Testing, Returning to Campus and Emergency Room Care During COVID-19

July 13, 2020

The University of Alabama is working to bring students, faculty and staff safely back to campus. Drs. Myron Pope and Richard Friend are closely involved with those efforts.

Pope is UA’s vice president for Student Life. Friend is dean of the UA College of Community Health Sciences, which operates University Medical Center, and a family medicine physician.

Dr. Tom Weida, UMC’s chief medical officer and associate dean for Clinical Affairs for CCHS, recently talked with Pope and Friend about testing, returning to campus and emergency room care during Covid-19.

TW: Dr. Pope, you’ve recently joined The University of Alabama as vice president for Student Life. What is Student Life?

MP: My daughter teased me just recently. She said since there are no students on campus, and you’re the vice president for Student Life, do you really have a job right now? The vice president for Student Life ensures that many of the co-curricular activities that take place outside of the classroom are available to students. We are really focused on helping students be successful and, likewise, helping them grow in terms of learning outside of the classroom. In many cases, we take what’s in the curriculum to the next level in terms of helping student develop and become ethical and engaged students who are going to contribute to society. The Division of Student Life (also is involved with) areas such as student health, counseling services, student activities and housing and many of the other programs that provide support for students outside of the classroom.

TW: So, Student Life is a critical area for students?

MP: It is. Certainly, for many campuses, students are inside the classroom for 12 to 15 hours per week. The question is, what are they doing the remainder of the week? We provide a lot of that support, guidance and programming for them so that it, again, adds to their learning experience.

TW: What are some examples of programming that you might be doing for students?

MP: As we look at the start of a semester, one of the things we have is Camp 1831, an orientation program under our First-Year Experience Program, which allows students to learn more about the campus, traditions, and (meet) people in their colleges and majors. It’s an opportunity for students to transition to college. We also do a lot of programming in the area of fraternity and sorority life (where) many of our students are engaging in activities are creating complex programs for their peers, and those programs allow them to grow as leaders and help them grow in terms of being problem solvers. Those are just a couple of the examples that we have under our purview that, again, help students develop during the time that they’re outside of the classroom.

TW: You have a fairly unique background and connection with UA. Can you talk about that?

MP: I’m originally from Sweet Water, Alabama, down in the Black Belt in Marengo County, just south of Demopolis. I came here as a freshman in 1989. I completed three degrees here. My undergraduate degrees are in History and English. My master’s and doctoral degrees are in Higher Education Administration. I also had a chance to be a member of the football team here from 1989 through 1992. During my freshman year, Bill Curry was the head coach, and during my latter three years Gene Stallings (was the head coach). During the time I was here, we had two SEC championships and a national championship.

TW: Since you started your role here at UA, in the middle of a pandemic, how have you had to adjust?

MP: It’s been interesting for sure. I tell (UA) President (Stuart) Bell all the time that I came here, and I had a million thoughts about what my first few months were going to look like, and I arrived and none of those thoughts have become a reality. But it’s been great to work with so many colleagues to make sure that we prepare for the fall semester. We know that’s going to be a little different as we return to full operations. But the reality of it is that we will continue to make sure that we provide a safe, healthy environment for our students. That’s been our top priority. Obviously, we have looked at many of the programs that we have in place for students, and we’ve had to re-invent them and think about ways in which we can conduct those programs and provide the highest level of support and service and a healthy environment for our students.

TW: And that safe environment obviously includes medical, which takes me to Dr. Friend. Tell us a little bit about your background.

RF: I am a family medicine physician. I also have extensive experience in private practice and emergency medicine. And as of late, I’ve been a public health official and have had to grow in that world very quickly. I’ve been here at the University for seven years, as (The University of Alabama Tuscaloosa Family Medicine Residency Program) director, as (Family, Internal, and Rural Medicine) department chair, as interim dean and now as dean of the College of Community Health Sciences.

TW: As a family doctor, you probably have to adjust for almost anything that can happen in your community.

RF: We have good training. There was no training for a global pandemic but we’re managing to get through it. And I think we’re going to get through it in great fashion as we welcome the students back.

TW: Tell us about the College of Community Health Sciences.

RF: The College of Community Health Sciences is one of the 12 colleges here on UA’s campus. Up until a few years ago, we were a non-degree granting college. Now we have two master’s degree programs, in Rural Community Health and in Population Health. We also have one of the oldest and third largest family medicine (residency) training programs in the United States. We have 48 residents total (training each year). We also have seven fellowships in family medicine disciplines such as sports medicine, geriatrics, hospital medicine, as well as emergency medicine, OB, pediatrics and psychiatry. In addition, we have the largest multi-specialty medical practice in West Alabama (University Medical Center) and we (have) over 150,000 patient encounters per year.

TW: What is the mission of the College?

RF: The mission of the College is to improve the health of the UA community and the surrounding community through research, teaching, scholarship and service. And I think now, more than ever, we’ve been vital in helping UA plan (for a safe return to campus) and remain safe. One of the unique things is that we really haven’t stopped at University Medical Center. We’ve been seeing patients all along. We’re very fortunate to have great physicians and great (faculty) on top of the science (of Covid-19). We’re able to analyze the science as it comes out. I’m very proud of the work that we’ve done. We’ve been able to keep all of our personnel at University Medical Center and all of our affiliated clinics safe.

TW: How have things changed in regard to Covid-19 and the hospital emergency room?

RF: It has changed dramatically. What we saw in the emergency room initially was that we were not prepared for the onslaught of cases. Never having seen this particular virus in the past, I don’t think any of us knew what to expect. I think now the medical community, the hospital community and the emergency medicine community, having four months experience and many published (research) studies, is in a much better place. Even though cases continue to rise, particularly in younger populations, deaths have not really followed that trajectory, which is good news.

TW: How do you approach the patient coming into the ER with possible Covid-19?

RF: Most emergency rooms have established special areas to (admit) patients called triage areas. We now have rapid testing (so) that we can identify quickly those patients that may have Covid and keep the other patients in the emergency room safe.

TW: Are the local emergency rooms being overwhelmed currently, or do you expect them to get overwhelmed as we get 30,000 plus students on campus?

RF: Our health system here is DCH Regional Health System. I really do think they’ve done a tremendous job at assuring that the community remains safe. We get daily reports, twice a day, that I submit directly to the (UA) President’s Office as far as hospital capacity, number of patients in the hospital with Covid, number of ICU beds, (number of) patients on ventilators. So, we know twice a day exactly what our capacity is, and we have not approached capacity. Having that information is key to keeping campus safe.

TW: Is there a plan if they do approach capacity?

RF: (DCH) hospital has worked on many contingency plans. I think they’ve converted a whole floor to a Covid floor. They’ve converted their ICUs specifically for Covid to help keep their personnel, and patients in the hospital who may have other illnesses, safe. And there’s contingency plans about utilizing more and more space (for Covid-19 if needed). One thing I can tell you is that through the Alabama Department of Public Health, everybody in every emergency room always knows what beds are available throughout the state. So, if we do get to that capacity issue, we will be in touch with other communities throughout the state that may have capacity.

TW: Obviously the fall semester is not too far away. Do you see that college-age students are going to be responsible for a lot of ER visits?

RF: I think what’s happening is very interesting. We’ve seen the vulnerable and the elderly really have higher mortality rates than the younger age group. Most people (who) get Covid in the 19-35 age group (will) either not know they have it or have very mild symptoms. We have telemedicine visits set up for the students. We have very accurate testing here on campus, where you can get results back in a day, and we also have rapid testing so we can get test results in 15 minutes. (Some) of the things that Myron and I have worked on (are) different plans to keep campus safe, and that includes the residential community and student health. People may not know that our lab at University Medical Center also serves (the Student Health Center). We’re confident that as we work together, we’re going to be able to keep students, faculty and staff safe.

TW: What will be needed on campus to stop the spread of Covid-19?

RF: We have some tools, and they’re not traditional tools. But what we have and what we’ve demonstrated through our time at University Medical Center, where we’ve seen patients throughout the pandemic, both in the hospital setting and the clinic setting, is that through social distancing, through universal face coverings, through good testing protocols, and then (with) contact tracing, we’ve been able to keep campus safe and the community disease burden down to acceptable levels.

TW: Dr. Pope, you’ve been involved in some of this planning. What’s your take on this?

MP: The highest priority for us is the safety of everyone involved – our students, faculty and staff, as well as others who may be coming to campus. We are really focused on prevention, which includes a lot of education, as well as what the expectations are as they return to campus. We are (including) in all of our orientation programs, our move-in packages and all of our initial programming on campus opportunities for our students to find out what they need to do to remain safe. Obviously, we’re not going to (be able to) remove all of the risk (but) one of the things I believe we can do is just continue to educate everyone. The second thing that we want to do is, if there is a situation where someone has contracted the virus, we want to be able to respond and support them. For the students who are living on campus, we want to keep them in place in their residence hall. If that does not work, if they’re in a situation where they have roommates, we will pull them out of that particular facility and we’ve set aside beds on campus to be able to quarantine them and keep them safe and provide medical care, psychological care and support, as well as food services. I feel like we have a very solid plan in place focused on prevention and then from there providing support to students as they encounter the virus.

TW: My understanding is that students who would potentially be quarantined would still be able to participate in class remotely because every classroom has a camera now?

MP: I’m not sure if all of the classes have cameras, but we have had extensive conversations with (UA) Academic Affairs (which) has developed an extensive protocol. If there is a situation where (a student) tests positive, we will have someone who will be in contact with their (professors) to make sure that they are aware of that and provide resources and support, either through cameras or through other methods, to ensure that the student is able to stay on track.

TW: Have there been changes with student housing because of Covid-19?

MP: One of the things we (did) as we went into the spring semester and as we came back from spring break was that we put all of our classes online. We have 8,400 students living in (on-campus student) housing, plus another 1,600 living in Greek houses. We utilized a staggered approach to have them move out, and we learned a lot from that. Essentially with that staggered process, we tried to eliminate the possibility of two people going into the same room or being on the same wing as they exited the campus. We are going to this same thing as they move back in. Typically, the move-in process is a three or four-day process. We’re going to be looking at close to a 12- to 15- day process in terms of moving in, to allow people ample time to move in so that they don’t have as many encounters (with others). We will test them on the front end to (determine) whether they are positive for the virus and work with them from that perspective. But the move-in process is going to be quite a bit different. Likewise, in terms of community areas, sitting areas and common areas throughout the (student housing) facilities, we’re trying to remove as many of those as possible. We just can’t keep up sanitizing behind them, so the best option is for us to remove those sitting areas to ensure safety. (We will) wipe down elevators and train our staff about ways to protect themselves and keep the environment as clean as possible.

TW: You mentioned students might be in class 15 to 20 hours a week. That other time, how are you going to get that message across that they need to be as careful then as they are when they’re in the classroom?

MP: It goes back to that education process. Those are the types of things that we’re talking to them about. About wearing face coverings. We’re talking to them about social distancing. We’re talking to them about sanitizing their respective areas. While they’re inside the classroom, we’re going to do as much as we can to keep them safe. And, certainly, as we move outside the classroom, we want to do the same. Obviously, the students don’t live in a bubble. We have 10,000 students living on campus, but we’ve got another 28,000 students (living off campus). We have about 5,000 to 6,000 students who take classes (as distance learning students) online already. But the other students, as they’re coming to campus, we know that they’re engaging, they’re living in their various communities, they’re living in their various apartments and homes, and they’re going out shopping. We’re going to encourage them to be good citizens and limit their time out and about, (and) make sure when they’re out and about that they have facial coverings, and also make sure that they are engaging in social distancing as much as possible. The challenge that we have (is) that this (UA) is a small city. This campus, with close to 50,000 people, is larger than many counties in the state of Alabama. And that creates a challenge in terms of trying to control everyone. But, again, through education, we are trying to cut down on as many issues as possible. Long term I think that we are going to see some issues, but I feel like we’re prepared to respond.

TW: Dr. Friend, tell us a little bit about screening. How does that work?

RF: There will be an app available, a web-based app, an app that you can have on your phone, and all UA employees, faculty, staff, and students will be required to input data into that app on a daily basis. And through that screening tool there will be follow up and those students that may be experiencing symptoms, we will ask them not to come to class and a visit (will be) scheduled (for them) through telemedicine.

TW: Are you going to test every student on campus?

RF: Every UA employee and every UA student coming back to campus will receive testing. UA students will receive a test within a short window before coming back to campus so that their families can know that they’re negative and feel good about them joining us. Those students that may be positive and not even have symptoms can then stay at home during the quarantine period and then join us 10 to 14 days later.

TW: What about during the school year, if somebody tests positive, what will be the approach then?

RF: The (UA) campus and System are really committed to doing sentinel testing, which means we’re going to be doing random sampling of the student population, faculty population and staff population – about 2.5% of the (UA) population – on a regular interval of a week to every two weeks so we’ll have a good idea of the positivity rate across campus and hot spots on campus that we can then deal with in a timely manner.

TW: And there’s contact tracing. How is that helpful?

RF: If we identify somebody that’s positive, we can reach out to them and isolate or quarantine that person so that they don’t contribute to community spread. We are going to set up very friendly protocols for them to stay in their quarantine quarters and to keep the infection isolated.

TW: You mention quarantine and quarantine quarters and that goes back to housing. Will there be enough room? Do you feel like you’re going to be prepared for this?

MP: Based upon what we’re seeing (here), and what we’ve seen around the country, especially within the region, 3% to 5% of the population is testing positive as students have returned to campuses throughout the region. With that in mind, with 10,000 students (living on campus), we’re shooting for 500 beds. We have a little bit of (room) as we have 8,400 to 8,500 beds on campus, but we don’t always fill those up. People make last-minute decisions not to attend or to live off campus or commute in. (In addition to) that space, we’re setting aside some space on campus to allow for isolation and quarantine. And we’re reaching out to some of the private property owners around the city. We feel pretty comfortable with where we are right now.

TW: What kind of non-academic activities do you envision will be allowed when students return to campus?

MP: We’re going to encourage them to limit their interactions as much as possible. At the end of the spring semester, they engaged in opportunities (to take) classes online, and many of their awards programs, meetings, etc., moved into the virtual environment. We’re going to encourage them as much as possible to (continue to) do that. We’re seeing that with our sorority recruitment process. Three-quarters of that program now is online, through a virtual modality. Another thing we’re going to do, and what makes sense in terms of social distancing, is have capacity limits in rooms. The third thing that we’re going to do is encourage them to wear masks consistently. That’s something that’s going to be mandated, and we’re going to model the way. We want to make sure that we encourage them and educate them as much as possible, while at the same time, on the back side, if there are issues, we are going to make sure that we try to put people back on the right path. We will also limit the number of events. We will encourage students not to have events where there are more than 100 people. If there is a situation where there are more than 100 people, they will have to get approval from my office. We will encourage them to have as many events as possible outside. We’ve seen the research, so we will try to structure as many of our events with large gatherings outside as much as possible.

TW: Graduation this year was a little different. Are there plans to do something more for students who graduated in the spring?

MP: Yes. We provided the opportunity for those who would like to come back to go through the commencement exercises in August. With that exercise, we’re going to have nine ceremonies and we’re going to limit each one of those ceremonies to no more than 400 or 500 students. And each one of those students will have only about four tickets (for) guests. In Coleman Coliseum, that gives us an opportunity to socially distance. And we will encourage all of our guests to wear masks. We don’t want to take away from the students’ opportunity to celebrate with their families. But with this modified version, they’re able to come back and engage in that activity safely.

TW: It sounds like you both have done a lot of extensive planning for the return of the students and opening up the campus full time. I would like to thank both of you for sharing your expertise.