3/15/2020: Interviewed by Andrew Theen for the Oregonian on 3/13:

3/13/2020:

The March 10th email to UO from Prof’s Graboyes, Burlando, and Redaelli (below the break) was prescient, and they’ve been quoted in the WSJ etc. Here is their update from Belluno in northern Italy. They note:

In the Italian town of Vo, which was an early hotspot for coronavirus 95% of the city’s residents were tested. Among the 3% who were positive for the disease, the vast majority had no symptoms. Had those people continued going around town, attending to their normal work and personal life activities, each positive person would have caused between 2-3 new people to become infected.

Hence the social distancing – the government has even postponed the Giro D’Italia. Click here for video from 1940 of Coppi v. Bartali. Fausto wins! UO’s coronavirus resource page is here.

New Letter:

March 12, 2020

We are three University of Oregon professors currently based in Northern Italy where the COVID-19 outbreak is raging. We are writing to alert residents of our home state to the public health emergency that is unfolding here in Italy and to raise the alarm about the limited window of time Oregonians have to prepare. We have 4 suggestions for how Oregonians should be preparing and responding–primarily through practicing rigorous social distancing and widespread closures of schools and activities–and call on all citizens to demand more widespread testing of suspected coronavirus cases.

We have experienced first hand how quickly coronavirus jumps from being a problem “over there” (China, South Korea, Iran) to “here.” In the past three weeks, the virus—and the Italian government’s response—have moved at what feels like light speed. A few dozen cases grew to a few hundred, into a few thousand, into more than 15,000. Quarantines of 11 towns, affecting 50,000 people turned into quarantines of entire regions containing more than 10 million people, which turned into a closing off of the entire country of 60 million people three days ago, which turned into a full stay in your home quarantine 24 hours ago. If you asked Italians three weeks ago about the risk of coronavirus, they would have laughed and mentioned China. If you asked Italians two weeks ago about coronavirus, they would have sent you a dark joke on WhatsApp. And if you ask someone about coronavirus now, they are scared.

The risk of coronavirus is not just that any single individual may get sick, but that the disease is contagious enough that the entire health systems can get overwhelmed in a matter of weeks. Here in Italy, hospitals in the northern Lombardy and Veneto regions are reporting that beds in intensive care units where the required care can be administered are near capacity and staff are working at their limits even after 20,000 additional medical and health workers were hired to augment services at hospitals and clinics across the country. The government has warned that if cases continue to increase in particularly hard hit areas they do not know how everyone can be treated.

These are sobering and scary realities. We recognize that coronavirus will not hit all parts of the globe equally hard, and we hope that Oregon is a place that is only lightly touched. Yet based on what has been seen from other countries already addressing this disease (China, South Korea, Iran, Italy) there is little to be gained by hoping for the best. There are, however, some clear and early lessons from countries that are already deep in their own emergency responses. We write to share some of these lessons, based on our lived experiences here in northern Italy and drawing on the professional training of one of us in the field of public health and knowledge gained from academic research on the history of epidemic and infectious diseases.

The situation in Oregon is far more serious than a look at the number of confirmed cases implies. Current Oregon Health Authority protocols dictate that doctors across the state only test patients who have severe enough pneumonia to be admitted to the hospital and people who have been in direct contact with a positive case. This is an incomplete testing protocol that is guaranteed to severely underestimate the number of cases in the state, because many positive cases of the disease often have few or no symptoms. These asymptomatic cases—when people feel healthy but are actually infected—spread cases to others in the community since these individuals continue with their normal activities. In the Italian town of Vo, which was an early hotspot for coronavirus 95% of the city’s residents were tested. Among the 3% who were positive for the disease, the vast majority had no symptoms. Had those people continued going around town, attending to their normal work and personal life activities, each positive person would have caused between 2-3 new people to become infected.

We make four suggestions to all Oregonians in order to better protect themselves and others. The measures we outline below go beyond current recommendations from the Oregon Health Authority or the Centers for Disease Control.

1) If you are sick, do not go out. Stay in your home. If you are concerned you may have Coronavirus, call your doctor or a hospital. Do not arrive at a doctor’s office, emergency room, or hospital without calling ahead since this could needlessly expose other people.

2) Even if you feel healthy, practice rigorous measures of social distancing. This means limiting public contact when at all possible. Work from home, have phone meetings rather than in person meetings, cancel all non-vital appointments. Cancel your plans in public spaces such as cinemas, theaters, pools, stadiums, or in large groups. Reschedule travel plans that require forms of public transportation or planes. When you are in public, aim to keep 3-5 feet of space between yourself and others.

3) Demand that schools be closed immediately and reduce the contact your children have with others through rigorous measures of social distancing. While children appear to be the age demographic that has the least complications from coronavirus, they are very effective spreaders of this disease.

4) Practice good hygiene. Wash hands frequently and thoroughly with soap and try not to touch your face. After being in public, always wash hands or use hand sanitizer as soon as possible.

The steps above were recommended by the Italian government from the very beginning of the crisis. Many Italians did not believe these rules applied to them, and did not heed the message. Failure of compliance contributed to a growth in cases, and now the newly adopted measures will require us to remain in our homes for at least two weeks.

We sincerely hope that Oregon remains a part of the globe that is little touched by this disease. But we want to encourage all Oregonians to prepare themselves individually and collectively to protect the larger public’s health.

Melissa Graboyes, Ph.D., MPH

Associate Professor of Medical History & African History

University of Oregon

Alfredo Burlando, Ph.D.

Associate Professor of Economics

University of Oregon

Eleonora Redaelli, Ph.D.

Associate Professor of Planning, Public Policy, and Management

University of Oregon

3/10/2020: Three UO profs write from Italy, call for online classes, meetings *now*

I know and respect all three, one has a Master’s in Public Health. They make three well-argued recommendations:

We strongly recommend that the University of Oregon shift to online classes ahead of diagnosed cases of COVID-19 in the university community or the larger Eugene area. All University sponsored and related travel, including study abroad programs, conference travel and invited lectures should be suspended for the foreseeable future. All University meetings and large conferences should be suspended or shifted to online platforms so people can begin to work from home without needing to be in direct contact with each other.

Many UO faculty have already cancelled class meetings and shifted to ersatz forms of on-line teaching for the duration. So far as I know no university meetings have been cancelled. I’m guessing that, if the Board meeting for Mon and Tu actually goes forward, even more Trustees than usual will be phoning it in.

Full text below:

March 10, 2020

Dear Mr. Le Duc and Members of the University of Oregon Community:

We are three University of Oregon faculty members writing because we are in a uniquely “privileged” position to talk about the risks of COVID-19 by being based in northern Italy for the past months, where we are witnessing first hand the expansion of the infection and the Italian government’s unprecedented response to try to stop the epidemic. At the same time, we have been following the UO response, and the wider state of Oregon’s, and decided that we must speak out to address what we see as glaring shortcomings in the current response.

In two short weeks, we have lived through the beginning of local transmission of COVID-19 in Italy, followed quickly by an explosion of cases around us in Milan and the larger Lombardy region. Our lived experience has taught us some sobering lessons about this crisis: lives are upended with unprecedented speed; events occur in quantum leaps; government responses that seemed either courageous or draconian one day become case studies of “too little, too late” mere days later; and public opinion about the risks and how to personally respond has not kept up with the pace of the disease’s spread.

Since local transmission of the disease was announced on February 22, government officials have taken strong action in consultation with respected epidemiologists, infectious disease experts, and scientists. They determined that in order to adequately respond to the virus, entire communities would need to be quarantined. What started with 11 communities and 50,000 people shifted after two weeks to a quarantine of 15 million people across most of Northern Italy. Two days later, the Italian government implemented a nationwide ban on movement, effectively closing international borders and having individuals remain in their towns unless they show proof of the necessity to move for work, grave health concerns, or family reunification. These quarantine measures will be in place until at least April 3rd. At the same time, tens of thousands of retired doctors and nurses have been rehired. Medical schools are sending their students to work in hospitals to try to staunch the shortage of staff and to prepare for the wave of patients that will arrive in the coming weeks needing intensive care. Schools, universities and all public events–including sport, religious, and cultural events–have been cancelled for the past three weeks. While this approach may seem extreme, we see these as necessary and appropriate steps.

As the first quarantined “red zones” were established, there were fierce critics of what people called the government’s over reaction. At the same time, public spaces including downtown areas, bars, restaurants, and clubs became noticeably emptier. With each passing day, as reality settled in, more and more people began following the government’s guidance for less socializing of all kinds. These shifts toward safer behaviors only occurred thanks to aggressive, consistent, scientifically-accurate government messaging that didn’t sugarcoat the situation. The goal was not to cause panic but to nudge people toward personal behaviors that could keep them healthy and help reduce new cases overall. Part of the challenge of this disease outbreak is not just to keep individuals healthy, but to keep communities as a whole healthy to make sure health systems and intensive care units are not overwhelmed.

While we live through this situation, we cannot help but notice the profound disconnect between the response in Italy and the response being taken by the Oregon Health Authority, the University of Oregon, and the larger community. To date, the state and the university have not recognized the seriousness of the situation. There remains only a short window of time to be proactive rather than reactive.

We recommend that the University of Oregon take in consideration three vital steps to safeguard the overall health of the community. We consider these steps as absolutely necessary based on our personal experiences living through the COVID-19 response in Italy, reinforced by the professional knowledge in the field of global health of one of us.

We strongly recommend that the University of Oregon shift to online classes ahead of diagnosed cases of COVID-19 in the university community or the larger Eugene area.

Because of Oregon Health Authority testing policies, it is virtually guaranteed that the number of cases in Oregon is being dramatically undercounted. Testing is currently only available for people who are sick enough to need hospitalization due to pneumonia, and people who have been in contact with confirmed positive cases. Epidemiological data from China and Italy show clearly that many cases—perhaps up to half of the total—have such light symptoms that people do not recognize they are sick and will continue with their normal activities. In one of the Italian towns (Vo) where 95% of residents were tested, the vast majority were without symptoms. Yet these cases remain contagious and can infect other individuals. Here in Italy, even with highly restrictive public health measures in place for the past two weeks, each confirmed infection is causing roughly 2.4 new cases. Moreover, hospitals here are reporting growing numbers of otherwise healthy adults under the age of 60 needing intensive care in order to recover. Assuming that most of our students, staff, and faculty are not “at risk” or “high risk” is a risky assumption to make.

Italian universities shifted entirely to online teaching at the very beginning of local transmission being detected. Top universities, such as Bocconi, based in Milan, are recommending that faculty break down lectures in short 5-10 minute videos covering specific topics, and fully utilize the chat and posting functions built in to Canvas and other platforms like G Suite. Contingency plans already delineated by the University of Oregon should be activated right away, so they are in place for the start of Spring quarter. This is also smart from a logistical perspective as advance notice to both faculty and students will allow for a smoother transition as the shift to online classes is likely inevitable.

All University sponsored and related travel, including study abroad programs, conference travel and invited lectures should be suspended for the foreseeable future.

In this area, the university must take cues not only from public health agencies like the World Health Organization (WHO) and the Centers for Disease Control (CDC), but also other universities and public health. Despite the strong leadership of the WHO in this time, they strive to remain a largely apolitical organization on good working terms with all countries, which means they are unlikely to recommend broad travel restrictions. The CDC is also unfortunately hamstrung in their public recommendations as they are a federal agency that must follow the tone of the larger government response.

All University meetings and large conferences should be suspended or shifted to online platforms so people can begin to work from home without needing to be in direct contact with each other.

As much as individuals can minimize direct contact with each other—both people who are sick and those that appear healthy—it will help keep the number of new infections caused by each existing infection low. Even two weeks ago, many Italian government officials in the hardest hit areas began to shift to online meetings in order to protect themselves, their staff, and their wider communities. If governments coordinating a complex emergency can do so without meeting in person, we are certain the University of Oregon can continue to function.

COVID-19’s rapid spread through Italy shows that actions that seem courageous today—the idea that the university stays open to serve its students in the midst of this difficult time—may seem foolhardy and needlessly risky when viewed just a few days later. Conditions are changing constantly in Italy, just as they did in China. It is unrealistic to assume that the United States is uniquely protected, and that what is playing out in the rest of the world will leave the US or Oregon untouched.

While we recognize that an epidemiological disaster like this one will not affect every place in the same way, now is the time to be prudent, thoughtful, and safe. The times are not normal, and the three of us are witnessing first hand the importance of timely collective action.

Melissa Graboyes, Ph.D, MPH, Associate Professor of Medical History & African History, University of Oregon

Alfredo Burlando, Ph.D., Associate Professor of Economics, University of Oregon

Eleonora Redaelli, Ph.D., Associate Professor of Planning, Public Policy, and Management, University of Oregon