Recent days have brought unprecedented challenges and opportunities to our higher education and academic medicine community because of the ongoing spread of the coronavirus (COVID-19). Last week, the U.S. Government declared the COVID-19 outbreak a national emergency, enabling significant actions to diminish the risk of further infections as well as to protect the U.S. economy. As government and university officials continuously monitor this situation, it has become clear that proactive, rather than reactive measures are necessary to diminish viral spread and minimize health and safety risks to students, faculty, staff and our communities.
Recently, the Centers for Disease Control and Prevention (CDC) issued guidelines for community mitigation strategies, which include recommendations for “social distancing”, a term that epidemiologists are using to refer to an effort to reduce close contact between people in order to reduce the likelihood of community transmission of the virus. According to those guidelines, criteria for increased risk entails contact with a symptomatic, potentially infected person, at a distance of less than six feet for greater than 10 minutes.
Data from the 1918 flu epidemic (Hatchett et al. PNAS, 2007) have shown that social distancing strategies help by ‘flattening the curve” through measures that can slow down the infection rate, making treatment of symptomatic patients manageable without overwhelming existing health care resources. However, the reality is that with state and local laboratories still struggling with widespread COVID-9 surveillance testing, the full extent of viral spread is completely unknown to date. Current projections issued guidelines assume that 10% of cases will warrant hospitalization, especially the elderly and those patients with chronic conditions, like cardiovascular disease and diabetes. These severe cases set COVID-19 apart from more familiar respiratory illnesses like influenza. This is compounded by evidence that the virus is tearing through an immunologically naïve population at lightning speed. If our experience parallels the Wuhan City/China experience, we can expect that U.S. cases will continue to rise for six to eight more weeks until we begin to see infection rates of the virus naturally decline. This slowdown will occur once a sizable portion of the population has been infected due to the emergence of “herd immunity” and the resulting decline of viral growth. Societal measures like closing schools, implementing work-from-home policies, and canceling events will slow the spread before reaching infection saturation. However, these interventions will only marginally slow the rate at which our healthcare system will become overwhelmed, with hospitals rapidly reaching capacity, mask shortages, infected health care workers, and resource shortages affecting the supply chain. Data have shown that when the infection rate reaches only 1% of the U.S. population, the measures we currently are taking are unlikely to prevent such overload. Clearly, exceedingly swift and austere action must be taken to try to prevent this scenario. Initial actions were wholly inadequate, and the lack of widespread surveillance testing is simply unacceptable. The best time to act is already in the past, but the second-best time is right now.
University campuses are dense, international communities that have become key stakeholders in regional and national efforts to address the COVID-19 health crisis. As members of the higher education community, we are presented with the responsibility to lead our communities and the nation with evidence-based guidance about how to best navigate the challenges presented by this pandemic. A particular focus of our medical college, on a local level, is determining how to strike the best balance between infection risk mitigation while remaining a vital, learner-centered educational enterprise where active discovery and innovation remain paramount. NSU MD and university leadership are in constant contact to ensure that we successfully strike this balance in concert with continuous, rapidly changing public health updates from local, state, and national sources.
A challenging component of responding to the ongoing crisis is the need to rapidly shift to an online medical instruction system. Many universities, including ours, have transitioned to online instruction for the time being. While traditional lecture-based learning may lend itself readily to an online platform, the active learning pedagogies employed by NSU MD, such as problem-based learning (PBL), team-based learning (TBL), and skill assessments are far more challenging to deliver online. Hence, we are presented not only with a challenge, but, also, with an opportunity to translate such pedagogies, not traditionally delivered online, into virtual formats that can be utilized more broadly. This activity, in and of itself, is a form of pedagogical innovation, and is something that NSU MD faculty, staff, and students are fully immersed in at the moment. In fact, our medical students, as part of their training experience, are working hand-in-hand with our faculty and staff to solution-seek best practices and optimal designs for this unique type of online curricular delivery. We look forward to disseminating our achievements in this regard to the larger higher education community so that the advances we achieve in this virtual realm will benefit medical education nationally. Conversion to large-scale remote learning requires considerable faculty effort, availability of IT and other equipment, and policies and procedures for managing curricular change; and, therefore, this achievement should not be underestimated. But, with the insight and guidance of our experienced faculty and with input from our talented students, we are up to the challenge. In addition to taking student learning online, we also are establishing telework arrangements for faculty and staff wherever feasible. In every possible way, NSU is taking proactive steps to minimizing the impact of this pandemic.
This outbreak is a clearly a wake-up call for our nation, and for all of us for that matter, illuminating the need for proactive and swift action to mount an effective emergency response to a new pathogen of this type, when compared to other countries or regions. Some early opportunities to contain the outbreak were missed and we must now pull together a unified national response to fight back. If there is any good news that will come from this it is that opportunities abound for re-examining our response in the post-COVID-19 era with regard to preparedness, policy, economic impact, and higher education. We will be better equipped in the post-COVID-19 era to handle such situations with more agility and enhanced expertise. But, first, we must get through the days immediately ahead.
While we are clearly in uncertain and challenging times, I have no doubt our nation, and each of us individually, will rise to the challenge and set things right again. In the meantime, stay informed, follow the official guidelines for hygiene and social distancing, check on your neighbors who might be in need, be patient in these trying times, and reach out if you are overly stressed or need help of any kind. We will all get through this together. NSU MD remains steadfast in our commitment to our students, our staff, and our community, and to our triple mission of excellence in research, education and health care.