One of Higher Ed’s Top Medical Leaders on the Science Behind the Virus and What That Means for Fall

00:17 Matt Pellish: From EAB, I’m Matt Pellish and this is Office Hours, a weekly podcast covering all things higher education. When looking for information about COVID-19, the impact the pandemic has had, we’ve relied very heavily on government officials, on the CDC, the WHO, the news media, others, which of course is not a bad thing. But there’s also a lot of great minds within higher ed providing some useful insights. On today’s episode, my friend Sally Amoruso is back to talk with one such expert. Dr. Jeffrey Gold is chancellor of the University of Nebraska at Omaha, as well as a physician and chancellor of the University of Nebraska Medical Center. As a leading expert on containing the spread of viruses, on pathogens, he’ll share some insights from the Higher Education COVID-19 Pandemic Recovery Guide that his team released this past spring, as well as a little of what we’ve learned since the pandemic began, and some smarter ways we can use data to make decisions about when, how we’re gonna bring folks back to campus. Thanks for listening, and welcome to Office Hours with EAB.

01:20 Sally Amoruso: Hi, this is Sally Amoruso, I am Chief Partner Officer with EAB, and I’m here today with Dr. Jeffrey Gold, who holds a dual chancellorship over both the University of Nebraska Medical Center and the University of Nebraska Omaha. Dr. Gold, we are thrilled to have you here today.

01:40 Dr. Jeffrey Gold: Thanks, Sally, it’s a great pleasure to join you.

01:43 SA: Perhaps you could start by telling us a little bit about your journey to those dual chancellorships.

01:51 DG: Sure. Well, I like to refer to myself as a nearly recovered cardiac surgeon, a product of a cardiac surgery training in the Harvard system at the Brigham, and practiced both adult and mostly pediatric cardiac surgery for 25 years on the East Coast and the New York City area. And then had the opportunity to become a medical school dean, a university provost, university chancellor. And then about six and a half years ago, was invited to become the chancellor of the University of Nebraska Medical Center and at the same time to serve as the chair of the Board of Nebraska Medicine, which is our healthcare delivery system here, it’s a large academic med center. And then about three years ago, a little more than three years ago, I was asked to assume the role at the University of Nebraska at Omaha which is our undergraduate and graduate public campus of the University of Nebraska system. So while I say I’m not a Nebraskan by birth, I am definitely a Nebraska by choice.

02:54 SA: Wonderful, and thank you for sharing that. And that really gives you such a unique vantage on some of the events unfolding with the coronavirus, and that’s actually how we came to talk with you because you have produced from this institution a really remarkable reopening guide for higher education and for others, quite frankly. But there are reasons why those two institutions came together and why you were really in a position to provide that guidance. Can you talk a little bit about the Global Center for Health Security and some of the other involvement that you’ve had that have really positioned you to be a leader in thinking through these issues?

03:36 DG: Yeah. Well, the story goes back a lot earlier than my tenure here, it actually goes back almost 20 years when under the leadership of Dr. Phil Smith, who at that time was the Division Chief of Infectious Diseases here at UNMC, that Phil had the wisdom and the vision to create a bio-containment unit. This was immediately post-9/11 when letters with white powder in them were being circulated, and anthrax wars were the name of the game. SARS. The original SARS outbreak occurred shortly thereafter. And so because of that and because of our proximity to United States Strategic Command, the decision was made to build a 10-bed bio-containment unit here. Which had multiple major advantages to it as a dedicated unit, but one of the most important was Dr. Smith’s vision that you not only needed to build a facility, but that you needed to have effective ongoing training of a team.

04:38 DG: And so between 40 and 50 individuals went through quarterly exercises in donning and doffing personal protective equipment, etcetera. But this became a reality for us shortly after I actually joined the group in 2014. If we dial back on memory clocks a little bit, that was when Ebola was raging in western Africa and there were a number, unfortunately, of American citizens, mostly physicians, who were volunteering in various parts of western Africa who themselves became infected, who were repatriated back to the United States for care. And I will never forget that fateful day in late August when we were asked by the Department of State to repatriate the first American citizen back to our campus. Well-known, it was Dr. Richard Sacra, who was a Massachusetts physician.

05:32 DG: And we had the opportunity to activate this extremely well-trained team. And so not only were there several patients who were repatriated who were with confirmed infections, there were a number of quarantines and isolations, and that got into a whole area of training. And so that really formed the next level of energy around what we currently call the GCHS or the Global Center for Health Security. So the Global Center for Health Security is a University of Nebraska Board of Regents Center of Excellence that focuses on all things from education and training to research, to clinical care and engagement, widely across the entire… All hazard spectrum. So right now, of course, we’re very heavily focused on COVID-19, and I’ll talk a little bit about that in a second, I’m sure, but everything from radiation and nuclear exposure to chemical exposure to trauma.

06:31 DG: All hazard, what is currently referred to in the vernacular as the “21st century threats”. So just to put this into a little different context, there are over 28,000 American military in South Korea right now. If there was a chemical or a nuclear exposure, either accidental or non-accidental, what are we gonna do with those people? How are they gonna be cared for? Where? Who’s gonna provide the care? What’s the supply chain to manage that? And who’s gonna do the training? So as a result of that, the Global Center for Health Security for years now has been training… The NDMS has been training the public health core in multiple areas of personal protective equipment in what we call special pathogen response, which are these highly infectious agents.

07:22 DG: So fast forward to January of this year, 2020, when we were starting to see these cases erupt in central China, in Wuhan City, it became very clear that American citizens needed to be repatriated back to the United States. So we were called very early on by ASPA. And of course, as is always the case, we say, “Yes. By the way, tell us what the question is.” And so we did, and in partnership with the governor and in partnership with the National Guard, we repatriated a large group of American citizens back to Nebraska. They were quarantined here, fortunately none of them became ill, and then they all went home to their states.

08:06 DG: And then shortly after that, we were asked to send a team to the Diamond Princess, which at that time was moored in Yokohama, Japan, with a good number of American citizens on board. And we actually repatriated all of the infected American citizens back to our campus, and they were quarantined, isolated, and unfortunately some of them were actually admitted to the hospital because they were so ill. And every one of them went home in good condition and are all now, of course, Nebraska football fans, and they will be forever. And that was in early February. So we’ve been involved in just endless requests by the partners, by state and local for training, education, and as you say, one of the things we’ve done early on was we were asked to visit some local meat packing facilities that had a large number of COVID cases, and as a result of that, pushed out a guide for the meat packing industry.

09:09 DG: And I guess the question was, “If you could do meat packing, why can’t you do K-12? And if you can do K-12, why can’t you do higher ed? And if you can do higher ed, where’s the guide for early childhood, the court system?” And it just went on and on and on. So now we have pushed out several guides, but I think of all of them, meat packing is probably the most popular one that’s downloaded. Long-term care and senior citizen guides have been developed as well. And just to give you a little bit more spectrum, our research scientists study virus transmission and we’ve had several key publications on the way that COVID is transmitted. We were actually actively involved in the recent letter that you may have read about that went to the World Health Organization asking them to reconsider the modality of spread.

10:00 SA: Yes.

10:00 DG: We could talk about that a little later if you…

10:03 SA: Yes, we will.

10:03 DG: If you wish. But also, we’ve worked very closely with the CDC, not only on guidelines, but actually worked very hard with them early on to look at the accuracy of some of the testing. We do test validation for both antibody tests and for PCR tests, antigen tests. We’re currently developing a number of new point-of-service tests in our own laboratories so that you could have almost instantaneous answers regarding immunity, participate in vaccine trials, we’re one of the main partners, principal investigators in the remdesivir trials that you may have read about. So this is an organization that has really leaned in on the basic science and applied research side, the education and training side, and of course on the clinical side as a major regional referral center for, unfortunately, patients that need hospitalization and critical care. So a 20-year story that has culminated in being at the right place at the right time to be helpful. And by the way, as a result of that, there’s been quite a bit of media attention. I was just looking at some of the numbers, and we’ve just exceeded $3 billion of earned media…

11:20 SA: Wow. Impressive.

11:21 DG: As a result of the subject content experts in our team, not including me of course, who really know what they’re talking about and who are just constantly being sought after for interviews and such.

11:37 SA: When you think about that 20-year context and history, you have made the comment that we really shouldn’t have been quite as surprised by this situation, which has really caught the entire country and had us on our heels. And you’ve also talked about how we need to be expecting future incidents. Can you talk a little bit about that? Because we really are on our heels in managing this crisis.

12:07 DG: Well, a lot of work has been historically done, not involving me, of course. As I say, I’ve learned more about viruses in the last six years of my life than I ever thought as a surgical clinician. Talk to me about children’s heart disease, I might know something, but the rest of this was certainly out of my zip code, as I’m fond of saying. But there’s just been… Ever since… Certainly since 1911 and the great flu pandemic, there’s been a lot of concern be it around SARS, be it around Ebola, and most recently, H1N1, that these were relatively contained and did reach pandemic status, many of these things, but not at a level that we’re looking at now.

13:00 DG: And yet, in spite of that, the Centers for Disease Control, the White House pandemic planning teams, there have been many, many federal exercises, there have been many colleges of public health and schools of public health that have been extremely focused on not only preparedness, but on mitigation and response strategies. People talk about, for instance, how we’re gonna roll the vaccine trials out, who’s gonna be prioritized. Well, I don’t know what’s gonna be recommended by our federal partners at this time, I know there’s a lot of work being done about that and I’m hoping that it’s being centralized and being coordinated. But there is a playbook that has been developed that came out of H1N1 that said, “When you get the vaccine, this is what you do.”

13:50 DG: And a lot of really bright people, far smarter than I am, put all of this together and it became a playbook. But the long and the short of it is, these zoonotic viruses, so called sloppy, replicating RNA zoonotic viruses that start in bat caves and other places, and whether it’s Ebola or whether it’s SARS or H1N1, these are devastating diseases. All I can tell you is when we were activated in 2014 for Ebola, Ebola is a surface contact-transmitted virus, so it’s transmitted through bodily secretions. It’s not aerosolized and it’s not a respiratory infection, so it’s not spread by droplets. But it’s got a fatality rate 75%-90%, depending upon how early it’s treated. Fortunately, there are vaccines available for it now. And by the way, Global Center is monitoring another recent outbreak in the Congo. And with air transportation and travel around the world, these viruses are in our cities in hours.

15:03 DG: And we see what’s happened here. It started off with a handful of cases in Wuhan City, in the Hunan Province of China, and how long is it before it’s in Seattle, in New York and in San Francisco? And then because of how mobile our population is, you sit in an airplane with 200 other people… And all of that, by the way, happened with Ebola. But it was extremely well-contained after the events that happened in Dallas with the hospital spread there. There was a lot of preparedness, but for a very long period of time that this was deemed to be someone else’s problem, that this was a Chinese problem that was gonna be contained in China. When we effectively closed our borders to Chinese flights and things of that nature, which was done the last week of January, there were 71,000 confirmed cases in Wuhan City and there were 15 in the United States, 1-5. So the theory was, “Keep it there and we’ll be fine.” And I guess history didn’t quite work out that way.

16:21 SA: And so as we look forward, it sounds like we should be expecting more of these kinds of situations to arise, just given the way that we travel and the global nature of the economy and the way that these spread. Would you say that’s correct?

16:39 DG: Yeah, I think so, Sally. I also think that there are gonna be a lot of lessons learned from this event, and hopefully it won’t become the flavor of the month. Obviously, the federal government has put trillions of dollars of resources into this because the economic impact of this pandemic, and of course, the sociological, educational, spiritual deprivation, all of those things have had an incredible effect. And by the way, I’m not sure whether we’re in the seventh inning, the fifth inning, or the second inning of this ballgame. And while it’s intellectually pleasant for me to talk about lessons learned and moving on, we are not only focused on the long-term future here at the Global Center. And I spend a lot of my time in the Washington Beltway talking specifically about that and have been for years, in building national preparedness, but we’ve gotta get through this. And as you’re well aware, the numbers that are being seen across the United States, recently exceeding 60,000 confirmed cases a day…

17:48 SA: Yes.

17:48 DG: With public health, the general rule of thumb is for every test that’s positive, there are 10 other people that aren’t being tested, so that means there may be 600,000 people. And we’re at the millions and millions of confirmed cases. And you put the total number of deaths into perspective… During the entire totality of the Second World War, just over 400,000 Americans lost their lives. We could be at that number before Thanksgiving in this country.

18:21 SA: That’s devastating. You mentioned just a moment ago our evolving understanding of the modality of spread, and quite frankly, that we are continuing to learn about this virus as we go along, not just about the spread, but about other perhaps more long-lasting issues as well. Can you touch on that a bit, Dr. Gold?

18:41 DG: Sure, well, respiratory viruses of this nature are typically spread by droplets, so the public health people have instructed me that, and this goes back to my medical school days, which is of course when the dinosaurs roamed the Earth as my children like to remind me and my grandchildren. But… The story is that these infectious diseases are spread in ways that are characterized as airborne or aerosolized spread, meaning they linger in the air, droplets spread, meaning they’re projected when people cough and sneeze, and these tiny little droplets that are projected. And then there’s what’s called surface spread, fomite and vector spread. So for instance, Malaria spread by mosquitoes, that’s considered a vector spread disease. So for a very long time, the concepts around COVID-19 were that the SARS-CoV-2 virus, which is as it’s called technically, is spread by droplets. Meaning that when you cough or when you sneeze, and gets into the air within a 6 ft radius, and the reason 6 ft is chosen is that is about the average of how far you can project a droplet. If you project it onto a surface like a countertop or a door knob and somebody else comes up against that countertop or door knob of with their hand and then touches their face, that’s another way the virus is transmitted. Which is why we’re asking people to wash their hands, clean surfaces and use protective equipment because face masks and face coverings could stop that projection.

20:25 DG: Well, first of all, there’s a lot of data that depends on whether you’re elderly and frail or whether you’re young and healthy, whether you’re gonna project those particles 2 ft or 12 ft. And there’s all kinds of studies that show that the distance is extremely variable. But there’s also data that says that you can recover live virus particles that linger in the air, which raises the question of aerosolized or airborne spread of the virus. Now, whether or not those virus particles that linger in the air can actually infect somebody, that gets down to the question of what the minimal viral load is. So for instance, measles virus. Measles is an airborne spread virus. The viruses linger in the air, and you can get measles just by breathing in the air of somebody else being in the room, whether they cough or sneeze or don’t.

21:28 DG: And we’ve also seen experiences, there’s a really recent case of a choir practice where 97 choir members were in the same room rehearsing. One of them had COVID, and 90 of the people in the room, without coughing or sneezing or anything of that nature, just from practicing their vocal arts contracted the virus. And there’s all kinds of stories like that in churches, in long-term care facilities etcetera. And so the concern is that some of these virus particles that linger in the air, which again, our researches and several others around the world have confirmed, may be important in understanding the spread of the virus. And of course, as you also mentioned… And that has very serious considerations about social distancing, personal protective equipment, use of face masks etcetera. Because we really need to prevent that, ’cause if we can get the virus just from being aerosolized, that’s gonna have a lot to do with what we’re gonna do in classrooms and teaching laboratories, concerts, athletic events, all of those sorts of things as we open our higher education systems and try to get back to a new normal. We also…

22:41 SA: Does this imply… I’m sorry Dr. Gold, but does this imply that the social distancing is insufficient then, if it’s aerosolized and it can travel much further?

22:52 DG: No. Again, I wanna just underscore the word, “If,” bracket, in bold italicized letters. If you can get the virus infection from aerosolized and airborne spread, excuse me, then it does have implications for social distancing.

23:10 SA: Right.

23:11 DG: What I think needs to be done is not just to confirm the fact that you can recover genetic fragments of virus from the air, but that those fragments are connected to live virus particles and those live virus particles are in sufficient quantity to be infective. So for instance, we know roughly how many influenza virus particles or how many Ebola virus particles, or how many measles virus particles it takes to get infected. We don’t know that for COVID-19. And so that’s a piece of research that needs to be done. But that’s why you see healthcare workers using N95 respirators, which are more accurate and more thorough in filtering air particles and can trap at least the smallest of all droplets. Our infectious disease colleagues and our public health people like to categorize droplet spread, surface spread, aerosolized spread, airborne spread, etcetera. I sort of think of this as a continuum. If there are tiny, tiny, tiny little droplets that contain virus, call it airborne, call it droplet, call it whatever you want, if it lingers in the air and gets swept through ventilation systems into other rooms and parts of your building, it acts like it’s airborne spread. So it just all adds up together to me is that we just need to continue to be careful and watch the science evolve.

24:43 SA: You were about to go to some of the other evolving aspects of understanding this virus.

24:49 DG: Yeah. So what I was gonna say is, just as we’re learning about spread and we’re learning more about the physiology of the virus itself, the genetics, the surface coding, etcetera, and as we’re developing vaccines and antivirals, and things of that nature, the… We’re also learning about the virus itself and the type of disease that it causes, and without getting into a lot of detail, we’ve learned about this Kawasaki-like inflammatory vascular disease. We’re learning about better treatment modalities, for instance, proning patients. We’re learning about how to avoid the use of ventilators, the remdesivir trial demonstrated you could reduce hospitalization. Some of the other clinical trials are actually looking promising as well, and I’m very excited about some of the vaccine development that’s ongoing. It’s just a recent report of some cardiac and vascular disease that may be prominent, and we’re just gonna have to monitor that and watch the evolution. But the more we learn about this, the better we can be prepared to care for patients, and the better we can understand how to prevent the disease.

26:00 SA: So our higher education university and college leaders are really thinking about so many aspects of information collection to inform their decisions around re-opening, and one of them is around community spread. And we’re currently in this situation where many communities are seeing surges. Can you speak about the PRAM dashboards and other ways that you would encourage them to be tracking key data, so that they can make a more informed decision?

26:29 DG: Sure, so the basic premise of all of the guides, whether it’s meat packing or higher ed, or early childhood or… Fill in the blank, is that in order to re-open a business, a school, a meat packing facility, you name the business, that there needs to be local control of the virus and there needs to be adequate access to healthcare, in-patient, out-patient testing, personal protective equipment, etcetera. And so back in the early days of the pandemic, to be accurate, I think 148 days ago, we developed something called the PRAM Index or the PRAM tool. PRAM stands for Pandemic Recovery Acceleration Model, PRAM. Sort of like a baby carriage. And the idea is pretty simple. Is that it looks at… It’s not a predictive model, but it looks at the last 14 days, and it tells you what the rate of change is in six key parameters. Which are the number of cases per day, the percent positive cases per day, and the number of deaths per day, per million population in each case.

27:48 DG: And then it also looks at the number of hospital beds, excuse me, the number of intensive care unit beds, and then the number of ventilators. And it looks at the ratio of where we are today, actually, the last three-day rolling average versus the previous week. So it essentially calculates what we call the reproduction factor. So the R0 is the reproduction factor for the virus, and that’s based on the number of cases per day today versus 14 days ago, which is considered one virus cycle in the case of COVID-19. And so it produces a dashboard, and the dashboard, for instance in the state of Nebraska, is broken down every 24 hours to the six healthcare collaborative geographic districts, which are spaced across the state. And also to the 20 public health, local public health districts. And so what’s happening in the Nebraska panhandle is different from what’s happening in Lincoln, Lancaster, which is different than what’s happening in the Omaha metro, as I sit here today.

28:53 DG: And so we publish this everyday, and there’s a little gas gauge that goes with it for each of these areas. That is either green, yellow, orange or red. And guess what, it’s probably not great to be in the red on a given day. And so the idea is pretty simple for… Let’s talk higher ed, which is what we’re interested in today. If a campus is gonna open, one of the University of Nebraska campuses are, we wanna be in the green, and we wanna be in the green for 14 solid days before we start to restore campus-based activities. Now, and the whole idea here is not to give us a projection, but to give us a real-time assessment and to know where we are. And so if we were to lose control of either access to healthcare or community spread of the virus as detected through the PRAM early warning system, which is really what it is, that would be a wake-up call to the university campus of, “You really need to be extra vigilant or you need to think about closing community events or doing those sorts of things real time.”

29:58 DG: ‘Cause they’re gonna be fits and starts. And we know that when we come back to campus, students are gonna get infected, faculty and staff are gonna get infected, ’cause we’re not through this for, I would say, at least a year until we have deployed widely, fit spread, active vaccination programs in place. So we’re gonna have to learn to live with this.

30:19 SA: Well, that’s right, and I think the dynamic nature of this virus and the way it spreads puts a huge burden on university leaders to create optionality around their ability to respond and to phase in or phase out different levels of in-person interaction. We recently did a survey of some of our partners, and the greatest concern that came up from university leaders is the ability to motivate students to comply with social distancing. And part of that, I’m sure, is because this has been seen as an old person’s issue and virus. What are your thoughts on that, in terms of our ability to engage students in behaving in a way that allows us to contain the spread? Are you optimistic? Pessimistic?

31:11 DG: I am, yeah. Our students and their families are… They’ve been living through this for almost six months now. Unless they’re living under a rock or in blatant denial, but it’s pretty rare right now, even here in Nebraska, which has been, I think very well managed for a lot of different reasons, a lot of different levels, that they even know somebody or read about somebody that they know and respect, be it a performer, or an actor or actress, a politician, somebody who they can identify with, who either had the disease or actually was hospitalized or heaven forbid, passed away, I actually have some close friends who lost their lives to this disease and…

32:00 SA: I’m sorry.

32:01 DG: And there’s no end to the tragedy, and we won’t waste this audience’s time on that. But the point being is, I like to think that our students are mature, and frankly, I am less concerned about what’s gonna happen on campus, than I am about what’s gonna happen off campus as we start to return, and that’s where education and counselling and mentorship and leading by example is going to… And are there gonna be episodes of students that are… Or for that matter, community or staff members that are gonna choose to have a different view and choose to express themselves differently? Sure, but at the end of the day, we did a survey of our students on the undergraduate campus at UNO and asked them what are the most important factors that they are concerned about in coming back to campus? First of all, they all wanna come back to campus. No question. But, the single most important thing, believe it or not, it’s not athletics or even their classroom activities. It’s their health, and their strong desire, even though they do believe this is a, quote, “An old person’s disease,” unquote, which of course is not the case, there are countless… Down to the newborn level of children who have died from this disease…

33:21 SA: Right.

33:22 DG: Yes, it’s more common in older people and people with comorbidities, but this is by no means restricted to the older population. But their single highest priority was to be safe and to keep their family safe. Excuse me. And so as a result of that, our highest priority in planning the return to campus, both at the med center here and at UNO, is safety. So we’ve got… We’re planning four different scenarios, everything from what we call the new normal, which is a de-densified classroom teaching laboratory on campus, situation.

34:03 SA: Yes.

34:03 DG: And stage four of that would be the opposite, totally remote education back to where we were in the spring semester, and we’re actually testing those models in summer session. So for instance, our aviation program.

34:18 SA: Yes.

34:20 DG: It’s tough to teach… To do experiential aviation… Not that flight simulators aren’t great, but these students aren’t here to spend all their time in a flight simulator or reading textbooks. Similarly our teaching laboratories and some of our graduate chem courses are operational, and we’re looking at that, we’re looking at different types of performance practice for some of our music and acting programs. It’s actually done some very interesting things, doing Zoom concerts. Which are… If you haven’t seen them…

34:52 SA: I love it.

34:53 DG: They’re just absolutely amazing. I just saw the performance of one of our string quartets, and it was just fantastic. So I am guardedly optimistic that we’re gonna create a blend of new normal that’s gonna be monitored constantly. I will point out another thing the guide calls for, that we have done is we’ve appointed a Director of Health Security for each of our campuses. And that’s somebody with both a medical and a public health background that can help oversee policy and procedural decisions, etcetera. So at the Med Center, with the breadth and depth of the Global Center, we’ve got a ton of that expertise, but nobody dedicated to the question of how are we gonna safely bring students and faculty back to campus? Who’s gonna monitor it? What are our policies are gonna be? Who’s gonna order the masks and make sure that there’s plenty of PPE? And so there’s a dedicated person on each of our campuses now to do that, and that’s been a pretty successful move, those people were all appointed in the spring and identified and given that authority and by the way, they all report directly to me.

36:06 DG: And so there’s absolute line of authority there, they sit in on every vice chancellors meeting, and so obviously, we do spend a lot of time talking about all things virus. It’s that and the budget right now. Of course, add in a very healthy dose of racial injustice and social determinants and things of that nature, so it’s been quite a tumultuous period of time. But having that expertise in the area of public health and health security has really been extremely beneficial, and I highly recommend it. Anybody that’s interested, we actually have job descriptions that are available for those individuals.

36:49 SA: So that brings me to my last question, Dr. Gold, which is looking forward, whether it’s this next year or the next potential threat, whether it’s a pandemic or otherwise, what advice do you have for university leaders in terms of continuing to invest in their preparedness?

37:10 DG: Yeah, that’s a great question because as I said earlier, I spend most of my time focused on what’s gonna happen tomorrow, in the next three months, etcetera, but we’ve been working very closely with the federal government, particularly with as per HSS and DOD and Department of State and others about long-term preparedness, and specifically about how we can affect meaningful public-private partnerships between the large academic medical centers of the United States and the federal government and the state and local governments. So we are in Region 7, and the University of Nebraska Medical Center is responsible for all of the multi-states that surround us to coordinate and organize all hazard disaster response. And I’m thinking that if nothing else happens here, one, our colleges and universities need to learn lessons, real time lessons, and codify that from what’s going on today, but also I would suggest to develop partnerships with these large multi-state regions so that they become a proactive partner and participant in the decision-making.

38:23 DG: Because one of the other things that we learned, which was really critical, is that we’ve got between UNO and UNMC, well over 20,000 students who, if they’re not in class, form a phenomenal volunteer group that can do contact tracing and testing and things of that nature, and volunteer in long-term care facilities, soup kitchens and other such things. And we’ve mobilized that, and if that could be all planned and rehearsed in advance, all the power to ’em. So I’m a big fan of so-called Future Scenario Planning. And as a result of that, I like to talk about rehearsing the future, so we’re rehearsing the future right now, unfortunately, it’s what the military would call “A live virtual constructive exercise.” Meaning it’s here.

39:12 SA: That’s great advice. Thank you so much, I love that. Rehearsing the future. Dr. Gold, thank you for your time today and for your insights and advice.

39:21 DG: It’s a pleasure to be with you. Best wishes.

39:30 MP: Thanks again for listening. Join us for our next episode a little bit closer to home for me here in New York when Sally talks with Adelphi University president, Dr Christine Reardon, who chairs the Commission on Independent Colleges and Universities in New York. She’s gonna talk about collaboration that’s taking place across New York State as schools are preparing for the fall as well as how they were becoming a little bit more involved in the decision-making up in Albany. I’m Matt Pellish, for Office Hours, with EAB.