Editor’s note: This commentary is by leaders of the Larner College of Medicine at the University of Vermont: Richard L. Page, M.D., is dean of the Larner College of Medicine. Jan Carney, M.D., M.P.H., is associate dean for Public Health and Health Policy and senior advisor to the dean at Larner, and was Vermont’s health commissioner from 1989-2003. Claude Deschamps, M.D., is senior associate dean for Clinical Affairs at Larner and president of the UVM Medical Group. Gordon Jensen, M.D., Ph.D., is senior associate dean for Research at Larner. Christa Zehle, M.D., is senior associate dean for Medical Education at Larner.
Our nation is in the midst of a debate about the risks, benefits, and methods of resumption of higher education this fall, and there are as many ways to address this question as there are universities. We are writing to provide our perspective, as leaders of Vermont’s only college of medicine, regarding plans for the resumption of classes for both the Larner College of Medicine and the University of Vermont as a whole. At Larner, we are fully invested in educating and training the very best scientists and physicians to serve Vermont and our nation. Our partnership with Vermont communities is integral to promoting the health of Vermonters and to the vitality of Larner and UVM. Our physicians and scientists have been engaged in every step of our university response to this pandemic.
The Larner College of Medicine converted to remote education in March at the same time as the rest of UVM. With emergence of the very first cases of Covid-19 in Vermont, Larner faculty were on the front line in providing clinical care at our partner health care institution, UVM Medical Center. Research faculty and staff have been directly engaged in supporting testing capabilities for UVM Medical Center and other health care facilities in the region. Our scientists worked closely with the Vermont Department of Health to share expertise and resources so that Vermonters were able to be tested for COVID-19 infection. During this period our investigators initiated 53 active, approved COVID-19 research projects.
Even as UVM was entirely remote, Larner began preparing to resume on-campus education, since we recognize that there has never been a greater need for healthcare workers. The challenge was how to balance the demands of clinical care with the importance of educating our future physician workforce, while ensuring the health and safety of our community. Communication and collaboration with our clinical and community partners and incorporating the most current scientific data was essential in planning for resumption of on-campus learning both at Larner and UVM. Our faculty includes experts in specialties essential in our response to this pandemic, including public health, laboratory science, infectious diseases, cardiology, thrombosis, ventilation, pulmonary and critical care, viral pandemics, and vaccine development. They have been invaluable resources to our fall planning.
We put a priority on resumption of clinical education, since remote learning could not substitute for this curriculum. Our fourth-year medical students returned to clinical rotations on June 1, and our third-year students in mid-July. This has been a successful, safe reentry, based on careful planning, adherence to the latest science, and the clinical experience gained in the past five months. Our on-campus pre-clinical education resumed this month as we welcomed our first-year students to campus for orientation on Aug. 10, and classes for first- and second-year students started Aug. 17. This return to in-person education follows the most current guidance from the Centers for Disease Control and the Vermont Department of Health.
In addition to personal protective equipment (PPE) in clinical settings, changes to our classroom environments have been implemented to ensure social distancing and limit group gathering size. Face coverings are required in our buildings and access is limited to those who are attending classes or employed in the building. All students returning to campus were required to participate in Vermont OSHA training and attest to compliance with quarantine guidelines; they continue to follow UVM Covid-19 testing protocols. Students and employees are educated and constantly reminded of our shared responsibility to engage in preventative behaviors (physical distancing, wearing masks and hand hygiene) both on and off campus to mitigate transmission of Covid-19 and are expected to hold one another accountable.
But what about the rest of campus? We recognize that the university has a larger, younger student population and has responsibility for room and board for many students. UVM’s return to campus plan acknowledges that our campus includes students, faculty, and staff, and that we are part of the broader Burlington region and community. Because Covid-19 can be spread by people who do not have symptoms, UVM’s approach uses a comprehensive Covid-19 testing strategy that begins before students return, repeats when they arrive, and at weekly intervals thereafter. It recognizes that testing must be connected to contact tracing, isolation, access to health care, and quarantine, all in close cooperation with the Vermont Department of Health and the University of Vermont Medical Center. This extensive use of testing is one crucial difference between UVM’s approach to return to campus, and that of other high-profile institutions whose experience has not been successful.
Universal masking, physical distancing, and hand hygiene — the most important personal elements — are reinforced in training, messaging campaigns, and through the Green and Gold Promise to which each student must attest. Of critical importance, we are fortunate to live in a state that has set a national example in its response to Covid-19; as of Aug. 17, Vermont had 1,530 Covid-19 cases, with only 1% positive tests, and more than 114,000 people tested. Close daily monitoring and regular reporting by the Department of Health has demonstrated the effectiveness of Vermont’s approach. We are putting into practice the best and most current science about Covid-19 in an environment of close collaboration, while monitoring results and making any needed adjustments.
This is an unprecedented time. When the SARS-CoV2 was first identified, there was little understanding of transmission or mechanisms of the disease caused by the virus; treatments were empiric and based on experience with other viral diseases. But we have learned so much — a search this week of PubMed (the MEDLINE database of references and abstracts on life sciences and biomedical topics) revealed 41,920 references related to Covid-19 published in the last nine months. We now have a far better understanding of this virus than we did back in March, and how we can best control transmission.
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With all that is being learned at this rapid pace, we hope for effective treatments and vaccines to be developed in the coming months. Until that time, it is important for each university to consider the risk and benefit of resumption of on-campus education. As Vermont’s academic medical leaders, we believe our college and the university are implementing a plan to maximize safety, with ongoing monitoring in real-time, for modified resumption of necessary on-campus education. That does not guarantee success, but we base our recommendation on the best science available, making modifications when necessary, to maximize the health and safety for students, faculty, staff and our community.