Higher Education Webinar: Targeting, Testing, and Mitigating the Spread of COVID-19

Martin D. Burke, chair of the SHIELD COVID-19 strategy for the University of Illinois system, and May and Ving Lee professor for chemical innovation and professor of chemistry at the University of Illinois at Urbana-Champaign, discusses targeting, mass testing, and mitigating the spread of COVID-19 on campus.

FASKIANOS: Thank you so much, Erica, and good afternoon to all of you. Welcome to today's Higher Education Webinar. I'm Irina Faskianos, vice president of the National Program and Outreach at the Council on Foreign Relations. Today's meeting is on the record and the video and transcript will be available on our website Cfr.org/academic. As always, CFR takes no institutional positions on matters of policy. We're delighted to have Martin Burke with us today to talk about targeting, mass testing,  and mitigating the spread of COVID-19 on college campuses. Dr. Burke has chaired the SHIELD COVID-19 strategy for the University of Illinois system, and is the May and Ving Lee professor for chemical innovation, and a professor of chemistry at the University of Illinois at Urbana-Champaign. In addition, he serves as associate dean for research at the Carle Illinois College of Medicine, and teaches at the University of Illinois Beckman Institute for Advanced Science and Technology, and the Carl R. Woese Institute for Genomic Biology. So Dr. Burke, thank you very much for being with us. The university, your university, has been in the news with the systems that you're putting into place. So we'd love to hear about the test that you've developed for the University of Illinois to target and mitigate the spread of COVID-19 and share some of the challenges and lessons that you're learning from the implementation as we are starting out this semester.

BURKE: Great Irina, thank you so much. And thank you to the Council on Foreign Relations for the opportunity to share our story. I'll go ahead and share my screen if that's okay. Okay, great. So thank you so much again. And yes, as we all I think went through this same challenge last spring, when the pandemic kind of came upon us. I was asked by our Provost to figure out how to stand up and strategically deploy scalable testing as part of the university strategy to try to reopen and stay open safely in the fall. The first thing that really struck me was that this is all about safety to empower the community. We called this our SHIELD platform to represent that focus on safety as the highest priority. We also recognize that while testing was going to be really important, testing is not a silver bullet. And so we really went after a comprehensive program to deploy fast, scalable testing as kind of part of a comprehensive effort. We call this our target, test, and tell initiative, and I'll explain exactly what each of those pieces is meant to represent. Really kind of a comprehensive data science-driven, strategic deployment of testing with fast communication so we can maximize its impact. The other piece is that there was a lot of challenges that required a lot of innovation, and in Illinois we love to innovate. And we use this as an opportunity to try to do that. I'll explain those things, as well. The target, test, and tell platform is meant to represent on the target side, using frontier data science and modeling to help us figure out who to test and how often to test them in a way that would maximally mitigate the spread on our campus. And I'll show a little bit about exactly how we've done that. The second test piece is we recognized quickly that the kind of traditional nasal swab-based approach was not going to be sufficient for the testing frequency that we were aiming for and the speed. And so we innovated and developed a new saliva-based test that's very fast and scalable, which I'll describe. And then the last piece was to figure out how to communicate the information from that test and put it into action as fast and as effectively as possible. And so I'll tell you about a new app that we developed called Safer in Illinois, which is available free on the App Store, which is an app that allows results directly to the user's phone as soon as we have them. Within hours, we get the results out to individuals, as well as digital exposure notifications that are proximity based. And, actually, the last piece, an access screen that if you're up to date on your testing, and you're not positive, you get access to buildings. But if you're not, you can't and so this has been a key aspect of the program that's been very helpful. The last is this entire process has been in lockstep partnership with Champaign-Urbana Public Health District, which is our local public health, which we think has been a critical piece of our success. And so we always like to say we're running a program that utilizes fast frequent testing, rather than running a testing program, because it really is a comprehensive, multidimensional effort that's critical, I think, for making this work. And I'll try to describe why we say that.

Just very briefly, some of the modeling that we did as the take off point was if we did nothing and we have fifty thousand people in our community as faculty, students, and staff, so if we did nothing to mitigate spread, pretty much everybody would come infected very quickly. This is obviously not the goal we wanted to achieve. And so we alternatively looked at really a layered approach. If we implied a range of mitigation tactics in combination, we found that we could actually predict a really good outcome. So, two times per week testing of everyone, so that’s fifty thousand people twice per week was the target. We also wanted to have a high degree of compliance with masks, classes greater than fifty online, and both manual and digital contact tracing. And if we put all of these together, we predicted that we would get a very safe outcome. So we would have a bump when the students came back. This was because they're coming from all over the country with positivity rates commensurate with several hundred of them who would actually have COVID when they came, and that we would be able to find them quickly, help them get isolated, and then hit a nice, safe, steady state and have a safe environment for teaching and research and also not cause infections in our community. So this was obviously the goal. And this led us to really understand that we had to have multiple layers in order to make this work. So we're looking at the R0 or the chances of any individual spreading it to others if they get infected. As we can see, testing twice per week does a lot, it really helps in a major way. But, it's not enough on its own. Just wearing masks that makes a really big difference. But, it's not enough to get us below one. If we start combining just masks and testing twice per week. Now we actually predict that we would be below one and head towards a really good situation. If you start adding in classes greater than fifty online as well as other ways to kind of mitigate spread, including contact tracing, now we get to R0s that are very desirable. And this is the situation obviously we're aiming for. 

When we started looking at this, we realized we're going to have to test everyone, probably twice per week, at least to start. And again, that's fifty thousand people twice per week, that was a very large testing load. And this nasal swab was not going to work. And the problem is, many of you've heard, people first of all don't like to do it. There's also a lot of supply chain issues associated with it. We wanted to find something that was good at kind of easy and rapid self-collection that would not require as much in terms of health care workers and much easier. And there were a lot of reasons why saliva started to look really attractive. Okay. The first is people will be much more likely to do it twice per week, because it's noninvasive. And there were reports showing that even if the detection level was lower, if you were doing it frequently, you can still get very good mitigation of spread. Now the really exciting news is there was a paper that came out last April showing that in fact, you can detect SARS-CoV-2 in saliva even more sensitively than the nasal pharyngeal swab. Okay, so this was very encouraging to us. And it's also the medium that matters. When you look at saliva, of course, that's how we spread SARS-CoV-2, we know now by droplets, as well as aerosols, and so you're directly testing the medium that matters and really testing for infectiousness. We also get a quantitative readout by PCR, so you're actually getting number of copies per mil in saliva, and really start to understand in a data driven way, how to mitigate this. The standard method was the NP swab, which then involves viral transport media, as well as RNA purification, all of which are supply chain costs and time bottlenecks. There was a very encouraging report that had come out in April, a new saliva-based method that had come out of Rutgers. But the challenge was, it still required a very specialized collection device, and it still required RNA purification. So it kind of slows things down, supply chain bottlenecks, and was still very expensive.

My colleague, Paul Hergenrother, had, I think, a really bold idea to take directly from saliva to PCR. Could we cut out all the supply chain, make a very simple process, thereby making this scalable, cheap, and very fast? And so we launched kind of a Manhattan Project-style effort over about six weeks, we looked at thousands of different possible ways to do this. And the bottom line is, we found that if you simply heat saliva at 95 degrees for thirty minutes, it inactivates the virus but also we think breaks it open, exposes the RNA, and you can go directly then in a buffer to a PCR reaction. Excellent level of detection down to five hundred. So even more sensitive than the nasal pharyngeal swab, consistent with some previous reports, without the RNA steps being skipped, so we were really able to keep that really nice component. And all the details are in this manuscript that we put on the bio archive. We also then had to create a lab that could actually do these tests. And long story short, we converted our veterinary lab into a human COVID-19 testing facility. We had actually tested that tiger at the Bronx Zoo back in February, you may have heard about, so we had a leader in this area of animal coronaviruses. And we transfer that into a lab that can do up to twenty thousand tests per day right on our campus. That was led by Tim Fan and Paul Hergenrother. So, just to give you a sense, real quick, of how we did that, the logistics, so we popped up twenty different tents all over campus, we set them up so you literally can't walk to class without walking by a tent. It takes about seven minutes to come in and submit your saliva sample. We've actually now performed almost 400 thousand tests since July. The results are back within hours, which is critical. And inside the lab we're using these Thermo Fisher QuantStudio 7s and some robotics to make this process fast. 

The last piece is the app that I mentioned. This allows you to get your results directly to your phone in a HIPAA compliant and very privacy-first manner. It's only decoded when it hits your phone. You can also opt-in for a digital exposure notification, which is proximity-based so it'll tell you if you've been close to somebody who is exposed. And you can also self-report symptoms, etc. The other key feature is that if you are up to date on your testing and you are not positive, you get a checkmark. And this is actually now required at any building in our campus, you have to show your app on the way in to show that you're up to date, and that you're not bringing in COVID. If you aren't up to date, you get an X. And this means you have to go get your test or you've tested positive and you should be isolated. And so actually entry into any of our buildings is now predicated upon being a safe member of the community to be able to enter that building. The really exciting thing is this has now been picked up by our community. So actually, to get into any bars or restaurants or coffee shops around here, you have to also show your app. And this is a really nice way for us to integrate with the community to maximize safety.

The last, I think most important slides I'll show you is some of our recent data. This is our dashboard, I think, from yesterday. And you can see we've performed a very large number of tests. So far, our seven-day positivity rate, I'm happy to tell you is now 0.31 percent. We were able to open and never have to shut down our classes since we started and still maintain that rate at this point. That's been a big exciting success in that regard. And just to show you a little bit of the story, the daily new cases is on the y-axis on the left, that's the blue lines. And here on the right, we actually have the positivity rate. Okay, so number of new cases divided by the number of tests for that day, that's the line in orange. And then the bars in green on the bottom is number of tests per day. And you can see this access goes up to twenty thousand. So, on some of these days, we're performing about two and a half percent of all the tests in the entire United States just in our one lab, so it really shows the max, the scalability of this test is actually quite high.  So really quickly, I'll just say over the summer, we did a pilot, we were testing our faculty, staff, and our graduate students. And you can see that we actually started about one and a half percent, we were able to bring that down almost to eradication. We saw some really encouraging signs over the summer, then our undergraduates came back, okay, and we knew we were going to get a couple hundred cases. That's almost exactly what we got so the modeling was very close to what we expected. But the models had predicted then that this would come right back down. And we had actually worked into our model that some of the students would go to parties. In fact, we had seven to eight thousand going to parties three times a week and not wearing masks. So we knew there would be noncompliance. That still should have been okay with what the modeling has shown.

What we didn't predict is that some of our students would make really bad choices when they knew they were positive. The vast majority of our students have done a fantastic job. We've got great students in Illinois, and they've been great partners. But, unfortunately, a small number of our students who knew they were positive from our test, chose to go to parties, host parties, or otherwise break isolation and interact. And that caused a real problem. So we saw a spike. Actually, we saw increase in our positivity rate. Interestingly, before we saw the increase in the cases substantially, and this very much both spatially and temporally correlated with unsafe activities that were reported. So again, I think the key here is, we hit this challenge, but we had a very fast frequent testing program, so we could see it early. Okay, so we got a very early warning signal that something was wrong. And we saw it before the cases even rose. So with that, we instituted, very quickly, changes.

The first was, we looked at all the data and greater than 95 percent of all the cases were with the undergraduates. We actually started essential activities only just for the undergraduates, we didn't disrupt research and faculty could maintain their normal activities. But the undergraduates were only allowed to go to class, go to lab, go to work, exercise outside or go to religious activities, otherwise, they were grounded. And this was at the risk of getting suspended if they broke that. We also started prioritized testing, so we knew the undergrads were the challenge. And so we started testing some of them three times a week, the rest twice a week, and everybody else only once a week. So rather than fishing in the whole ocean, we just fished in the smaller pond, faster testing, faster results. And that also helped. The last was we saw a gap. Even though we were trying really hard to work with our Champaign-Urbana Public Health, to isolate as quickly as possible, there was still a delay in communicating to Public Health, and then them finding our students.

So we launched our own team, we called it Shield Team 30. The goal is to find and help safely isolate all new positives within thirty minutes. That's actually been a big success and really helped move things along faster. We started texting the students, instead of calling them. Apparently they like text better. And the text said, you know, you're positive, we want to support you, here's all the things we can do to help you. And if you don't respond, you're suspended. So we coupled the carrots and the stick. And I think that got us a really good level of compliance. You can see the result as we were able to bring the numbers quickly right back down. And a couple of things I want to emphasize, we looked very closely, and we didn't see any crossover between our students and our faculty and staff. Okay, zero. We actually tried very hard to find even a single case and we couldn't. We also have seen no evidence of crossover from our students into our surrounding community. And so I think because we're able to turn it around very quickly, we're able to stop that obviously very undesired outcome. We're not letting our guard down. We figure this could also, of course, get back into trouble very quickly if people make bad choices. And so the other thing we're doing is really amping up our efforts to partner with our students to really help them have the tools they need to make really good choices, have lots of safe socialization options, and have severe consequences if they choose otherwise. 

Okay, so just to summarize, we've learned that fast, frequent testing can help mitigate the spread in a large university community. The testing is not a silver bullet. It has to be integrated with all these other aspects to make sure it works. Our I-COVID test, as we're calling it, is a direct saliva to PCR test that enables fast, frequent testing on scale. Prioritized testing can make a big difference. Mechanisms to help people isolate quickly and safely is really important. And if anyone's interested, we're working very hard to try to make our platform accessible to as many people as possible. We're a land-grant institution, it's our mission, just to try to make impact and serve the public good. And if you're interested, Bill Jackson would be happy to talk to you about how we're trying to do that. And there's his email address. Thank you so much. Very happy to take any questions.

FASKIANOS: This was fantastic. Thank you so much for that overview. So, first question, how much has this cost the university?

BURKE: It took us about $10 million to stand it up. And it's going take about $10 million to run it through the semester.

FASKIANOS: And have you made your test, the saliva test, offered it to other communities? I know you're partnering with your community, but it seems like in other parts of the country, it would be a useful tool.

BURKE: Yes. We are on a mission to try to help anyone who wants access to what we've done, to help them replicate it in their own community. And so we've launched a collection of programs to try to do that. One is called Illinois SHIELD, the goal of which is to try to get our testing capability out to our entire state. The other one is called Shield T3, which is trying to help get it beyond Illinois, to the rest of the country and to the world. And both of those organizations are actively in the process of trying to build those partnerships and expand access. Shield T3 is working with I think now thirty or thirty-five other institutions, at different levels down the road of engagement, and about five or six other universities are already using our approach. And there's about seven different countries that have now teamed up with Shield T3 and are working on that to try to help get it out beyond the U.S. So, we're all in on trying to help expand access as best we can and really looking forward to partnering on doing that.

FASKIANOS: Fantastic. All right, let's go to all of you. 

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FASKIANOS: First question. What is the degree of efficacy as compared with the no swab test? And what is the cost per test? I know you gave us the cost for the overall.

BURKE: Sure.

FASKIANOS: This question comes from Mojubaolu Olufunke Okome, professor of political science, Brooklyn College, CUNY.

BURKE: Great, thanks for the question. And we've included the data I’ll describe in a manuscript that we published on the bio archive that I included in the presentation. Happy to send it if people want to find the link as a follow up. We did some comparisons to the nasal swab, the overall concordance looked really good in general, things matched really well. There's some times where things don't match because we think that the nasal swab will stay positive, far beyond when people are infectious. That's actually been an issue with the nasal swab. But overall, the concordance is really high. And now as I mentioned, we've run 350 thousand tests or more, and we track the CT values, which is the number of times you have to go through this thermocycler to see the virus. And we routinely see detection limits down to like five hundred copies per mil, which if you look at all the literature for the nasal swab, that's actually substantially lower than typically what you see with the nasal swab, or at least on point with the best cases. We've also done direct comparisons with other saliva tests that had been authorized via EUA authorization from the FDA. And we found ours to be more sensitive than the other tests, particularly one, for example from Yale. We think we've got an excellent level of sensitivity. And again, we've now applied it on population scale and seen it working. So we think it's got lots of data behind the fact that this test can work really, really well.

FASKIANOS: Great. The next written question comes from Bob McCoy. Perhaps this is not relevant to the intent of this presentation, but a significant barrier to successfully fighting COVID-19 is the politicization of what ought to be a purely medical matter by the current administration. How can this be countered? 

FASKIANOS: I'm not sure you want to take that on. But if you do, go ahead.

BURKE: I'd say we're a land-grant institution. Our mission is to serve the public good, and we feel like we have found something that can be helpful and our goal is to help make it as accessible as possible.

FASKIANOS: Great, thank you. Other questions. I see another one in the chat box. People are doing that instead of...

FASKIANOS: Bob McCoy is a fellow with the University of Montana. So thank you for giving us your affiliation, appreciate that.

FASKIANOS: You said you have very severe consequences for the students that are going to parties when they know they're positive. Are you suspending people? What are the consequences that you've implemented?

BURKE: They get suspended.

FASKIANOS: They get suspended.

BURKE: The people who are the most upset when that happens is the 97+ percent of all the other students who are doing a really great job and trying really hard to make this work. And I think what we've seen is, again, the overwhelming majority of students have been fantastic partners in this. And they're really proud that their university is being viewed as a model for maybe how we can stay open safely. And they also don't want to go home and have to take the rest of their courses online, in their parents’ basement. So they've been on social media, and in every other way the loudest advocates for let's all team up and make this happen. It's been a relatively small number of students who have made really bad choices. The brutality of this situation is the math is not on our side. Small numbers of people can make really tough situations very quickly, and I think this is 2020, we're in the middle of a pandemic, we all have to do our part. And that includes the students, they have to understand. You cannot throw parties, and you certainly cannot throw parties when you know you're positive. It just doesn't work. And I think the etiquette has to change. As a society, we have to say you just cannot act that way. And there has to be severe consequences when people make that choice.

FASKIANOS: Just as a note, we've passed the threshold in the United States of 200 thousand dead to this virus, and I think the projections now for January 2021 is, I think I heard today, 400 thousand. So, or somewhere there. So clearly, our behavior needs to change as a society.  There's another written question from Sunny Jha, an anesthesiologist at USC in Los Angeles, and a frontline COVID doctor. What are your thoughts on the idea of an immunity vaccination passport?

BURKE: Great. So first, Dr. Jha, thank you so much for your courage, and you're protecting all of us as a frontline health care worker. It's obviously heroic, and we really appreciate everything you and your colleagues are doing to keep us all safe. And I would say that we have tried to look very closely at the science behind the potential for reinfection. And the likelihood that someone may or may not be infectious post their kind of standard isolation period. And bottom line is, we're still trying to convince ourselves that there is a period of time during which someone would not be able to transmit the virus. We're being cautious and very data driven around this. So for us, we're not doing like an immunity passport. If someone does test positive, and they go through the standard isolation, and then are released by our Champaign-Urbana Public Health District, we actually put them back into our testing pool. And so you still have to test twice per week, we can follow their CT values, and we're doing this and if their CT value is very high, which is typical, that would translate to them having a very low level of virus in their saliva. And the science that's available would tell us they're not going to be infectious. If your CT value is very high, we actually allow them to continue. If their CT value is low, we put them back in isolation, and we track it. And if it ever drops back down, we put them back in isolation. And the idea is if they get reinfected, we would see it and as you probably know, there's been about five cases that have been confirmed around the world of people being reinfected with COVID-19. So we're playing it very cautious right now. But we'll continue to follow the science and the data. And if we can get to the point where we convince ourselves that for a period of time, the risk of reinfection is very low, then we will change to give a window of time where the person probably doesn't have to test but we're not there yet. That doesn't mean we're saying we think that you are infectious. We're just saying we want to be super cautious and careful about when we make that decision.

FASKIANOS: And in terms of the isolation, when a student tests positive or somebody on campus, is isolation in their dorm room or do you have a special isolation unit? Or where are you quarantining people?

BURKE: We set aside 5 percent of our total housing at the outset for isolation and support. And typically, for example, if it's a building, we have thirty thousand students in Illinois, so there's a lot of different housing situations. And so, in a large building, one of the floors would be set aside for isolation, for example. Students then are moved from their room into one of these isolation rooms, and we provide them a lot of support. I think that's obviously really important. We need to make sure that they have access to food and social support as well as any healthcare needs that they have. We partnered with a local health care provider through what's called a pandemic health worker program. They can get a kit that helps them track their symptoms. And they have telehealth, we have our Champaign-Urbana checking with them every day. We check in with them every day. There's a voluntary support Zoom meeting every day for everybody who's in isolation if they want to kind of talk to others and try to talk through challenges together. We really try to take a very supportive approach to this. That said, there's also, as mentioned, severe consequences if people don't stick to the isolation plan, they can be suspended. And I think that's actually important that we have both.

FASKIANOS: There's a question in the chat. I don't know who asked this question. Maybe they'll identify themself. Would this model work for nonresidential universities, like a commuter campus, community colleges, and city colleges? What recommendations would you make for these institutions?

BURKE: Yeah, it's a very different challenge, and we recognize that. So we are in some ways, fortunate to be in a very, somewhat contained situation. We call it a semi-contained community, because of course, there is travel in and out. But in general, it's much less than, let's say, for living in a major city or urban setting where there's lots and lots of mixing, or students are going home every night and having lots of interactions, and then coming back. So it's a different problem, we think that it's probably going to require customized kind of variant of what we've done. And that's actually going to be true in a lot of other situations as well. We're now trying to work with folks, think about army bases, and prisons, and vacation destinations, and K through 12. And they're all these different archetypes that are going to require customization or optimization of the program in the process. We don't have all the answers for those. And I can't give you data, because we haven't done it yet. But we think there's lots of opportunities to customize what we've done for different situations and try to figure out how best to mitigate the unique challenges associated with those different situations. And so that's what Bill Jackson and his team are working on, is trying to come up with these archetypical programs that could be in a sense, utilized in different situations and the learnings from each could then cross-fertilize each other. We're trying to set it up that way, so we can learn as much as we can quickly.

FASKIANOS: Fantastic. That question was from Elsa Dias in Colorado. So thanks for identifying yourself. 

FASKIANOS: The next question in the chat comes from Bob Klein at Ohio University. He likes the art behind you, by the way. He is also an ACE fellow. COVID-19 pandemic is happening alongside mass protests against black lives matter. For, as one example, how are you balancing rights together and exercise free speech with the need to manage the COVID-19 pandemic? ASU had some issues with this and he's wondering how you're dealing with it.

BURKE: Obviously a really important question and something that we all need to think about. How to help enable and empower those really important protests in that conversation to happen. We've been working very closely with our student affairs, academic affairs groups who really think very carefully about these types of challenges. And we've been cognizant of the fact that we have to be able to be open and flexible to allow those things to happen. We've had protests also on our campus, and those are allowed to happen. And I think the idea is to try, of course, to promote social distancing and safety as much as possible. And there's been, of course, many examples where people have been protesting very safely and socially responsibly, and of course, are really important things to protest about. I think that's really where we understand it's really important and we're really trying to make sure that that's able to happen.

FASKIANOS: Great. The next question comes from Dick Foster. Coronavirus blood tests were among the first solutions attempted. Blood was traditionally fluid tested. Saliva was dismissed as not having the potential for accurate diagnosis. If you agree that the sequence is correct, what was the breakthrough that led to saliva testing? We almost never hear about blood testing these days.

BURKE: I think that way back in March and April was when there was some initial hints that perhaps saliva could be used. I think a paper that really was helpful to us because we were already really trying to figure out if saliva could work. There was a paper from Anne Wyllie at Yale that they put on the archive, where they had shown as I showed in the presentation that you could detect SARS-CoV-2 and saliva more sensitively than the nasal pharyngeal swab. So that was a very helpful, I think, discovery. It still used RNA isolation, and I think we've all heard about through the team here were able to discover is that you can actually skip that RNA isolation and then go directly from the saliva to PCR, which really helped make a big difference in terms of its usability and scalability. I think the evidence accumulated quickly, and then the team here was able to breakthrough on the skipping RNA isolation. And now it looks like a really good way to do it. I think there's an inertia associated with the nasal pharyngeal swab because it's been around and it's been widely used. But there's lots of reasons why I think saliva-based testing can make a big difference, especially start thinking about fast reading testing of entire populations, started by K through 12. And there's just so many advantages to the saliva-based test. We're really trying to get the word out there that this can really be helpful and hopefully our story can really move the needle and people switching to saliva.

FASKIANOS: Bob has a follow up about the protests. Did you build that kind of activity into your models?

BURKE: We didn't specifically build protests into the models, but we did build seven to eight thousand students going to parties and probably not wearing their masks into the model. So some level of noncompliance to make sure that we were being very eyes wide open about the fact that these are young people, they're going to want to socialize. Again, what we didn't build into the model was willful noncompliance with known positivity. That's something we've now had to reckon with and deal with. We're working on trying to become increasingly cognizant of the challenge in the real world, as opposed to what we hope for, and we're learning every step of the way. That said, we don't view the noncompliance as something that can't be changed either. So, in addition, to continuing to now make our models better, we're also trying to push back against that noncompliance and really bring that down, because it's critical. I think it's humbling to recognize, we could build, we could test everybody every day. And still, if you go to parties, when you're positive, it's not going to work, right. So it really does have to be a really robust program. It's multidimensional, multilayered, and you've got to get community buy-in and a really good level of compliance. Everybody's got to do their part. That's just the reality of the situation.

FASKIANOS: I know, you said, you were working with colleges and universities and trying to get the word out. Is there any central repository of information that universities and colleges can consult for best practices and models of success?

BURKE: Yes. We have a repository of information about our system and how to deploy it. And that's where Bill Jackson is leading this effort called Shield T3 to try to help do that. So if anyone's interested, if you would contact Bill Jackson he would be very happy to work with you. And as I mentioned, I think thirty plus universities are already engaged with him. And we're aware of about five that have already been able to stand up our testing capability on their own campuses. And our goal, again, is just to maximize the impact as best we can and to try to help everybody benefit from our experience here. I think there'll be the best point of contact if people are interested.

FASKIANOS: Great. I'll get the contact information and share out that information to the group on this call, and maybe even to people not on this call, because I think this information is very much needed. Have you been working with the CDC?

BURKE: We've met with them. And we've been sharing all of our information with them. Because obviously, if it's at all helpful, we're really happy to do it. We have actually been sharing pretty regularly our information with them in the hopes that it can be of some benefit. They're very engaging, and they ask great questions, and lots of back and forth. It's been a good dialogue with them.

FASKIANOS: Great. And in terms of your partnership with state and local officials, how has that been working? Again, it's so important to have those synergies between the health officials and the local leadership at the sub-national level. So I think that would be informative to people on this discussion.

BURKE: Sure. Yeah, we've been very fortunate. We have fantastic leadership at the University of Illinois. The university level here, at our systems level, and we have a fantastic partnership in relationship with our Governor Pritzker. And it's been a huge asset. I can't begin to say how strong and important that's been. And we've also got a great relationship with our local Champaign-Urbana Public Health District. Decades of history around that and getting through some other tough situations. Of course, nothing like this. But measles outbreaks and things like this that have really tightened those bonds and learn how to work together. And we have a great relationship with our Illinois Department of Public Health as well. And we've been in close contact with all of them. So Chancellor Jones, our chancellor here at the University of Illinois, just a passionate advocate for our land-grant mission and doing everything we can to try to maximize our impact and serve the public good. Tim Killeen, who's our university president, very early on, he called this an Illinois moment in the making, and asked us to make sure we made it as big as possible. So that kind of visionary leadership has just been tremendous. And we have worked closely with Governor Pritzker, his office, and the entire state. It's just been tremendous partnership throughout the whole process, which we're very grateful for, and looking forward to continue to leverage to try to make the impact as broad as we can.

FASKIANOS: Another question in the chat box. Given how this virus disproportionately affects black and brown communities, what are you doing to promote this test as a public health benefit to those communities?

BURKE: Yeah, absolutely. So it's a critically important point. And we're working very hard to try to figure out how we can do that. That obviously means those are the communities we have the chance to having the most positive impact. And so, we want to figure out a way to do that as active conversation, the discussions going on right now. Exactly along those lines. And up till now, we've been focused on just trying to get it up and running and successful here at our university. Again, we're not celebrating anything. And we know we've got a long way to go because there's a very dynamic situation. That said, we feel like we've finally been able to show that it can work in our setting. And so now, a very large amount of effort is being pivoted towards how do we try to get this out to as many communities that need it as possible? And as the question correctly points out, there are groups who are very disproportionately affected by COVID-19. And so of course, a very important goal is to try to get this to those groups in a way that can really help turn that around. So it's a very high priority.

FASKIANOS: So in terms of your mode of instruction, you said over fifty students in a class is remote. So obviously, under fifty, you're meeting in classrooms. How have you reconfigured your classrooms in order to be socially distance? What are your professors doing, etc.? Do your professors have the option to be remote? Or is everybody in person?

BURKE: Okay, great. So yes, we have offered online option for both the students and the professors. If it's done live, it's by choice, everyone chose to do that. And so in terms of maximizing social distancing, there was a whole other team that spent the whole summer trying to figure out how to do that as best that we can. The decision was made, any classes that are greater than fifty are moved online. Okay, so as you point out, the classes have to be fifty or less. And what we did was just tried to use our largest lecture halls as much as possible is one of the key strategies. So many of the classes that were, let's say, thirty, people usually would be in a small classroom, you do the exact same thirty people, but in a large lecture hall, and then you can, of course, space everybody out. There's a lot of people who've chosen to try to go outside and have their classes, especially while the weather's nice and small groups, types of classes, which can also really help. There was a huge effort towards maximizing cleaning protocols and trying to figure out how to clean between classes and avoid any cross-contamination that way. And also a lot of thought around, of course, aerosolization and ventilation and trying to really think through issues associated with how to minimize the chances of spread through aerosols. It was really a comprehensive effort led by another team that was deployed just to think about those issues. And we've been working closely in concert with them to try to synergize with what we're doing with what they're doing. And so far, as I mentioned, I think the most important statistic I can tell you is, we have not seen any evidence of transmission in the classroom. And so I think that's really encouraging. And the problem is actually outside the classroom, in the residence halls, and mostly actually off campus. That's where we've had our biggest challenges, actually, is residence halls off campus. And so again, we're pivoting and flexing and trying to focus all of our energy on as much as possible mitigating that. But I think it does argue you can have in-person classes safely if you've got a very strong mitigation strategy. And of course we all want to get back to teaching our students and performing research and helping educate the leaders of tomorrow. And that's what we're committed to doing. And so I think it's very encouraging in that regard, that we've been able to do that.

FASKIANOS: And have you had a drop in your international students?

BURKE: I don't know the numbers, but we've actually had remarkably little loss of students coming in. We had a very high percentage of our students came and are actively participating in in-person classes. I don't have the exact breakdown between national and international. But overall, we've actually had most of undergraduates come back.

FASKIANOS: Noe Ramirez just raised his hand. Noe, go ahead, and accept the unmute prompt please.

Q: There we go. Thank you very much. Appreciate this opportunity to ask this important question. When you mentioned the high prevalence rate with the Latino and Black communities. I recently read some research that diet could be highly correlated with risk to COVID, especially the diet involving, for example, the gluten that is oftentimes found in, that is common in Latino diets like with flour tortillas, or the pastas, for instance, that other groups may consume regularly. Are you familiar with any research that might point to the diet also being a risk factor for COVID, particularly among the nonelderly population?

BURKE: Thanks for the question. I'm not an expert in that space. And I don't have any additional information or I'm not read up on that issue. I actually don't think I'll be able to comment specifically. Otherwise, to reiterate, as already has been discussed, the numbers are clear that there's certain communities that are being disproportionately affected by COVID-19. And so I think, of course, obviously, we need to help understand why that is and what we can do to try to address it. I don't have any specifics to add on the question you're asking. But just to acknowledge that it's a really important issue, we really need to better understand it and try to help.

FASKIANOS: Bob Klein has a follow-up question from Ohio University. How's the concern over clinical placements, internships, and student teaching being managed when students are going off campus?

BURKE: We have here at the University of Illinois, the Carle Illinois College of Medicine, which I'm very grateful to serve as the associate dean for research, and we have our students in the clinics. And the answer I guess I can give you is that they all have to go through the exact same kind of rigorous, twice weekly testing program, at the beginning, that everybody else did. They've also been switched to once per week, since we've changed the progress testing towards undergraduates, because we didn't see challenges in that space, but they're all being tested frequently, like everyone else. And I think that by having it be comprehensive, and having all of that data, it's allowed us to make sure that we look out for any issues in those spaces, and we haven't seen them yet. And so without evidence that there's any challenges there, the plan is to keep them on the same testing frequency we have now.

FASKIANOS: You mentioned that in order to enter bars and public spaces in town, you have to have this check. So how are the locals taking that? And do they have access to the test as well? And how often are locals who aren't part of the university system being tested?

BURKE: So first, the bars have voluntarily chosen some of them to use this, if you're an Illinois student. They did actually make a provision, if you're not an Illinois student, you can just show that you've been tested recently by printing out your test. And I think they use that to let them in. I've not actually seen the process working myself. But that's why I've heard that it's being done. If you're not able to get the app with the test from the university, there are alternative ways to show that you're not positive. And, and again, it's not all of them. But what's been really good, it's been the bars and restaurants that are most frequented by our students. They've been able to use this as a vehicle to help kind of partner towards creating that safe socialization environment. We have not, yet, been able to expand our testing to our local community. But it's a very important goal, and we're working very hard to try to get there. So as I mentioned, up till now, we've just been trying to make sure we got it up and running in our own university’s faculty, students, and staff and make sure we can make it work. And as we continue to try to refine that process now that we've seen evidence that it can, we're really working hard to try to expand access to our community.

FASKIANOS: Bob Klein had a clarifying point he meant also student teachers in the schools.

BURKE: Okay. Everything I've been describing is for the University of Illinois, not for the K through 12. Just to make sure we're being clear. K through 12 is a critically important goal. We're trying really hard to figure out how to help in that space. But everything I've been describing is for faculty, students, and staff at the university. And actually everyone in any of those groups is participating in the testing program. That would include any of our teachers or members of the community who are teaching the students.

FASKIANOS: Thank you. The next question comes from Nel Martinez. Once the vaccine is available, have you thought about making the vaccine a requirement of all students, faculty, and staff? Clearly this is going to be a year, we hope, and it may be even longer before this may be an option, but will you make it mandatory or optional?

BURKE: So we haven't made any decisions as to whether a vaccine would be mandatory or optional.

FASKIANOS: If there are any last questions, I'm happy to take them. Otherwise, we can bring this to a close. You've given us so much information. And it's clear that this model should be taken to other parts of the country and other communities. Because, as you said, if you're not testing, then it's hard to control this, or contain it. So any other last questions? I think the queue is done.

Martin Burke, thank you very much for doing this. We really appreciate it. I will circle back to you if you would be willing to share the presentation, or at least your bio archives and contact information, so people can follow up with the members of your team who could help push some of these things forward. We will also include with that a video and transcript of this session so that you can share it. Because I think the information that you've given us is so important, and we need to get it out there. So thank you very much.

BURKE: Thank you so much for having me, and giving us a chance to tell our story. Thank you.

FASKIANOS: For all of you, in between the first and second presidential debates, we are hosting a Virtual Election 2020 U.S. Foreign Policy Forum on Thursday, October 1, from 3:00 to 4:30 p.m. Eastern Time. The discussion will address foreign policy challenges awaiting the winner of the election, and what Americans need to consider as they cast their vote in the coming days. So I hope you'll join us for that event, and you'll share the invitation or the announcement widely with your networks. So again, please follow us on @CFR_org and @CFR_Academic on Twitter, and go to Cfr.org, Thinkglobalhealth.org, and Foreignaffairs.com for additional information and analysis on COVID-19 and a whole array of topics and issues, and I hope you all stay safe and well. So thank you. Thank you again, Martin Burke.

BURKE: Thank you very much.

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