The University of Louisville School of Public Health and Information Sciences was on high alert after learning that a person who tested positive for COVID-19 had traveled by plane to Louisville during the first week of March 2020. Says Professor and Associate Dean Dr. William P. McKinney, “Some of our personnel were transiting the airport when the case was likely present, so there was immediate concern.” Dr. McKinney explained that concern increased further when it was learned that many persons were exposed, and several were infected, at a major fundraising event at an art museum on the UofL campus that same weekend. They learned that persons exposed or affected included a number of local VIPs as well as nationally recognized politicians.
The school’s immediate response was confirming that those exposed were going to quarantine according to CDC recommendations and getting reliable information out to the health and public health communities. The implications for classroom-based teaching were also a top priority. Very shortly after these events, a major COVID-19 outbreak was noted at a large retirement facility in Louisville. An employee who knew she was sick came to work anyway, needing a paycheck, and not truly understanding the true implications of her actions. She was the person who dispensed medications to all the residents on the second floor of the building, where the weakest and most vulnerable residents were living. As a result, a massive relocation of residents was required, and 17 persons died out of the approximately 30 exposed. Dr. McKinney added, “It was very clear at this point what we were up against.”
UofL SPHIS mobilized several informational events. Even before the outbreak affected Louisville directly, they were tracking its impact internationally and nationally through an emerging infectious diseases course. They presented an online tabletop exercise with the University of Texas/Rio Grande Valley simulating the impact of SARS-CoV2 there and participated in a regional informational webinar through their Public Health Training Center (PHTC) during the first week of March. A statewide webinar and follow-up national webinar, both held in conjunction with the PHTC, followed. SPHIS faculty had numerous interactions with local media to provide updates and worked to offer contact tracing training for interested persons.
Volunteers from UofL SPHIS made important contributions to contact tracing through the local health department and campus health. The Louisville Metro Department of Public Health & Wellness (LMPHW) and UofL SPHIS worked to increase local capacity for contact tracing. A total of 18 students and four alumni were trained to serve as case investigators and case callers with the LMPHW’s COVID-19 Epidemiology Group. Teams were organized for regular meetings with UofL’s associate vice president for research and innovation, the director of the NIH-sponsored level 3 emerging pathogens research lab, and the division of infectious diseases. Research groups were set up to monitor outcomes of community patients and health care workers infected with SARS CoV-2.
A team of UofL SPHIS researchers projected trends in COVID-19 cases for regions and counties in Kentucky using a model of epidemic dynamics called the susceptible-exposed-infectious-recovered (SEIR) model, which allowed the team to measure the efficacy of public health policy interventions created to contain COVID-19. Initial results showed the positive effect of social distancing measures in Metro Louisville. Further work by the same team explored the impact of weather conditions on the risk of disease and documented the degree of adherence to mask mandates and advisories in the community. UofL SPHIS is maintaining a website to make these data available to the public.
As the pandemic progressed, other faculty became involved with efforts to follow activity of the virus through wastewater monitoring. Well before the confirmation that vaccines would be available, teams from UofL SPHIS and LMPHW planned how to set up an accessible site for rapid distribution of vaccines on a large scale and included public health students in a drive-through influenza vaccination clinic as a precursor of larger events to follow. A faculty member serving as liaison member of the CDC’s Advisory Committee on Immunization Practices (ACIP) helped to ensure that key local personnel were kept informed of emerging guidance and vaccine-related information. Ultra-low temperature freezers from the university were located to store vaccines once that need was announced. Students, faculty and staff were trained and participated in the mass vaccination events that followed. Faculty helped structure and maintain a database of UofL students, staff and faculty who had received the vaccine. Outreach efforts were made repeatedly to reduce vaccine hesitancy that was based on inaccurate information. Faculty studied groups of special concern, including racial minorities and the LGBTQ+ community. Throughout the pandemic, faculty participated in meetings with university administrators, the health department, the mayor’s office and local hospitals to ensure that accurate and up-to-date information was being shared and that vaccine was offered equitably to historically underserved communities. At present, a team is working on the assessment of vaccine availability and use of oral antiviral agents for the treatment of COVID-19 infection.
Dr. McKinney explains that the school’s efforts were not without challenges: “There was resistance locally to the idea of a shutdown of businesses and churches that was difficult to deal with. When it became clear that masks were helpful in controlling transmission, monitoring mask usage despite resistance was the next hurdle. Later in the pandemic, helping to counter misinformation about vaccines and false claims about pharmaceuticals became our focus. Within UofL SPHIS, the greatest challenges were making a smooth transition to online instruction in the Spring of 2020 and in supporting effective faculty interaction while working remotely.”
Dr. McKinney concludes, “The critical question that has not received enough attention is: How can future outbreaks similar to that of the original SARS (2003) and SARS CoV-2, whether they involve SARS CoV-3, a pandemic influenza strain or another pathogen entirely, be prevented? We need to address the risk associated with large-scale, live animal markets, where species of the same kind from different regions, or many different animal species, are brought together in tight quarters together with humans. These have proven to be favorable incubators for novel viruses with enormous potential for causing disease and death across continents. We cannot continue with business as usual and expect that the same catastrophic events will not happen again soon. By changing our approach, the hope is that we will be better prepared and well-equipped to respond to future public health threats.”