Dean Amy Fairchild of The Ohio State University College of Public Health recalls the beginning of the pandemic. “In the midst of spring break, informed by both public health and medical leaders at the university, Ohio State’s president made the decision to have students stay home and shift to all virtual learning to end the semester. That started a late spring and summer scramble to set up a group of experts charged with evaluating the science around indoor masking, testing, classroom and office distancing, resident hall density and developing recommendations for fall 2020 so that the university could make a decision about whether to have a limited face-to-face experience or conduct the semester entirely remotely.”
Priorities needed to be set as the university moved into a response. Fairchild says, “More broadly, I was thinking about what we knew about major global threats historically and how immense the response and resources would have to be if things were as bad as they seemed. I knew that I wanted to offer to be part of the university’s response, help answer questions the public was asking and support all the experts within our college in their efforts to partner with local and state public health and inform the public about the science, even if that science was a moving target. And I wanted to ensure that while we relied on the best science available, we were transparent about the values that necessarily guide decision-making in the face of uncertain and rapidly evolving evidence. Above all, I was worried about the most vulnerable among us and knew that the obstacles to good health and access to protections would be inconsistent for different populations.”
“The real mobilization started with the Comprehensive Monitoring Team or CMT. That group was supplemented by representatives from our office of student life and, on occasion, academic affairs, so that as we create a complex monitoring system that brought together nearly 60 data sources to make recommendations about testing cadence, masking, gatherings and communications, we understood the practical constraints that shaped the decisions leaders had to make. The key to that group being effective was early buy-in from the provost and president,” Fairchild explains.
The school’s efforts quickly expanded. Fairchild says “At a university our size, situated within a major city, what started out as a small group of volunteers using Excel to track cases and close contacts evolved to a team of 100+ staff during high volume periods. Our initial staff heavily relied on redeployed Ohio State staff, student employees and public health graduates wanting to apply their previous experiences to assist with managing and tracing COVID-19 case volume and transmission. As the pandemic progressed, creating contact tracing automations based on current policy became an essential component of our work.”
“The pandemic also created the opportunity to align data analytics resources. We stood up the Ohio State/Infectious Diseases Institute (IDI) COVID-19 Modeling Response Team, which had been an informal and loosely organized interdisciplinary group that included mathematicians, statisticians, epidemiologists, infectious disease physicians, geographers and environmental health risk modelers. The group stepped up to lead analytical efforts for Ohio State’s Comprehensive Monitoring Team and contributed to modeling and monitoring efforts at the Ohio Department of Health,” Fairchild says.
When facing a pandemic with so much uncertainty, mobilizing change was a serious challenge. “From early on in the pandemic, it was clear that even in key relationships where public health’s expertise was valued and respected, that we’d have to be tenacious, patient and at times insistent if we were going to influence policy in ways that would best protect and inform the public, especially those at greatest risk of the worst outcomes. But we also had to be pragmatic. From the very outset, we framed our work in terms of fundamental tradeoffs in a context of uncertainty.”
She continues: “The risks of widespread community transmission were a matter of urgency. As we cleared the initial epidemic surge, we began to address the many layers of disease, economic and social risks simultaneously. Although many questions were unanswered, social distancing measures blunted the epidemic surge, creating an opportunity to increase the capacity for surveillance and contact tracing on the part of state and local health authorities. The capacity for viral and antibody testing changed the landscape for us as a university by Fall 2020.”
At the same time, as a city and state we had experienced nine weeks of stay-at-home orders that amplified collateral viral harms. These included: a battered economy; an increase in mental illness due to lockdown trauma and related stresses; reduced educational, clinical, performance and athletic opportunities; impediments to career development and recruitment; disruptions to social interactions, networking and the university experience; research obstacles; restraints on the university’s role as a resource and special partner in the community; and reduced tuition, state funding and other revenue.
Each of these harms, in addition to disease, impacted students, staff and faculty, and hindered the university’s ability to fulfill its educational and community missions. Each person was both a victim (in terms of COVID-19 infection or other harm caused by isolation orders) and a vector (someone able to transmit COVID-19), the latter of which was potentially complicated by the significant rate of asymptomatic or mildly symptomatic infections. Moving forward with measured and carefully crafted re-opening plans — while taking into account a broader view of risks and harms — was essential to protecting the health and welfare of our community. But there were loud voices at both extremes in the community. There were some who would accept only zero risk, which could not ever be promised. There were some who did not accept that the risks were serious and resisted sound public health measures, from masking to vaccination.
“Navigating that terrain — which was both political and touched on values related to community, responsibility and accountability — required effective translation of evidence, transparency about what we knew and did not know about the risks and benefits of different options with clear explanations for why we favored one over another, and explicit discussion of the ethics and values that guided our recommendations to decision-makers,” Fairchild says.