For anyone in the global public health community, it was never a question of if another pandemic would strike, but when. After all, the past two decades had seen a consistent pattern of zoonosis—infectious diseases passed from animals to humans. So, when COVID-19 began its march across continents to kill tens of thousands of people, University of Miami President Julio Frenk, one of the world’s leading public health experts, was not completely caught off guard.
It was that knowledge of such diseases, combined with his experience on the front lines battling four previous pandemics, that helped the University get a head start on preparing for the coronavirus’s eventual arrival in Miami-Dade County, he told an online audience of about 70 people on Thursday during a Coral Gables Chamber of Commerce virtual talk—The State of the U in the Age of COVID-19: Leading in the Era of a Worldwide Pandemic.
“As the crisis became clear, we knew we would need to replace predictability with adaptability,” Frenk said of the institution’s efforts to mitigate the impact of the virus. With the spring semester only at the midway point, for example, University leadership sent students home, migrating courses to online platforms.
But that was just one strategy. Weeks prior to that, the institution had already started ramping up its response efforts, mobilizing its Office of Emergency Management and making sure its UHealth—University of Miami Health System had adequate supplies of personal protective equipment, diagnostic test kits, and drugs to treat critically ill patients. “UHealth really was ahead of the curve,” Frenk said.
Fighting not only to safeguard its community of students and employees and to treat patients as the only academic health center in South Florida, the University also has had to deal with the uncertainty that typically accompanies crises such as this. And it has done so by having effective contingency plans in place to address every possible scenario, according to Frenk.
“We’re very good at that because we do it for hurricanes every year,” he explained. “Obviously, the difference is that with a hurricane, you have a clear beginning, a middle, and a clear end. But with a pandemic, it is not as clear-cut. We’re not even sure what the beginning was, and we don’t know when the ending will be.
Effective communication also is critical, Frenk said. “This is the first time humans have experience with this virus. And even though we have lessons we can extrapolate from previous experiences, we’re not sure exactly how it’s going to evolve.
“The only way we deal with that uncertainty and the anxiety it creates is through communication that’s clear, concise, consistent, and credible,” he continued. “And, this is what we’ve been doing.”
Frenk has used both written and video messages to communicate with the University of Miami community, the latter of which, he said, works more effectively.
Moderated by Mark Trowbridge, president and CEO of the Coral Gables Chamber of Commerce, Frenk’s talk fell on the day the University would have kicked off its annual spring commencement exercises, which have been postponed. Instead, students, faculty, and staff received an end-of-the-year video message from Frenk. “As I told them, we must work very hard not just to adapt to a new normal,” he said. “Our test is to build a better normal as we progress through this pandemic.”
Speaking from his home office, Frenk said the “breadth and depth of the impact” of COVID-19 is unlike anything he has ever seen in his long, storied career as a physician and former minister of health for Mexico—primarily because the virus exhibits a combination of characteristics that make it a daunting challenge to overcome. “It is very contagious, much more contagious than influenza,” Frenk said. “And people who are healthy or only showing mild symptoms can transmit it in a very efficient way. For SARS [Severe Acute Respiratory Syndrome], only people who were very sick could transmit it. You didn’t have widespread transmission. And, that is what makes this particular strain of coronavirus so complex.”
He noted University research initiatives now underway to combat the virus. Among them, a rapid diagnostic test being developed by Sylvia Daunert, chair of the Department of Biochemistry and Molecular Biology. There is also an innovative vaccine being created by Natasa Strbo, assistant professor of microbiology and immunology. And, an FDA-approved clinical trial by Camillo Ricordi, director of the Diabetes Research Institute, to test the effectiveness of umbilical cord-derived stem cells on COVID-19 patients.
A vaccine, he said, remains the best hope of defeating the virus. But short of a cure, drugs to treat patients are critically important because they can mitigate symptoms and, in turn, help shorten hospital stays—giving some relief to overwhelmed medical facilities facing bed shortages.
Testing also is crucial, Frenk said. While diagnostic tests, conducted with a sterile swab inserted far into a patient’s nasal cavity, is the most common way to determine if someone still has the virus, antibody blood testing is aimed at determining if someone has been infected by the virus at some point and might now be immune to it.
Using a pinprick blood test, Erin Kobetz, professor of medicine and public health sciences, and researchers at Sylvester Comprehensive Cancer Center are partnering with Miami-Dade County to help assess the prevalence of COVID-19 throughout the community as a part of an effort that could help determine when social distancing could end, Frenk noted.
“As we start to reopen the economies, the key will be testing. We need to test everyone before coming back and on regular intervals,” said Frenk, noting that the University will have enough diagnostic testing kits available to test students and employees as part of a plan that also includes contact tracing and isolation. “We have already made adaptations so that as soon as any student or faculty or staff tests positive, we have dedicated space to isolate them and their contacts,” he said.
“That has to happen in every industry,” Frenk said of isolation measures. “But we need to have enough tests in our public health departments to allow companies to go back and test constantly so that we can then limit quarantines to the cases and their contacts. And, we won’t have to go back to wholesale, across-the-board, stay-at-home orders.”
Addressing when students will return to the University, Frenk said “the current plan is to open our campus and on time in the fall,” but with certain measures in place to lower campus density. “Right now, we have a task force concentrating only on rethinking and redesigning all of our spaces and processes of work,” he told his virtual audience. “We’re not going to go back to the world of pre-COVID. It has to be a different one. In some aspects, it will be better, in others it will be challenging.”
Some of the other issues Frenk addressed during his hour-long talk include:
- A second wave of COVID-19 may very likely occur in the fall, so this year the University is requiring that everyone get flu shots. “You don’t want to be sick with influenza while COVID-19 is out there,” said Frenk, adding that UM has increased its usual order of flu vaccines.
- Athletic events will take place probably with empty stadiums until at least the end of the calendar year.
- Clinical operations on the medical campus have resumed elective procedures. “It’s a gradual ramp up,” said Frenk, adding that the University is moving forward cautiously in that area and ensuring that adequate protective measures are in place.
- Handshakes and hugs are on hold. “I don’t see us going back to handshaking in the near future or hugging and kissing,” said Frenk when asked by Trowbridge if those social gestures will return any time soon. “We can figure out other ways of expressing respect, of acknowledging when someone is there, of saying, ‘I recognize you; I feel positively for you, I love you.’ But we will keep some of those [social distancing] practices for a while. Eventually, my suspicion is they [handshakes and hugs] will come back because we have such a craving for actual physical contact.”
