Higher Education Webinar: Campus Health and Safety

Wednesday, July 22, 2020

Chief Health Officer and Professor of Medicine, Division of Infectious Diseases, University of Michigan


Vice President, National Program and Outreach, Council on Foreign Relations

Preeti N. Malani, chief health officer and professor of medicine in the division of infectious diseases at the University of Michigan, discusses campus health and safety measures to be taken for the fall term.

FASKIANOS:  Thank you, Maureen and welcome to everybody 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. CFR Higher Education Webinars bring together college and university presidents, administrators and professors to explore strategic challenges and share best practices for meeting them. We are delighted to have Preeti Malani with us to talk about campus health and safety measures in the fall term as we are still in the midst of the pandemic.

Dr. Malani is the chief health officer and a professor of medicine and division of infectious diseases at the University of Michigan. As chief health officer, she serves as an advisor to the president on matters of health and well-being of the university community, including disease management, public health preparedness, and promotion of healthy practices and climate on all three campuses. She is a director of the National Poll on Healthy Aging based at the Institute for Healthcare Policy and Innovation, and serves as an associate editor of the Journal of the American Medical Association. As a graduate of the University of Michigan, she had a master’s in journalism at Northwestern University's Medill School of Journalism, and received her MD degree from Wayne State University. She completed her internal medicine residency infectious disease fellowship at the University of Michigan, where she also received a master's in clinical research design and statistical analysis.

So, Dr. Malani, thanks very much for being with us. As colleges and universities race for the fall, can you talk about what you're thinking about and doing at University of Michigan? What your health and safety plans are to reopen the campus?

MALANI:  Thank you, Irina. Thank you to CFR for having me. It's really an honor to represent the University of Michigan and to share a bit about our bizarre pandemic planning journey. I don't think anyone really could have predicted where we would be. So, a couple of caveats is this is really hard work. Things are changing. And although I'm the one speaking to you today, this is really not my work. It's the work of hundreds of people. And I've been fortunate to be part of the planning, but this has really been a labor of love for so many of us.

As you heard, I'm an infectious disease physician. So, I pay attention to WHO reports and I heard about this cluster infections in January. And on January 20, I sent an email to my boss, the University of Michigan president who happens to be a physician and immunologist and he's always you know, he likes to be kept up to date and I'm just going to read you part of the email. Happy New Year. Quick update. I'm sure you've heard about this outbreak of respiratory illnesses from Wuhan city, China, believed to be a novel coronavirus, so like SARS and MERS. Situation's dynamic, but risk of person to person transmission appears to be much lower than SARS. Lots of unknowns right now. The CDC and WHO are involved along with Chinese public health. And then go on to say, you know, we're going to do this and this and we'll pay attention. And I'll kind of let everyone know, just as an FYI, for situational awareness. Sure enough, the next day, the first case in the United States was identified at that time. It was the first case in Seattle. And here we are now more than six months into the pandemic. COVID has changed everything, not just in healthcare, where I work, but how we interact socially, and how we learn. I think back to March, which really feels like a lifetime ago, within a matter of a few days, every college and university in the United States and really, most places in the world, made a unplanned, rapid pivot to remote learning. And at that moment, it really felt like we flipped a switch. We turned off the lights. We closed the door. And we just said, "Go home, everyone go home." And if you could go home, you left. Health and safety was really the only consideration. And we have numerous considerations about things like equity inclusion, overall well-being.

We were very concerned, it's hard to learn remotely. It disadvantages people disproportionately who already are going to have more difficulties in learning environment. Depression, anxiety, loneliness are already at epidemic levels. What is isolation going to do to make that worse? But, the risk of COVID really drove our decisions at that time. And we've learned a lot since then. My state of Michigan was was hit early. It was hit hard and we fortunately came out of it and have reengaged a lot of our economy. Clinically, we've learned a lot of things including the potential for asymptomatic transmission, and the importance of face coverings in terms of prevention. And now it's July and we're poised to return to learning with what is being dubbed, most places a hybrid model with lots of things planned as remote, but some smaller classes and other activities end up in person format.

But unfortunately, the fall semester is just a few weeks away. And the pandemic is not under control in the U.S. And in fact, in some places, it's completely out of control, especially in the southern and western U.S. And as a nation, we're seeing about 60,000 to 70,000 cases a day. This is all in the backdrop of still having issues with testing, especially in regards to turnaround time, capacity, it's still taking far too long in several states to get tests. And there's not a clear strategy nationally on how to contain the virus. So, it's really been 50 different countries in some ways, with different states, having different processes and procedures and really being at very different points in the pandemic. In the best of circumstances, I think we all knew that getting back to face to face learning was going to be difficult and it will be difficult. And in fact, several schools that initially planned on being back in residence have rescinded those decisions in recent days, because it is so complicated.

But many public health experts, including myself, believe that there is a way to resume residential learning in a careful, thoughtful manner that mitigates risk, with the understanding that there is always going to be some residual risk when you are gathering thousands of people. And there will be cases of infection even with the best planning. But this all can really only happen if community spread is controlled and again, in some parts of the country, that's not the case right now. We don't always talk about the why of why to do this because frankly, the safest thing would be to just stay home and wait this out. And for some people, that's going to be the best option. But there are a lot of whys as to the importance of trying to make this happen and in trying to get back to something that feels more like normal and is the more traditional in residence face-to-face educational opportunity.

In late June, the University of Michigan announced plans for a public health informed in-residence semester this fall. And this was met with lots of celebration by students and parents and faculty and everyone, we're really excited about it. And this is going to be a mixture of in person and remote classes. It's gonna be structured in a way that promotes best practices from a public health standpoint, while also fulfilling the university's core mission of transformative education.

Getting to that announcement required effort of hundreds of members of the event community it was an extremely detailed process; it included several workgroups and committees. Then, there were several guiding principles with health and well-being not just for campus, but the surrounding community and our state at large being at the top of the list.

Another big consideration, and I want to sort of put this out there, is that COVID is unfortunately here to stay. So, one of the principles was also thinking about how can we adapt? How can we reframe and find ways to do some things in person, but have flexibility too? One of my colleagues refers to this as the flexible fall plan. I think that that's a good way to think about it. These advisory groups included a committee that addressed the numerous public health considerations. And this included—I was part of that committee. They were several members of our School of Public Health faculty. And what was great is these are the same people who have been advising our state governor, and other leaders on how to get our state back on track. So, we really had excellent expertise in terms of what we do, what can we scale. Another committee looked at ethics and privacy which are really important when it comes to COVID.

The provost organized several subcommittees that considered every aspect of education. Everything from small learning places, studios, performance studios, labs, graduate students, international students, foundational courses, the large courses, academic spaces other than classrooms, instructional planning, and each of these were separate standalone committees that also included student engagement in every one of these, really understanding what the student leaders were saying, and really getting diverse opinions and input from all corners of the student body. And I have to say it was an extraordinary process. I, I started to joke that, you know, we were we were a little bit later than a lot of schools in terms of making our follow announcement, although we were headed in that direction. But I kind of joked that it was like sort of the typical Michigan way where we did all our homework, we did all the extra credit, we wrote this big, long paper, and we handed it in.

And so a lot of that work, and actually, I'm going to share in the chat box, the amazing blueprint, a lot of it's there and some of the advisory committee work is also there can be found on these websites for people that are interested. Now, not all of the advisory committee work ended up being incorporated in the end, but it's pretty interesting reading. The university leadership has made it really clear that the semester ahead is going to look and feel very different than anything we've ever seen before. The plan is to conduct an in-person semester that focuses on sort of basic public health strategy. So, things we've all become very familiar with: social distancing, wearing face coverings, washing our hands, monitoring ourselves for symptoms, clinical testing, contact tracing, quarantine, minimizing travel out of the area, and really having shared responsibility for these things.

One of the big issues is large gatherings. College campuses are like one big large gathering, and some of the concerns that have been raised in recent weeks by peer institutions have included the fact that there've been large parties on campus and what could that do? Could one bad decision end up really impacting the entire region? So, I like to quickly summarize some of the key components for the fall plan. And again, that amazing blueprint has all the details.

One comment I wanted to highlight is the importance of communication. Our communication colleagues and our vice president of communications Kelly Michaels have been there every step of the way with us really since day one. And they've helped us produce FAQs, help find holes where we weren't providing enough information. And they've really just done an amazing job of curating information. So that is one good thing that all of us should use as our communications colleagues and public affairs folks. The name Maize and Blueprint implies that things might change and need to be adjusted as conditions change. And I think that that's also important in terms of managing expectations is that this is our plan, but the plan is subject to change like a blueprint.

From a standpoint of instruction, students can choose from an in-person, remote, and mixed-instruction depending on their needs. We recognize that some students are going to need to take courses remotely. And whether that's their personal health or their family's health issues. And we wanted to make sure that that was an option. For decisions about what to teach and how to teach was being done at individual school and department level. In general, large classes are going to be remote, small courses will be in person, and medium will be a hybrid depending on everything else, like classroom spaces and the pedagogical requirements. There'll be other changes to reduce density, fewer seats, limitations on gathering and public spaces. You won't be able to go into every building all the time; you might need an ID card to get in; you might need to be screened to get in; classrooms are going to be reconfigured.

There's also a realization that remote teaching is different. And one of the things that the provost and others did was to make sure that there are resources to help improve remote teaching, to understand that there are ways to improve course design and have best practices when you are working remotely, it's not quite the same.

The academic calendar has been redesigned to reduce back and forth: we're going to start on time, we're going to cancel fall break, and we'll plan to end before Thanksgiving, with the finals and the rest of semester being done remotely. When we come back in January, it's really hard to know what things might look like. But we're going to also start a little bit later with the understanding that we might need a couple weeks just to get things ready for campus.

We recognize that a lot of faculty, staff, students, and parents have concerns about return in-person learning. And we're continuing to develop plans, particularly for those who are medically vulnerable and high risk. We are putting together a dashboard really collating the data we have, and having this in a very transparent and ongoing fashion of who's being tested, how many students are tested, how many are positive, and although some of this information is available in different spaces, we want to make sure it's available in one place for everyone. We've also thought about triggers that It might change what we're doing, this idea of like a yellow, orange and red area. We're finalizing plans and protocols for testing. Testing of asymptomatic individuals will primarily focus on students living in communal housing, whether it's the residence halls or co-ops or fraternity houses.

We've also really worked closely with our county health department. And in fact, our environmental health services group is a deputized arm and so they can do outbreak investigation where have more resources for contact tracing. Housing is going to include quarantine spaces, and we've been doing this since March, we've had students get sick, who can't go home, and we have a plan to take care of them: everything from getting them there, getting them fed, supporting their well-being, supporting their academics. So that's going to be something that we anticipate the need for.

International students are a special concern. We have an international center that's working on policy and visas. We're going to figure out that need for quarantine after arrival. Our health service has been phenomenal and their ability to take care of a lot of patients with COVID. They've had a lot of practice. And fortunately, we haven't had any students get seriously ill. But if someone does get seriously ill, Michigan medicine is a few steps away—where I work—and we stand ready to take care of people. And we again, we really hope that that's not the case, but we have a lot of experience taking care of patients with COVID. And it's it's one more part of the plan and it helps leverage that expertise. We're developing screening tools and self-monitoring plans that came about supply chain, having enough hand sanitizer, for example. And basically all this combined will be a stackable set of interwoven interventions that can enhance the health and safety of our community. Campus is going to look different. We're working on some of those details. Co-curricular activities will be different. Common spaces like libraries will look different. Dining will probably be grab-and-go for the most time.

And again, I just, you know, there's not a one-size-fits-all solution for all colleges and universities to resume in-person learning and some are going to be better positioned to do this than others. And again, I think that the University of Michigan is sort of typical of a lot of large public schools, in that our borders are not set, people come and go from campus. Spaces are different, and the scale of our enterprise is really massive. I want to thank everyone who is listening in for all you're doing to support your campus community. This is really, really hard work, and it isn't going to end anytime soon. We're only halfway through this marathon. So, pace yourself and I hope that you will also find time to take care of yourself while you take care of everyone else.

FASKIANOS:  Thank you very much. That was terrific to hear what you're doing and now let's go to questions and comments and sharing best practices.

(Gives queuing instructions.)

Let's go first to Reynold Varret.

Q:  Hello, Reynold Varret, president of Xavier University of Louisiana. The question I would ask you is to ask a more nuanced answer, how you're managing the apprehension of faculty and staff, especially faculty who are older, who do want to teach their students but at the same time, have a sense of apprehension and how you're assuring them of a measure of safety when engaged in person.

MALANI:  Thank you, Reynold, for that question. I think that that is such a key question. It's not just faculty but I think parents and students as well and part of this comes down to the communication. We're actually in the midst of doing some smaller town halls and trying to answer questions; trying to be aware of these of these concerns. These are real concerns for folks. And I think, you know, for some folks, it's not going to feel good to come back, it will be unsafe because of their own high risk. We also, one thing I didn't talk about in my introductory comments was this idea of shared responsibility. And having really like a zero-tolerance policy among the students, and we're figuring out exactly what those details look like. But then there's a like a shared responsibility compact among the students that they've helped develop. Now, this idea that I can't go and do what I want necessarily because it's gonna affect everyone else. In the classroom, it's got to be safe, which means everyone's got a mask. No one can come in there who is sick. People have to maintain distance, respect, safety. And we're actually, a lot of our leaders on campus, our deans in particular, are showing examples of this and leading by example, many of them are teaching, but this is an ongoing issue. It's one that we're trying to address through careful communication. But, you know, I understand the concerns.

FASKIANOS:  Let's go to Pearl Robinson.

Q:  Pearl Robinson, Tufts University. I'm also on the faculty senate. And this morning, we had one of our updates by the president. Similar things though, I think you're more inclusive. The question I actually wanted to ask is: how are you handling what undoubtedly is an upsurge in demands for diversity and inclusion?

MALANI:  Thank you, Pearl. I think if I understand that, and again, University of Michigan, the diversity, equity inclusion aspects are really central to everything we do. And it's actually been one of the big initiatives of our president. Part of this, you know, this whole pandemic has not affected people in a uniform way, you know, whether it's clinical outcomes, or economic issues, and a big aspect of all the effort to try to get back to some sort of semblance of an in-person, residential experience really focuses on that. And not just, you know, at every level, it's like the equity in terms of your educational experience, but also what the community looks like because you know, being at home isn't the same. And being home for some people isn't safe. And we saw this play out in our spring, where some people couldn't leave campus and it was quite remarkable to me and I really think about the well-being piece.

 I should add, I'm actually a Michigan parent. I have a child who is a third-year student at Michigan. So, this is very personal to me and I am also a faculty member teaching. But I think, really for us, we are thinking about the DNI. The other aspect is that in classes, some students, some faculty, others may need accommodations. And I think being very sensitive and very specific with those instances to make sure that the classroom remains inclusive, and that it is a good place for everyone. And again, our our director of the services for students with disabilities is involved with our operational planning. But I want to say that it's been the lead folks in this area have been involved. They've been at every table, whether it's public health, it's a lead group, or the provost group. Important issue.

FASKIANOS:  Thank you. Let's go to Patrick Duddy.

Q:  Good afternoon and thank you for doing this. I'm curious to know more about how Michigan is going to handle both faculty and student—especially graduate student—travel, in connection with research, both research within the United States and research internationally. Thank you. I'm at Duke University.

MALANI: Thank you, Patrick. This is this has been a good discussion. I also didn't mention that our research enterprise has ramped up during the summer, which we're very happy to see. And it's actually given us an idea of what, of course the scale isn't what we'll see in the fall, but we've actually got all the wet labs back up and obviously some research continued. And there have been some instances where people have had to travel to another state, or even another country, to resume their research. And these have been handled by the case-by-case basis. University wide, we have a suspension on travel. I don't like calling it a travel ban. But that's basically like, it's sort of a pause on travel for multiple reasons, including the just the safety piece for campus. And frankly, I don't think people are really traveling to meetings and things right now they're traveling because they have research obligations or other obligations. So, we do have the ability to allow that. And I think it's especially important for graduate students, obviously, other investigators, but graduate students who have to be somewhere to finish up their work. There is some allowance for that. And again, we have a safety plan, and some of them never came home, frankly, because they're so integrated in that community. What we aren't doing is letting undergraduates and frankly, they're not in the labs at this point either because of density issues, but resuming research, especially has been one of the exceptions to some of the travel restrictions, but it's been on a very limited case-by-case basis and it really has to be reviewed at high levels. So, we're trying to make exceptions and be reasonable.

FASKIANOS:  Let's go to Mojúbàolú Okome. Excuse my pronunciation; you can correct me.

Q:  Okay, it's Mojúbàolú Okome. And I teach at Brooklyn College, which is part of the CUNY system. So you know, a lot of what you're saying, I think, sounds great for institutions that have resources, that have money. We have a budget cut underway, and we were not flush with money before. So, a lot of this and then we are predominantly commuter campus at Brooklyn College. There's a tiny dorm that is a for-profit person that built it. And I have to also confess I have a lot of underlying conditions. So, I am very, I'm very concerned about people's eagerness to embrace face-to-face teaching. Because it just takes a, you know, one infection to affect some people very drastically, whereas other people might recover very easily.

So, what is going to be gained by every institution thinking that they can do this? I think you need resources. Apart from the communication thing, if you can't really maintain social distance, if you cannot clean as well as you need to do, if you can't do a lot of these monitoring, it's dangerous, and it makes absolutely no sense. So that is my feeling. That's my comfort level. However, I also have a child who is in medical school. And he's actually on campus. He has not come home since COVID started. He's able to afford to do all these things that I'm concerned about. But you know, it's a matter of money and we can't, you know, there are these divides in terms of access to resources. So, there are poor institutions and wealthy institutions. And I'm concerned that the wealthy institutions are kind of just making it seem cool, we can do this, it's possible. Poor institutions, we have students of color. We have had faculty deaths at Brooklyn College, student deaths, staff deaths. When this kind of thing happens, it's very different from where nothing has happened, and it's all cool, we have money, we can do this. So, there's a disparity. And I think it's a kind of wake-up call for Americans who are not aware that we have this disparities and they have life. They have impact, significant impact on people's lives.

So, I just wonder where are the voices of people who are not, who don't have money, who don't have the resources in this discussion? And that brings the question of diversity. Okay, because it's, there's a race, diversity, and black. Lots of black people have died a lot more black people than, you know, people of color have died. Poor people have died more. You know, so where are these voices in this discussions that we're having? Because I think we are having discussions of people who have voice and resources and power and then they're saying this is possible, but I dare say that, you know, for me I think we need to kind of be more inclusive, be more thoughtful. And America is not doing well, when you compare this country with other industrialized countries in terms of managing this crisis. Thank you.

FASKIANOS: Thank you for that.

MALANI:  Yeah. Thank you Mojúbàolú. Well, I agree with you fully. And I hope it came out in my comments that this is not something that every college and university can do. I think that Michigan is uniquely suited to do it. And in part because things are better here, in terms of the pandemic right now than they were. I mean, we were one of the hotspots just like Brooklyn and New Jersey and others and like some of the places are right now. We actually, we saw this play out we saw it play out on our campus, we also had deaths on our campus. And this this disease is not proportional. Absolutely there are people who are very vulnerable. And that is one of the guiding principles. And one of the issues is that not everything can be done in person. And, you know, frankly, that idea of the flexible fall. It's not just like, "hey, we're going to be in classes as usual." For some people, it's that that classroom is not going to look at all like what it normally looks like. It may be a very large classroom with very few people and it may be an outdoor classroom. It may be a lab that occurs, you know, in our arboretum or something like that. So, I do think we need to think about that.

I didn't mention that the University of Michigan system also has two regional campuses that sound a little more like the CUNY Brooklyn system too, both in Flint and Dearborn, and these issues have been discussed and the resource issues are different on those campuses, not just in terms of enrollment and money and what things look like and what our student body looks like in terms of who they live with, if people live in intergenerational families, many of them with grandparents, and parents and siblings, and others. And the health resources are also different in different areas. And I think that those are all important considerations. This can only be done if everything kind of falls into place. And I mean, you know, some of it has to do with the pandemic; some of it has to do with planning. But, a lot of it has to do with how the students are going to come back and manage their day to day life. Like if they're not going to be responsible, this will end very quickly. And I think that that's very clear, it's been made very clear. There's some schools where the deans have really made very, very zero tolerance statements. And I think those are strong statements because this is why we can't put people at risk with this. But at the same time, I do believe that this is here for a long run. So, thinking about what we can do safely, not that we can do everything because we certainly can't do everything. It's a very small portion that we can do. But I agree with your comments. Thank you.

FASKIANOS:  Let's go to Andrew Guertler next.

Q:  Oh, good afternoon. I'm Andrew Guertler from James Madison University. I'm the medical director. I have two related questions. You stated earlier that schools shouldn't open unless community spread is under control. I'm wondering how you would define what under control is and kind of addition to that is have you developed criteria for closing campus if certain things occur?

MALANI:  Yes, thank you, Andrew. You know, the issue of community spread is a complicated one and the numbers that people talk about, you know, hundred cases per hundred thousand. That's a pretty high number. And some of the states that are having a lot of spread right now are lower than that, but they concern me. So, you know, for me, you could come up with a cut point number, but it's also the trend and where things are going. And this doesn't move fast, like the curve doesn't go up fast, and it doesn't come down fast. I mean, that's what we talk about flattening the curve. And we saw this we actually in Michigan, where we're overwhelmed, and to the point where we thought 3000 people were going to need to be housed in a field hospital. So, this is very real to me. We had many, many patients at the hospital who were very ill. So, we pay attention to sort of what's happening in the region very closely. And we do have triggers, and this is something that our School of Public Health folks are helping develop. And they're doing this for the state as well. But this idea of, you know, even like a yellow, orange, red, and like at what point where we would we say "you know what this is... we can't continue." And we actually have some of those. I don't have them in front of me. But we came up with case counts and percentage increase over several days. But those are important considerations and to have something so that it's not just like a, well, I think this is good, or I think this is bad because you don't want to really make a premature decision either way. Like, if it's sort of a stable, but sustainable count, you know, you might be okay, continuing some things but, you know, clearly when things are going in the wrong direction, you might need to take a pause also. You can send me an email. I'm happy to share some of the materials that we put together on that.

FASKIANOS: Thank you. Let's go to Jennifer Collins.

Q:  I'm sorry, I just unmuted myself. Yeah, Jennifer Collins from University of Wisconsin Stevens Point. And actually, the previous question just asked my question, which was about whether you have specific plans at University of Michigan for closing, because we at University of Wisconsin are also open. And I think one of the concerns that a lot of our faculty has is that from the system level, there is no clear specification about what would be the point at which we might say, you know, that there might be a call at the system wide level to say, you know, this is not sustainable at this point. So I think that's an important question. Thank you.

MALANI: Thank you, Jennifer. And the Wisconsin system is so interesting, because you have multiple campuses and they look very, very different in terms of who is there, how big it is, what the resources are, and obviously Madison is, you know, big, it's actually pretty similar, you know, a lot of ways to Ann Arbor, including the health system and that we've actually spent time thinking about this.

We also have really developed a very close relationship with our county public health department because one of the big concerns in all of this is how our campus affects the whole region. And this is something that, you know, there are a lot of things that keep me up at night, but this is definitely one of them is, could we be creating a situation where we make the whole region less safe? Do we do we create it and you know, maybe even unknowingly, it's just a matter of like, there are risks to bringing large groups of people to campus and so, you know, thinking about density and all those things, but we have actually put some numbers down and some triggers down. I actually wish I had had them in front of me. I don't want to tell you the wrong numbers, but it really has to do with the trend of the tests. Obviously, the percentage positive matters and what's happening in the region matters too. But this is something.

When we talk about losing campus, I think it really is shutting down remote, you know, shutting down in person learning, having more of a stay at home order, I really hope that Michigan doesn't go back there. One of the other things that we didn't talk about is that a lot of our students are going to be on campus no matter what. And I mentioned my son has been living on campus the last couple months, he went back to his house once the stay-at-home order lifted. And we have a fair number of students, not the full number by any means. But they're here they're kind of doing their student things. They're working remotely or mostly at home because there's not a lot of places to go right now. We're also working closely with the local businesses. So, some of the things about the bars, the bars are closed in Michigan so far, which is good. There are restaurants that have bar-like atmospheres, but you know, that's one thing that in-house dining has decreased. So, it's kind of like a moving target. And we're working with lots of different external partners on this because we don't want the University of Michigan to put the whole region at risk.

FASKIANOS: Which kind of testing are you going to be implementing?

MALANI: So, this is a good question. Yeah. So, the final plan is not rolled out, but this is likely what it will be. And, you know, I, again, there are pluses and minuses, every school has a different plan. Some of the concerns we have is, we want to have a rapid enough turnaround that it's helpful. We didn't feel like our clinical lab could handle 10,000 more samples over the course of a few days, you know that that was probably asking for too much, especially because they need to prioritize clinical care and their regional lab for other parts of the state. So, what we're looking at right now is a system where we would test students before they get here, like right before they get here with the idea that you'd have a rapid turnaround, you sort of get a clear bill of health.

We'll also recommend that they're going to be doing sort of self-isolation before they come in. Some of these details are yet to be announced to the students, but we're trying to finalize these. And the idea is the ones living in congregate housing, so mostly our first-year students in residence halls, that they would need a negative test, a PCR test of some type before coming, but it will be self-administered. Details are not quite final. But I think those principles are important that the clinical lab can't necessarily absorb 10,000 more samples.

We also are going to offer testing to some other groups and actually focus on some other large congregate settings, including fraternities, sororities, and co-ops and then other students that are coming from high risk places that might be living in their own apartment. And some of this is going to be self-identification and some of it will be our planning. We're not going to test the entire campus. And there may be a question. So, I'll just go ahead and answer this: it's about testing staff and faculty. This is a tricky question. And I guess the best way I can talk about it is as a health care worker, working in a setting where we have a lot of COVID, we're not testing everyone there, because transmission is so low. And that, again, it's controlled environment and healthcare setting. But if you can wear a mask, if you can maintain distance, that exposure is not felt to be significant enough that it makes sense to do a lot of testing now. If people have symptoms, even mild symptoms, I'm an advocate for doing a lot of testing. Because I think you want to know like, what, what's happening in the background. And then we're finally we're going to be doing surveillance testing. And this will be random surveillance testing. And one of our school public health faculty is going to help with this.

And again, it's resource intensive, I think it gets back at the earlier point, this is hard to do. This is not something that every school can manage, or that it would make sense to try, but because of the size of our school, and because we do have a big School of Public Health, that they do this type of work, we're planning to do surveillance, and it'll be like in different places. And we might do 100 swabs one day, one place, and 100 in another place, and then, depending on those results, we might need to go in and do more testing, if we're seeing transmission. So we're trying to get at it from different ways, both the testing as well as the public health interventions, and trying to recreate campus. But there's no playbook for this. You know, there's not a simple way to do this. But our feeling was after a lot of deliberation is that we could do it and we could do it safely.

FASKIANOS: Thank you. Let's go to Allen Weiner next.

Q:  Thank you very much, Dr. Malani. I'm Allen Weiner from Stanford Law School. A question that I have for you: you noted, of course, that there are risks associated with bringing students back onto campus and in person teaching. And but of course, there are huge benefits as well of doing that. And I'm wondering if you have been explicit in any way about some kind of formula for calculating, for engaging in that cost, benefit, risk reward analysis, and I asked, in part because at Stanford, I'm just a passenger on this bus. But one of the things that I do in my free time is serve as a school board official for a public high school district. And here I'm having to make that decision. And I don't really know what the formula is for balancing the risk to staff and students versus the benefits of having people on campus. Thank you.

MALANI: Thank you, Allen, I think it's a complicated calculus. And as you know, there are benefits, otherwise, we would focus as we did in March, and as some regions are doing right now, solely on the risk of COVID, which would be, go remote, fully remote, let's just wait it out. But we didn't feel after doing the homework that that was necessary. And now again, things can change because the pandemic changes from week to week, month to month. I'm not aware of any specific calculus on this. I will say that the risk to staff and faculty and I, you know, people can disagree with me on this but with the kind of plans we have with the kind of contact people would have on a day-to-day basis with students, there's minimal risk. I truly believe that because I thought if I feel like that there's a risk to the community, I wouldn't consider doing this. And again, it requires that everyone mask and that people stay home. And that we have maintenance of physical distancing. Even if people are sick and asymptomatic, they're not spreading if they're masking and that's been shown. So I think that that piece of risk like to the essential work force, to faculty, although I understand why people are nervous about even being on campus and being given an outside space, that risk can be managed, especially on a college campus where you have bigger spaces and you have ventilation and windows, it's going to be harder in a public school. And that's a separate discussion and it's one that in my free time I've also been having conversations with my daughter's school, and they've actually decided to start the year remotely, even though they were positioned to do it well. It would be good to actually have a measure and you know, the one thing I know of is someone who did a calculation of like, what's your calculation of infection? What's your calculation of a poor outcome? Etcetera, etcetera, etcetera, versus what's your benefit? And there are economists and others who understand that, who have done some of that, and you can email me and I can send you a paper I'm thinking of, but in my simple mind, like my simple like doctor mind, where I'm not putting numbers on things, I think of, can we mitigate risk to where it's acceptable? And that's in contrast to being reckless, and you can be reckless. But that would never be acceptable in my mind.

And I really feel like we, the way we're planning this is to try to do everything possible to decrease and manage risk while having some of the benefit. I mean, the truth is, there's not going to be a lot of in person coursework. That's likely the case because so much of it for the first-and second-year students is like in large spaces. And because we've gotten good at things like Zoom, but we want to make sure and there are some settings, the health sciences, performing arts, where if you're not in person, you really can't continue learning and it gets back to the issues of equity. It's back to the issues of you know, making sure families know that their kids gonna continue. I'm kind of veering off topic here. But it's a it's a good question, and I sort of look at it as is like, is the risk acceptable?

FASKIANOS: Thank you. Let's go to Noe Ramirez.

Q: Very interesting lecture. I really appreciate this. Looking beyond the current crisis, ma'am, what do you foresee as the implications for science and so far as perhaps getting on an edge on politics? I see that science has advanced considerably, however, is perhaps not enough since the enlightenment era took hold, and we still see politics influencing decision making that is data driven, that is empirically driven, based on observations, which you have eloquently cited many examples of, ma'am. What do you foresee as implications for science and higher education in so far as perhaps promoting civic engagement for students to take greater note of the importance of science and data-driven decision making?

MALANI: Thank you. I, you know, I actually am hopeful for science and I say that not just as a physician, as the chief health officer for the University of Michigan, I say that as a mom of two young adults that are, one is almost adult, and, you know, I think this is such a remarkable time to be a young person and to watch what's happening and the importance of science that it's being played out every single day and, you know, science shouldn't be a political thing. It's, you know, science is science. We talk about, you know, you can have your opinion, but you have your facts. Facts are facts. And science, to me, is less about opinion and more about facts. So, I actually am hopeful that this is going to also generate interest in the next generation around epidemiology and public health and all kinds of science and social justice and all the different aspects of our lives that have been changed and well-being. But, you know, I do hope that the political will will be there to support these things. One of the remarkable things is the progress we have made towards a vaccine. And again, we don't have a final timeline on that or whether it works, but I'm very hopeful. And it's a remarkable thing. It's a remarkable demonstration of what science can do. So I'm going to be optimistic and say that is ultimately going to be very good for science and the importance of science.

FASKIANOS: Thank you. Let's go to Dorothy Marinucci next.

Q:  Hi, I'm Dorothy Marinucci from Fordham University in New York. And I'm curious to know, what do you advise about fall sports? I don't think I've heard it come up in the conversation here. I would like your take on that. And Michigan's a pretty big football school and playing football this fall.

MALANI: Thank you, Dorothy. Actually one of the other roles I've had, it's been really interesting. So I'm a huge sports fan, especially college football, especially my alma mater, Michigan, and I've been part of the team advising our Big-Ten commissioner. You know with sports it's complicated, and I think we don't know. We'll know in the next few weeks what happens in terms of the fall season and those discussions are being had, you know. And again, I have viewed sports in a couple of phases returned to training and returned to competition and we have returned to training at Michigan. It doesn't look like training did last year.

But it's actually been a good learning experience for our campus to sort of understand how to sort of reengage a community. And in this case, you know, there are high-risk coaches, there are high-risk staff. There's some students who are high-risk who are athletes. But that next step of competition is complicated and football is one example. Same would apply for soccer and basketball and other big teams because of travel. We're seeing this in the professional leagues now that they're even having trouble with this idea of bubbles and testing and they're having issues with turnaround time. NBA is having trouble with testing turnaround. So how can a college campus do better than the NBA in terms of resources?  So, a lot to be seen.

One other issue with sports that's a problem, obviously, is the gathering in terms of spectators. And I don't really envision spectators being like they normally would if football does, indeed, continue. And I think it's a, these are discussions that will be had by NCAA and the conferences in the next few weeks. But right now, it's been about return to competition. And that's been more or less successful. Some places, although a lot of places have had to stall including a couple of the Big-Ten schools; Ohio State and Indiana that I'm aware of, because of some transmissions and new cases that have come up. So in a way it's a good experience to learn what's happening within that space because it's a high-risk space, but also potentially representative of what fall might look like on campus and can we can we manage that, but lots to be seen, but lots of barriers to getting back to sports.

FASKIANOS: Can you talk about what you're doing in terms of reconfiguring your art space and your library space to help with social distancing and those matters?

MALANI: Yeah, absolutely. And again, I think there may be some full reports on our president's homepage of the committees related to COVID. These are like, sort of the comprehensive recommendations, but not all of them will be followed. But they may be helpful to some of the the folks that have joined us here. You know, in the libraries, a lot of it is about just removing spaces. You know, it's about like, okay, walking around and saying, well, let's move this table, let's move this table, and like we'll have this many people here and everyone has to be masked and creating that distance. Our libraries are not yet open. The plan is for them to open. Our unions also, like I've personally done the walkthrough on the union and tried to help reconfigure the space. One thing I will say is that there are a lot of spaces on campus that aren't going to be used, things like ballrooms and big auditoriums, because we're not going to have big gatherings. So, also re-envisioning how those spaces might be used to help offset some of the lost space. So, the libraries are going to have fewer people a little bit like every other space that's open. The art studios, I haven't been as involved with those discussions. But what I've heard is some of it is trying to have one person at a time, this idea of not having to share equipment, because there's concerns with how close you are. So, it means having the studios open more hours, it means, you know, sort of twenty-four-hour access and kind of rethinking when students work and how they work. Maybe plexiglass could work some of those settings too, but it's kind of a case by case. We had a whole committee that looked at those issues around performance in studios.

FASKIANOS: And how have you reconfigured your research labs. I know you've said they've continued to operate, but what measures have you taken to remediate those spaces?

MALANI: The biggest issue around, Irina, is density. And what we asked for in the research labs was 144 square feet per person was in the lab. So, you think about that, that's like six feet in each direction. That's a lot. You know, there are not a lot of research labs that can have a lot of people in them. But this is the that was a very conservative look. And actually, because it's gone well, they've actually increased the density just this past week to thirty to forty-five, I think is the percentage. They reconfigured with tape and got rid of common areas, the kind of things that that people like to do in research labs, like they like to kind of sit and have a cup of coffee, like that's not happening now. You're kind of in there, you do your work and you leave, which is good for efficiency, but it's not necessarily good for people's well-being. So, I think rethinking that. But the research labs were very much like walk through, tape off, figure out how many people can be in there. And it's actually gone remarkably well. We've been 99.9% in terms of masking, we haven't had any cases or any transmission. And we've been able to slowly increase to seventy-four buildings that are open, but it is resource intensive. Each building has a greeter and like they, in conjunction with our governor's executive order, there's a screening process every day and people have to fill out a form, but I think people have gotten used to it. And they're very excited to be back to their work. And I think we have looked at the research ramp up as sort of a preview to the fall and if we can do that well, hopefully it will set us up to have a good fall. And you know, I don't compare the two. I think fall is much more complicated, but it at least has helped us work out some of the hiccups.

FASKIANOS: Do you have a sense of how many students will opt to come back on campus versus those who feel that they need to stay home and do, you know, to do their classes remotely?

MALANI:  Our sense is that most students, a majority, 90% plus will be on campus. I think there are a few considerations. One is that some of the out of state students who feel like well, if I'm not going to really have a normal semester, kind of hard to envision paying that much money, I might as well stay home and take classes locally. I know of some cases like that. Others have already, you know, they have their homes here. They have their community here, some of them never left, and they'll continue. And in terms of our residence halls, they are almost all first-year students. About a quarter of our undergraduates live in residence halls. We also have some graduates but it's a little bit different format and different kind of population. Most of them didn't have any trouble in terms of housing contracts. We were able to, to procure the class that we thought we would. So, you know, remains to be seen; the final details aren't out. But we we didn't have a lot of loss of enrollment so far.

FASKIANOS: Fantastic. Well, we are at the end of our time. So, Preeti Malani, thank you very much for being with us and sharing all that you're doing at the University of Michigan, and we will share a link to the video and transcript of this discussion, as well as share the resources that you referenced in your discussion so that people can take a look. You can follow her on Twitter @PreetiNMalani. So, I encourage you to follow the research and things that she's thinking about. So, thank you very much again for being with us. I hope you will also follow @CFR_Academic on Twitter and visit cfr.org, thinkglobalhealth.org and foreignaffairs.com for additional information and analysis on COVID-19. I hope you all are staying healthy and well during this challenging time and we look forward to reconnecting in our next Higher Education Webinar session this summer. So, thank you all


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