired with this situation and becoming maybe a little more complacent or daring and perhaps going to events they weren’t going to before, maybe not wearing masks, maybe not staying as quarantined as we had been when we were kind of in our quarantine mode.
And I think the other thing that goes against us, particularly in New England, is the weather is starting to get cooler, and so the gatherings that used to be happening outside or the things that we liked to do outside are now shifting more to indoor spaces where, of course, there’s more risks of infectious spread.
I think some of the important things that our state could do, and we are one of few left, and I know it’s always been controversial, but is to perhaps mandate masking. I think we’ve been really good about it, but I think it’s been really difficult for individual employments and schools and communities to actually implement it without there being kind of this order or this mandate to do so. I think it would level the playing field for everyone in New Hampshire to say, “Well, if we’re in New Hampshire, if we have visitors or if we’re just out in public spaces and around people, then we should have masks on.” Obviously if you’re hiking, and you’re away from people, it’s not as important, but I can certainly attest to the fact that if you’re not wearing a mask hiking, you’re in the minority. I’ve been seeing tons of people wearing masks. And I think it’s all because we really want to do the right thing, and everyone in our state and community really are trying. And I think that’s been our benefit all along compared to what’s happening in other states that are as rural as us.
Helble:
Yeah, that’s actually an encouraging message. And that’s certainly something here, as a private university campus, although not a bubble with walls around it, but as a private university campus, we have tried, and I have tried, so many have tried, to stress that with our students who have largely been responding. When in doubt, wear your mask. You’re sitting in a room by yourself, but someone else could walk through? Wear a mask. You’re on the green, and you might run into other people? Wear a mask. There is very little cost to doing so. The sense of self assurance that it provides to everyone else is wonderful, and it helps prevent transmission of disease, which can be asymptomatically transmitted, so it’s hugely important, so thank you.
I want to make sure we have time to get to Justin and questions that come in from outside, so I just want to take a moment to ask one last question. Julia, I’m going to ask this of you and ask you to be brief if you can, in your response. But I know this is a question that’s on the minds of many, particularly our student community. Over the course of the summer, I think in late July, you wrote an op-ed as the town manager in Hanover that offered some thoughts to our community on what you would like to see in terms of student behavior. And this, of course, was before we had brought students back, and you had no way, none of us had any way of knowing how that would unfold. But what motivated you to write that op-ed? What message did you hope to convey, and what kind of interactions have you had with students since then?
Griffin:
The motivation to write that op-ed, Joe, came from two directions. One, the behavior that we were seeing of our Dartmouth student population, and not just the Dartmouth student population, but when you’re talking to Dartmouth students, one way to approach them is through The Dartmouth. We were seeing similar problems with our high school and younger-age population and young adults in their sort of 20s, was the large gatherings without masks, no social distancing. That had us really concerned about the potential for COVID spread. And we were particularly concerned about the potential for if that practice continued through the fall with students who had been away from town since last March and would be coming back to the campus in the fall, potentially bringing more virus vector with them, that we could see a COVID spread in a part of the state where we had worked so hard since last March to prevent the spread of COVID.
I wrote the letter to try and shake things up a little bit in terms of, “Folks, we need to pay attention to this.” And I also wrote it because I’m a very active participant in the International Town-Gown Association, which is a group of town and College officials that get together on a regular basis to talk about issues of mutual concern. And as you would imagine, town and city managers since last spring in college communities have been talking very actively about this issue.
So actively that we decided as a group, we needed to begin to take a position firmly reinforcing the notion that we need all of our population to take this seriously, but in particular focusing our efforts on the college-age population because the risks are so great that transmission can occur in that population without significant symptoms or a really significant impact of the disease, but can be spread to other more vulnerable members of the population.
Helble:
Right. Great. Well, thank you. Well, it certainly got noticed in our student community, and I think there are times, Julia, where being provocative is helpful and exactly the right approach to take. It certainly elicited a large conversation on our campus this summer, including in The D, and I think it was helpful to all of us in thinking about moving into fall term operations. Justin, let me turn it over to you in the small amount of time we have remaining, and see what kind of questions have come in for our guests.
Anderson:
Sure, Joe, thank you. I would like to extend a little bit beyond 4:30, which is a little unusual given our late start. I hope that we can get in a couple more questions than we might otherwise be able to. Since you ended with Julia, and talked about being provocative, I guess I’ll stay with Julia with what might be a little bit of a provocative question. A viewer writes in, “It appears that the town of Hanover and Dartmouth have different public health standards when it comes to masking and such. How are you aligned, the Town, and Dartmouth, and how are you working together to keep the entire population in Hanover safe and Dartmouth students not feel like the town is out to get them?”
Griffin:
The good news is, Justin, we have been working very closely with the college since early March, before it was clear that we had a pandemic by the tail. But when we were anticipating that we were heading down a potential long, dark tunnel, and coordinating on our public health approaches. The challenge in a state like New Hampshire, however, which is a purple state with a Republican governor who has tended to support the president’s position on the issue, for example, of universal masking, our governor has not been willing to make masking a universal requirement in the state.
Consequently, individual towns have had to adopt these ordinances over the course of about two months this summer, scrambling to try and anticipate in many cases in our college towns, the return of college students. Consequently, we have a patchwork quilt of compliance around issues like masks. But by far the population that we’ve been the most pleased by have been Dartmouth College students since they’ve come back in September. When the College really pressed this issue, and the town was able to back it up with our own mask ordinance, it was the College students who were taking the leadership role, and particularly emulating for our high school and middle school students what they needed to be doing when they came into town.
Anderson:
Thanks, Julia, and I just want to take a moment to just acknowledge that there has been very good coordination. We’ve been in meetings together, emails, exchanges, and such, and so thanks for that. I know that it will continue. I’d like to go to Antonia, and maybe try to turn a little bit to what could be positive news, at least in the future. Somebody writes in to ask, “What should ...” I think this is in the context of seeing increased cases in the region in the country. Someone writes in to ask, “What signs should we look for to know that, or to believe that, we have actually turned a corner and that things appear to be getting better, and that perhaps we might be beginning to get closer to some form of normalcy?”
Altomare:
Yeah. What are those signs? Some of the things that were making me happy in the summer were the declining number of patients that were hospitalized in our state, which we got down to single digits, which was incredible. Down from in the hundreds at our worst, and the number of new positives that were happening on a daily basis. Really looking at, well, how many new infections are really happening and how long is it taking that number to double? That’s our case-doubling count.
You know, we went out a couple weeks where it was taking seven to 14 days as opposed to just a few days to double. So that slowing of the infection rate is certainly a clue, as is the number of patients being hospitalized. I think when people ask me, “How long is this going to go on,” I don’t think it’s going to be a switch turning off. I think this is going to be a very slow, long process, but I do think there will be an end eventually. I just think we need to accept right now what might be the new norm to get us through this with the least amount of harm to ourselves and those around us.
Anderson:
Lisa, if I could go to you. A questioner asks whether we can elaborate on staff-positive cases and observes that there appear to be people who are positive who were not tested, or who did not appear to contract the virus on campus. Basically the question is, “Should we be concerned about community spread?”
Adams:
Well, I think as Antonia mentioned, and Joe mentioned too, we are seeing increased community transmission. That’s been confirmed by both New Hampshire and Vermont health departments, which to me, again, is just a message about doubling down on all the things that we’ve been doing to keep ourselves safe, that we were doing throughout the summer, and to really be continuing those fastidiously throughout the fall. I think, again, we know there’s community transmission. We have to be prepared for that, and that is something, frankly, that I think as we’ve also said is something that we would expect to happen with the change in season, and shift to more indoor time.
You know, I do think our testing protocols, our testing schedule, by identifying cases in employees shows that it’s working. We are identifying cases very early on. We’re able to make sure that people are isolating, perform contact investigations quickly so that contacts are able to quarantine and be tested promptly. So I feel like our system is working. Our process is working and doing all the right things that it should be doing so that we are able to react quickly and do what we can to halt transmission in the cases that we identify.
Anderson:
Julia, I’d like to go back to you for one last question, and that seems fitting because as the representative of Hanover, whether you work at Dartmouth, or attend Dartmouth, or work at Dartmouth-Hitchcock as Antonia does, or are a viewer in the community, we are bonded by our link to the town of Hanover. One person writes in a question specifically for Julia Griffin, “How are you addressing the potential for transmission in town, in the town of Hanover, particularly with restaurants operating,” at least as this person describes, “at full capacity?”
Griffin:
Good question, Justin, something that we worry about. Quite frankly, we have an awful lot of folks in the Upper Valley who even if a restaurant can operate at full capacity, once we close our outdoor dining and they’re reverting to indoors, I think people aren’t going to patronize the restaurants by sitting in. So we’re actually working with a restaurant group on a couple of drive-through takeout options.
One-stop shopping as it were for individuals who want to order a takeout meal and know it’s available for pickup in one location rather than having to dash into each restaurant, to enable us to continue to support our downtown restaurant community without feeling pressured to dine in. Because as I said, I’m concerned that the dining-in option is not going to be particularly successful. One, because people are uncomfortable, and two, because I think we may see more community transmission, which is what we want to avoid. So takeout curbside, takeout curbside, really important. We’re trying to enhance the opportunities for our downtown restaurants.
Anderson:
Thanks a lot, Julia, and thank you also to Lisa and Antonia. That was really interesting and helpful. To our viewers out there, again, apologies that we had technical difficulties at the beginning. We promise that won’t happen next time. Right, Joe?
Helble:
Right Justin. We’ll hold you to that. All right. Well, let me add my thanks, Julia, Lisa, and Antonia for a very helpful and engaging discussion on the health situation and the measures that we’re taking in the community. It’s extraordinarily informative, and I know matters a lot to people in the Dartmouth community and the surrounding Upper Valley region. Let me just finish with just another word to our viewers. Just a reminder that we all acknowledge how challenging this is, and I simply ask, we all ask, for your patience and understanding with the restriction. It’s for your understanding of why we are operating the way we are, operating to ensure the maximum potential for a successful fall term and a successful winter term return.
I also ask to every member of the Dartmouth community, particularly when things seem particularly challenging in a moment as winter approaches, I ask you to picture that gathering, picture that moment, whether it’s going to be next June at commencement, or later in the summer, or sometime next fall. But when we get through this, when we will get through this, when we gather as a community and we have the opportunity to be together in one place, maybe on the Green, and celebrate what we have collectively done to navigate this year successfully and return to normal operations, how extraordinary that’s going to feel having done so as a community.
So thank you for your engagement, thank you for your support. Thank you for everything all of you are doing to help enable continuity of our education for our extraordinary students. That’s all for this week. We look forward to seeing you again in two weeks on Oct. 28. Until then, everyone stay safe and stay well. We’ll see you in two weeks.
