COVID-19

For two years, the world has been battling COVID-19 with masks, vaccines, and lockdowns. But countries have largely failed to channel their shared experiences into a blueprint for action.
Feb 4, 2022
For two years, the world has been battling COVID-19 with masks, vaccines, and lockdowns. But countries have largely failed to channel their shared experiences into a blueprint for action.
Feb 4, 2022
  • India
    India’s Contact Tracing App Is a Bridge Too Far
    Aarogya Setu, India's coronavirus contact tracing app, raises numerous concerns around transparency, privacy, and governance.
  • South Africa
    South Africa Provides Good News on Seasonal Influenza
    In the United States and other developed countries in the Northern Hemisphere, there has been anxiety about the consequences of the COVID-19 caseload overlapping with seasonal influenza (flu) in the autumn and winter (2020-2021). There have been alarming projections that hospitals and other medical facilities could be overwhelmed. In response, there are already public campaigns underway urging Americans to get their seasonal flu shots. In South Africa, already with the highest COVID-19 caseload in Africa with over 600,000 cases, seasonal flu most years kills some 12,000 South Africans. Late August, the end of winter in the Southern Hemisphere, is the end of the flu season. This year, however, there have been almost no cases of seasonal influenza in South Africa. According to American media, flu has also largely passed by other Southern Hemisphere countries, such as Argentina, Australia, and New Zealand. South African experts attribute the steps taken against coronavirus as stopping flu in its tracks. Shutting down schools (where flu incubates frequently), wearing masks, and social distancing have proven highly effective in stopping flu. Faced with the COVID-19 pandemic, many more South Africans than usual have availed themselves of flu shots. Why are those steps so much more successful against flu than COVID-19? Those same experts note that COVID-19 is much more lethal and spreads more easily and quickly than flu. Measures strong enough to stop flu are not strong enough alone to stop COVID-19. Nevertheless, the news from South Africa and the Southern Hemisphere is promising. Maybe the Northern Hemisphere will be spared the misery of flu in the upcoming autumn and winter flu season.  A side note: COVID-19 also seems to be on the retreat in South Africa, with the caseload declining. President Cyril Ramaphosa has reduced the lockdown, though mask wearing and social distancing remain mandatory. 
  • Conflict Prevention
    Peace, Conflict, and COVID-19
    The Center for Preventive Action has created this resource for those seeking information and analysis about the effects of COVID-19 on peace and conflict.
  • Southeast Asia
    What’s Behind Mainland Southeast Asia’s Surprising Success Against COVID-19
    With the exception of Thailand, the five countries of mainland Southeast Asia are some of the poorest in the Asia-Pacific region. According to the World Bank, Cambodia has a per capita GDP of around $1,600, while Myanmar’s is roughly $1,400. Laos and Vietnam fare only marginally better, each at around $2,500. Their political systems run the gamut from semi-democracies to authoritarian one-party states. Yet despite some initial missteps, they have all largely suppressed COVID-19, proving far more effective in addressing the pandemic than most developed countries, including the United States. Vietnam, a country of roughly 95 million people, has reported a handful of deaths and only 784 total cases, as of Sunday. It has seen a recent surge, centered on the coastal city of Da Nang, but even that outbreak remains small by global comparison. Its neighbors have done nearly as well. Thailand, which has a population of just under 70 million, has not had locally transmitted cases in weeks, and only around 3,300 cases in total. Many aspects of life are returning to normal in the capital, Bangkok, and in other parts of the kingdom. By comparison, Florida, with a population of around 21 million people, has recently been averaging about 6,600 new cases per day. Cambodia, meanwhile, has had only around 200 confirmed cases, and is even allowing in Americans, a risk few countries are willing to take right now. Laos and Myanmar have had only 20 and 358 confirmed cases, respectively. While the real number of cases is likely higher in all of these countries, their performance still stands out as a bright spot in the global fight against the coronavirus. Many of their maritime Southeast Asian neighbors, particularly the Philippines and Indonesia, are struggling with high caseloads. Few observers predicted mainland Southeast Asia’s success against COVID-19. Back in February, I criticized the region’s initial response to the pandemic; even several months later, I did not imagine how effective these countries would be in containing the virus. While Vietnam quickly responded to COVID-19 with border closures, lockdowns and a major public health campaign, Myanmar, Thailand and Cambodia were slow to stop all travel to and from China, the initial source of the epidemic, and some of their officials shared misinformation about the virus. Thailand, however, soon righted its approach. It imposed a state of emergency in late March, and launched a national task force to combat COVID-19. While the Thai government has used the state of emergency to suppress dissent—authorities arrested multiple opposition activists last week—it also appears to have helped slow the virus’s spread. Moreover, early lockdowns in Vietnam and Thailand probably helped smaller countries in the region like Cambodia, which did not impose restrictions quickly but may have benefited from having fewer travelers from its neighbors. More recently, mainland Southeast Asian countries have been world leaders in getting near-universal compliance with mask wearing, in many cases very early in the pandemic. At least 95 percent of Thais and 94 percent of Vietnamese wear masks in public. In some cases, like Vietnam, this is because the government imposes tough fines on anyone not wearing a mask in public. Other states have relied more on longstanding social norms promoting the use of face masks when sick. Countries in the region, even the repressive ones, have also displayed impressive levels of transparency about COVID-19 and the government response—even while they stifle dissent and limit the flow of information about topics other than the virus. In Vietnam, where the ruling Communist Party controls all aspects of political life, the Ministry of Health is putting case information online. Laos has embarked on a national public information campaign that is extremely transparent by the standards of one of the most autocratic one-party states in the world. To be sure, Vietnam’s response has built on years of “efforts to improve governance and central-local government policy coordination,” as Edmund Malesky and Trang Nguyen note in a recent report for the Brookings Institution. Many governments in mainland Southeast Asia have also worked to ensure that their coronavirus response measures impose minimal financial costs on their populations—critical moves to getting broad public buy-in. As Nguyen and Malesky note, Vietnam’s policy is to cover most costs for citizens related to the response to COVID-19, including quarantines, coronavirus tests and hospitalizations. Cambodia, in turn, has relied on aid from the World Bank and other overseas entities to help ensure that people are not opting out of COVID-19 restrictions due to an inability to bear the cost. Some of these strategies should be replicable in other developing countries, given enough political will. Masks are cheap and effective, and many other states could copy the combination of pressure and skillful public campaigns to get as many people to wear masks. Other hybrid or authoritarian states would do well to heed Vietnam’s example, which has shown that transparency about COVID-19 doesn’t necessarily endanger the state’s dominance over politics. In other words, if they come clean with their publics about the spread of COVID-19 and their responses to it, they are not necessarily setting themselves up for a broader political backlash. Likewise, other developing countries may be able to copy efforts from mainland Southeast Asia to ensure that COVID-19 quarantines and treatment remain free or highly inexpensive, which is the best way to get people to take tests, isolate and go for treatment. Beyond these clear strategies, some residents of the region, including several medical researchers, have suggested that mainland Southeast Asia may have benefited from unique cultural practices that make contagion less likely. For instance, many people in mainland Southeast Asia do not greet each other with handshakes or hugs, but instead with a palms-pressed-together gesture, while standing apart from the other person. Taweesin Visanuyothin, the COVID-19 spokesperson for Thailand’s Ministry of Public Health, told the New York Times that Thailand’s success “has to do with culture. Thai people do not have body contact when we greet each other.” However, in large, packed cities like Bangkok, Yangon and Ho Chi Minh City, people walk close together, jam into buses and other public transportation, and generally come quite close to each other. They may greet each other without body contact, but the sheer size of these places makes it hard to practice real social distancing. Thus, the true reasons for these countries’ success in containing the virus likely have more to do with their policy responses. Other researchers speculate that some people in mainland Southeast Asia may have some natural immunity to COVID-19. In one study from southern Thailand, more than 90 percent of people who tested positive for COVID-19 remained asymptomatic, a much higher share than normal. The reasons for this finding, however, remain unclear. One thing that is certain is that Thailand and its neighbors, which have had experience fighting other infectious diseases like SARS and dengue fever, have collectively emerged as a rare pocket of resilience in the face of the coronavirus pandemic. As similarly low-to-middle-income countries in Latin America are hit hard by the coronavirus, and nations across Africa brace for a surge in cases, their governments could benefit from looking eastward and taking lessons from mainland Southeast Asia’s response.
  • Southeast Asia
    Mainland Southeast Asia's Battle Against COVID-19
    With the exception of Thailand, the five countries of mainland Southeast Asia are some of the poorest in the Asia-Pacific region. According to the World Bank, Cambodia has a per capita GDP of around $1,500, while Myanmar’s is roughly $1,300. Laos and Vietnam fare only marginally better, each at just over $2,500. Their political systems run the gamut from semi-democracies to authoritarian one-party states. Yet they effectively suppressed COVID-19, proving far more effective in addressing the pandemic than most developed countries, including the United States. For more on why mainland Southeast Asia has had such success, see my new World Politics Review article.
  • Education
    How Are U.S. Colleges Dealing With Coronavirus?
    The coronavirus pandemic has forced colleges and universities into a precarious balancing act between student health and financial survival. What does it portend for the future of higher education?  
  • COVID-19
    Which Countries Are Requiring Face Masks?
    As the pandemic continues, more than half of the world’s countries are mandating the wearing of face masks in public. Is it helping to slow the spread of COVID-19?
  • Religion
    Responding to COVID-19 and Racism: Learning From Faith Communities
    Play
    Rabbi Shoshanah Conover, senior rabbi at Temple Sholom of Chicago, Bishop Michael Curry, the twenty-seventh presiding bishop and primate of the Episcopal Church, and Dr. Mohamed Elsanousi, executive director of the Network for Religious and Traditional Peacemakers, discuss how faith communities have responded to the crises of COVID-19 and racial unrest, and what we can learn from their experiences. Dr. Charles Robertson, canon to the presiding bishop of the Episcopal Church, moderates. This webinar is part of the Religion and Foreign Policy Program's Social Justice and Foreign Policy series, which explores the relationship between religion and social justice.  Learn more about CFR's Religion and Foreign Policy Program. FASKIANOS:  Good afternoon and welcome to the Council on Foreign Relations Religion and Foreign Policy webinar series. I am Irina Faskianos, vice president for the National Program and Outreach here at CFR. Today's webinar is the third in our Social Justice and  Foreign Policy series, which explores the relationship between religion and social justice. As a reminder, the webinar is on the record and the audio video and training script will be made available on our website cfr.org and on our iTunes podcast channel Religion and Foreign Policy Program. To turn today's conversation over to my colleague and friend, Dr. Charles Robertson, canon to the presiding bishop for ministry beyond the Episcopal Church, and he will introduce our speakers and moderate the discussion, and then we will turn to all of you for questions and comments and the latter half of this hour. So Dr. Robertson, over to you. ROBERTSON: Thank you, Irina, very much so. It is wonderful to have all of you on this call today. We welcome you to this special presentation on responding to COVID-19 and racism, and having a view from various panelists from the different faith communities. I am honored and delighted to be able to introduce to you Dr. Mohamed Elsanousi, who is executive director of the Network for Religious and Traditional Peacemakers, a global network that builds bridges between grassroots peacemakers and the global players. Prior to this position, Dr. Elsanousi, was director of the interfaith and government relations for the Islamic Society of North America, and also recently was selected to join the NGO Working Group on the UN Security Council. Welcome Dr. Elsanousi. I am also pleased to welcome Rabbi Shoshanah Conover of Temple Sholom in Chicago, senior rabbinic fellow of the Shalom Hartman Institute. She serves on the executive committee of the Chicago Board of Rabbis, is a leader of the pioneering work of the Illinois Religious Action Center of Reform Judaism, and sits on the board of the Midwest Anti-Defamation League. It is wonderful to have you with us, Rabbi. CONOVER: Thank you. ROBERTSON: And finally, the most Reverend Michael Curry, who is presiding bishop and primate of the Episcopal Church, having previously served for over 15 years as Bishop of the Diocese of North Carolina. Well known to many for his sermon at the Royal Wedding in 2018, Bishop Curry also is an author with a new book coming out, Love Is the Way: Finding Hope in Troubling Times, appropriate for this conversation here. Welcome Bishop Curry. CURRY: Thank you very much. ROBERTSON: Now as we get started, before we turn to our listeners and let them have part of this conversation with us, I'd like to get this conversation started by thinking about this unprecedented time which we find ourselves. We've seen how COVID-19 has impacted every area of American society and indeed, across the globe. With past crises of various types, religion and religious institutions have been able to provide some kind of communal support needed to weather the storms around us. But in some ways, faith communities have been hit particularly hard, particularly because of social distancing, and the need not to be close together. I'd like to see how this has played out from each of your perspectives, how have you seen this going in your various traditions? And why don't we start with you, Rabbi, if you could start us off and then just go from there? CONOVER: Sure, and I'll say that, that firstly, it's an honor to be here. And as I look at the world around us right now, how appropriate that we're having this conversation today, when we are as a Jewish people marking Tisha B'Av, which is a commemoration of the destruction of both the first and second temples in Jerusalem, we mark that on this day, the ninth of the Hebrew month of Av, and I'll say to this is that when we look around, one of the things that we always make sure to chant is from Eicha, from Lamentations, where we say, Eicha yash-va badad ha'ir rabati am, alas, lonely since the city once great with people, and I will say that those words resonate so deeply in this time, because we actually pile on top of the destruction of the temple, so many layers of loneliness and pain. And this notion of looking around, especially in the city of Chicago and around the world, how we sometimes are feeling so lonely in these moment. I'll say that in our congregation, we reach out to so many people, we've reached out, volunteers have reached out to everyone in our community, to have phone calls, to set up weekly calls, to go grocery shopping, to get them up on technology. And there is a loneliness that is pervasive. Some can't remember the last hug that they felt, or the last conversation they had face to face with someone. But I'll also say that, even as we lament the not being able to gather in person and on this day, lamenting the destruction of the temples. We also remember the transformation that can happen even in this time. And that we know that we have wisdom to draw on. In the Talmud, the sages actually quote a verse from Ezekiel, where they're trying to figure out is God with us, even when there are these destructive patterns, even when not only were there once this great temple, but also there were large other places of worship that are open no longer. They quoted Ezekiel, who said “vayehi lahem l'mikdash m'at b'artzot asher ba-usham,” that saying that, even when there are these destructions, I will then be with them as a little sanctuary, wherever they may go in any area they may go, and the sages say that that means in smaller synagogues and study halls. But we also realize that this means that it's happening in people's homes. And I don't know about you, Bishop Curry, or you, Dr. Elsanousi, if you've noticed that what happens when we are able to see into each other's homes. There's an intimacy that's there, that when we see each other and how we are situated in our homes, we do feel like these are smaller sanctuaries, where holiness still resides. And even though it's not the same as being able to be in person and feel that warm embrace, that somehow we're able to still relate so deeply to one another. And thank God I think that that is still being able to carry us through this very difficult time. ROBERTSON: Dr. Elsanousi, Bishop Curry, would you like to either one of you jumped in? ELSANOUSI: I will let Bishop Curry begin because just in the order of the revelations, so we had the Judaism, next and then the final one is Islam. ROBERTSON: What a wonderful idea. Thank you. CURRY: Well said, well said my brother. None of us have been through anything quite like this. There are a few survivors of 1918. But where virtually, if not the whole world, the vast majority of it has been confined to quarters, if you will, by an invisible adversary, who is an equal opportunity employer in the damage that it does. And this has been this has been profound and the impact on human beings on us and human society is we don't know what it will be. It has unveiled wide disparities between rich and poor. Those who have access to effective medical treatment and those who do not. It has been a revelation, of the wide disparities between how just people just here in the United States live that for many, the notion of social distancing is virtually impossible because you have extended families living in small quarters. I mean, and many of us like me, I have a home and it's just me and my wife and her two cats, and our children are grown and they're on their own and they're in their homes. But many people don't have that kind of opportunity and option. It's revealed, deep anxieties that are undergirding and fueling divisions that were already there. It is revealing some of our discontinuity and profound and justices and wrongs that have been there all along, which is why this pandemic is not only biological, but it is sociological, and it is deeply spiritual. It has, from my faith, it has challenged our faith tradition, in some deep ways, almost like the Hebrew psalm, "How should we sing the Lord’s song in a strange land?" And we've had to try to figure out, how do you do that? And even when some churches are able, at places are able to regather in small numbers, the notion of even singing is dangerous for the spread of the virus. So how should we sing the Lord's song in a strange land when we can't even sing it? I'm not sure of anything globally that has quite impacted us this way. And just talking to friends from around the world. It's even more profound. When you travel around the world where healthcare, and access to clean water, and access to clean food is really problematic. This is, as the rabbi said, how lonely sits the city that was once full of people. This is a moment of lamentation. And I'll stop there. But that may be where our deepest religious resources may be able to help us to navigate when the city is lonely, and you can't sing the Lord's song. And yet, somehow, you must taste and see that the Lord is good. Hmm. That that's a profound challenge for all of us. ROBERTSON: Thank you, Bishop, Dr. Elsanousi. What would you add to that? ELSANOUSI: Well, thank you. Thank you so much. Dr. Robertson I'm really honored to be here and thank you, Irina as well for having us, just delighted to be among friends here. There is no doubt we're definitely living in an unprecedented time and with COVID-19 and also other issues of social justice, here. It is completely different. Tomorrow, I will be celebrating Eid al-Adha, the Festival of Sacrifice here at home alone with the family. And this is true for Muslim communities in the United States and around the world as well. And this is for the second day that we are celebrating at home because we cannot gather and we have to observe the social distancing. And also today, we lament on more than 150,000 American lives that passed away because of COVID-19. And almost more than half a million lives from around the world. And there are millions of people who are sick as well. So really, this is an unprecedented time and it has impacted our life in all aspects of life as Bishop just mentioned. But also as a community, it also brought us together in terms of connecting to our families, as well as one of the things that in our communities people say that instead of having 3,000 Muslim imams in the United States, now probably we have hundreds of thousands of imams because we do the collective prayers at home, and, and one person leads that prayer. So basically, that person is an imam. So we have hundreds of thousands of imams. So that's may be the positive aspect of this challenge that we're facing. But around the world also, as we speak right now, the pilgrims in Makkah, it's an unprecedented time, they are now leaving the Mount of Arafat heading to Makkah after basically completing the Hajj. And this is the first time you have only 10,000 pilgrims in Makkah, last year 2.5 million of them. So this pandemic basically impacted our spiritual life, our social life, and all aspects of our lives here and around the world. But here in the United States, the Muslim communities also brought us together in the sense that the Muslim community come together and they created a task force just to respond to COVID-19.  How to provide guidance to communities in terms of worship and practices, in term of social justice, in terms of solidarity with our most vulnerable people in our communities, as well as how to strengthen our inter-religious and interfaith relationships, also. So we're trying to do our best so that we can overcome this hard situation that we're going through. ROBERTSON: Yes, the implications for everyone, including for us in the faith communities is indeed fascinating. I'd like to note by the way that a future issue of the Journal of Religion and Health, which is to be released this fall, is going to have a special section devoted just to what has this meant, this disease in relation to religion, and it's going to be a compilation of articles edited by Curtis Hart and Harold Koenig, it sounds fascinating. I think there are so many implications. But that's not the only problems we're facing right now. All of you alluded to this, and Bishop Curry, in other times, I've heard you quoted as speaking of the twin pandemics that we are facing, not only COVID-19, but also a resurgence of racism, and racialized violence, as we've seen in the tragic deaths of persons of color in Minnesota, Kentucky, Georgia, all over, not to mention anti-Semitic and anti-Muslim hate crimes occurring. How have these parallel crises intersected? And what role do you all see faith communities playing to help make a difference? Bishop, why don't we start with you on that? CURRY: I thought we're going to go in the order of revelation, but okay. Now, the virus was here a long time before we knew it. And we don't know how far back whether December, November or even before we don't know, nobody really knows. But the virus was circulating invisibly, certainly in January in February. And then we became fully aware by March. We didn't know the fullness of its impact. I remember when I was doing planning with our staff, and we were planning for more intense meetings, we planned through the end of April because we figured, well, it will probably be over about then, and then we can go back to normal. We didn't know, we really didn't know that the reality of the pandemic exposed itself later and we saw it. But there was something the virus was there when we didn't know it or didn't acknowledge it. The virus of racism, the virus of anti-Semitism, the virus of bigotry, the virus of hatred, the virus, if you will, of turning on Asian-Americans, just because the virus came from China, similar to calling this flu of 1918 the Spanish Flu when it had nothing to do with Spain, or nothing to do with anybody Spanish, that's a deep virus that reflects a deep fissure that at least in the context of America, has been here since the founding of this republic that I deeply love. But it was conceived in sin, conceived in inequity, conceived in injustice, the forced removal and slaughter of native peoples, of indigenous people, the enslavement of African peoples, and then the prejudice against waves of immigrants coming to this country, the story of Asian Americans, of Japanese Americans. In turn I was just talking to one of our bishops yesterday. He's a bishop of the Episcopal Church, his parents were in an internment camp here in the United States of America. The reactions to Muslims in our communities, attacks on people because of their faith in America. Now, I know America is better than that. I know those ideals are real and strong. I believe it. I know Thomas Jefferson was a hypocrite, but the ideals he wrote about, “We hold these truths to be self-evident, that all men that all folk are created equal," those ideals were true, even if the one who wrote them was a liar. This has been at the heart and soul of America. And indeed, the heart is deceitful above all things as the Prophet. The truth is, it is part of our human dilemma. And so this virus has exposed a deep fissure that was there that is taking many manifestations now. It is the human tendency to divide, to hate, to conquer, to dominate. And that tendency is a self-destructive tendency. Dr. King taught us a long time ago, "We shall either learn to live together as brothers and sisters, or we will perish together as fools." The choice is ours, chaos or community. This virus, this pandemic, is now causing us to figure out, will we live as community wearing facemasks, staying six feet apart from each other, listening to the public health officials? Will we choose community and learn to live by loving our neighbor as ourselves? Or will we submit to the chaos in which nobody is going to win? Our religious faith, all of our faith, say we must choose community. ROBERTSON: Rabbi, Dr. Elsanousi, either jump in. ELSANOUSI: Absolutely. I really agree with Bishop Curry here and, and the pandemic of COVID-19. That's where we're where it is and, and this has been going on for the last, you know, hundreds of years and I think this is something that definitely, we need to look into. And the coronavirus, exposed that and exposed our weaknesses. And we see that,  in our faith communities in our non-faith communities. But to address those issues, we have to have a whole of society approach. This is a time that we need to have a whole of society approach. This is not an issue that could be addressed by a single community, whether it is a religious community or secular communities, or other communities, we need to have a unity of purpose to address the pandemic of COVID-19 and the pandemic of racism. Because all of us, we go back to Adam and Eve, all of us, regardless of our color, or race or language, or any kind of orientation, we go back to Adam and Eve. So if we believe in that, then we are able to address these man-made crises that we're facing today. So that's really that's the bottom line of it, but we need to have the willingness, and the intention, and the sincerity to address that issue. Because all of our scripture, they're talking about this clearly, they're talking about, all men are created equal. All of the scriptures are talking about this, there is no superiority of an Arab above a non-Arab, or a block above a white. And that's the last message that the Prophet of Islam Muhammad, peace be upon him, actually said before he passed. He left it at that. There is no superiority all of us created equal. So what we are facing today is something that could be addressed by all of us, and not only here at home, but it's around the world. It's around the world. Also, we see this aspect of racism. We see human trafficking, we see new slavery going on in the world. So that needs to be addressed. CONOVER: Thank you so much. And I'll say this Dr. Elsanousi, I love that you brought us back to Adam and Eve and this notion of being created, as I would say it, B'tzelem Elohim, all of us created in the image of God. And so and I want to bring us back to that, that in the Garden of Eden with Adam and Eve, and this notion of what kinds of questions do we need to be asking ourselves in this moment? So we started off, I shared that we read Eicha, which is from Lamentations on this day, eicha, that word means how, and I think getting to how, also we ask a question that was asked of Adam and Eve in the Garden of Eden, which is just a little bit of a changing of that word from eicha to ayekka. The same letters, but just with putting the vowels just so, ayekka which means where. God asks Adam and Eve, just after they had eaten from the forbidden tree, where are you? And here's the question that I think we need to be asking ourselves right now. How is this still happening? And where are we? Where are we as a community? Bishop Curry, I so appreciated what you raised as far as we need to see ourselves as a whole community. And as we see ourselves as a whole community, then we show up for each other. And we are there for each other, as you said, with face masks, social distance, but we're there. We're showing up for one another because we see ourselves as one community. And I'll say something that gives me great hope, is seeing our youth involved across all differences involved in these movements today. That gives me great hope. And I'll say that the word hope, kav, comes from, in Hebrew the word tikvah, it comes from the word kav, which means thread. And I see that actually what we could see ourselves as a whole community is that we are threaded together. As Martin Luther King Jr. said in this shared garment of a shared destiny, that we then are part of this garment all threaded together. And so God willing, what we're seeing today is how we continue to ask ourselves, where are we? Where are we needed, so that we can make sure that we continue the hope in the future of shifting what have been the ills to something where there is great equity and justice for all of us. ELSANOUSI:  I'm glad, Dr. Robertson, I'm glad that you know, Rabbi Conover brought up the critical role of youth. This morning, we hosted youth from Southeast Asia, on Zoom, from the Philippines, from Thailand, from Myanmar, and from Indonesia, talking about COVID, religion, and conflict. And one of the things that the youth have said, they said the COVID crisis provided the opportunity for an intergeneration kind of collaboration within the houses of worship, because the youth are more savvy in terms of technology, and unfortunately, our worship and religious institutions are dominated by, basically, I would say senior citizens or basically, kind of non-youth leadership. So, but this provided an opportunity. So, she was saying that this is now they're coming to help. And that created a level of collaboration, will help also in the transition of leadership. So this point of view is quite critical. ROBERTSON: Indeed, we're going to come to, we're getting ready to take questions from our listeners. But right before we do, let me just ask you to briefly comment. This is a Council on Foreign Relations discussion. I'm curious as to what is the role of religious institutions at this time in terms of international advocacy, international assistance? What is our role to play in these in this area? If I just have a quick something from y'all and then we'll dive into our, our listeners’ questions. CURRY:  I'd like to jump in quickly, please. Because of the pandemic, obviously and some other climactic issues, the United Nations has identified the fact that the danger of global starvation, which will particularly impact children, is now maybe the next pandemic itself. That some of the many of the advances that we made in the Millennium Development Goals and the various strategic initiatives, UN and other governments, may be rolled back, and hunger among children is going to be pandemic. If there's not swift intervention by the international community, I mean, that is a fact. That's just apparently a fact that's right at our door. And there are there going to be other realities like that, that are going to be impacted by this. That's going to increase migrations of people, and issues of immigration, and migration that are not only true here in this country, in the United States, but are true around the world, are going to become more intense, and the need for religious voices to be moral voices of human compassion, and decency and caring for one another, not as I mean, the days of thinking these are soft values, are over. These are hard-headed values that will save that human community. That compassion, and love, and justice are the ways that we as a human community can navigate this. Anyway, that's going to come more to the fore for all of us. I'll stop there. ROBERTSON: Anything you all would like to add about our role within these areas, especially in advocacy? CONOVER: I just want to amplify what Bishop Curry just raised and that is just that if we as people of faith, are not listening to the prophetic call for justice, we're not listening with the right ears, that that is our role. And then we need to work with government officials the world over to make sure that they are enacting what the values are so that people can live better lives. And so I would say that we're called on this sacred partnership, that's not always easy, but it has to be a sacred partnership, so that we can be that moral voice, that prophetic voice that listens to the people who are most hurting. And then we can make sure that we're working carefully with elected officials the world over to make sure that we enact fair laws and then execute them well for justice. ELSANOUSI: There is no doubt the religious institutions really do have an important role to play in terms of advocacy, and. also partnerships with governments, and we have seen that. And unfortunately, Bishop, you mentioned the Sustainable Development Goals (SDGs). Unfortunately now were almost, 10 years from the SDGs. And when you look into the review, most of the countries are behind in terms of meeting the SDGs. So we are also facing a number of challenges. You remember the Secretary General of the UN called for ceasefire during this COVID to provide an opportunity for communities to address issues that you raised, particularly in the conflict areas. But we had to wait three months to have the UN Security Council to issue a resolution agreeing with it with the Secretary General and we did a lot of work on that. We had religious leaders actually wrote to the Security Council, there were letters wrote and signed so that we encourage the Security Council to really, rise above the politics between countries and issue resolution for ceasefire supporting the Secretary General so that we can support those who are the most vulnerable people. So really the religious community, they have a role to play. Just last week, the Muslim World League and the Forum for Promoting Peace, they had a conference in the Muslim world called the Jurisprudence of Emergency because of COVID-19. And how all the 57 Muslim countries can provide directions and collaboration and also with governments. We know religious institutions in the Muslim world are controlled by government. But yet the voices of religious actors and leaders is very important. Because COVID-19 broad challenges, we have to examine our fundamental or pillars of the religion itself, how it could be basically adapted to war with the kind of situation. ROBERTSON: Absolutely, especially since we've heard Dr. King quoted a couple times today, think about his role and the role that religious players played in the Civil Rights Movement. And earlier today, I was on the phone with folks from the Desmond and Leah Tutu Foundation, and remembering the role that Archbishop Desmond Tutu played in ending apartheid there. So indeed, we have we have both a role and I think a challenge to take up that role and figure out how to be those profits. Now I believe we're going to turn to our callers. I've been grateful to see what some people have been writing in the chat room. But we'll now get a chance to hear from some of them as well. Irina?   FASKIANOS: Yes. So everybody, if you're on a computer, click on the participants’ icon, and raise your hand. And if you're on a tablet, click on the more button and you can raise your hand there. And we already have several questions in queue questions and comments. So the first one will go to Salam Al-Marayati. Thank you. AL-MARAYATI: Thank you. It's good to be with you. And good, great panel and really appreciate the conversation. ROBERTSON: Tell us who you're affiliated with as well before you give us your question. AL-MARAYATI: Oh, sure. Salam Al-Marayati, president of the Muslim Public Affairs Council, and Eid Mubarak to Dr. Elsanousi, and it's good to be with all the panelists as well. My question is related to foreign policy and that is we hear a lot about displacement of populations. And we hear about the problem of human trafficking and sex trafficking and, war and refugees. And we kind of look at it as well, that's just part of it collateral damage of the way the world is. And how can we as religious voices change the paradigm in foreign policymaking to make that a priority in our national security agenda? We spend so much money in hardware and surveillance and military, we don't spend enough on human capital. And so how can we as religious voices work towards that and make that a real priority in our policy and not just, well, we'll do it if we have extra money and we end up just getting the crumbs from the budget to deal with these very, very serious issues. And I just wanted to get a response from the panelists. Thank you. Thank you. ROBERTSON: Thank you for that very good question. Who would like to, to dive into that? CURRY: I'll take a quick dive and then let Dr. and Rabbi come in. One of the things that we can do as religious communities, as people of faith, is to advocate with public officials, those who have authority in matters of foreign affairs, but in true in all matters, to make our values valuable. That we must put at the top of the agenda, the maintenance and preservation of human rights and human decency. Those values that are there, if you can bullet underneath those broad categories, which our religious traditions share, and many people who are in public policy, whether foreign or domestic, at least claim to be religious. So, if you claim to be religious, then let us call you to the high calling of your religious faith, whatever it happens to be. And there are values about human brother and sisterhood, about human community, about justice and truth and compassion, and love of neighbor. I mean, we actually share more than we disagree about, and those are the core things and foreign policy must be centered and grounded on the values that we in this country claim are what has made this country great. So if that is the case, then let us make our values valuable by actually living them out in the policies that we execute. Both in terms of budget priorities, and in terms of foreign policy, and how this country acts in the rest of the world. CONOVER: I love that just a few years ago, we had a panel on restorative justice at our synagogue. So on our pulpit on our bema, we had a number of different elected officials, one of whom was State Attorney General Kim Foxx, who said that a budget is a moral document. And I think if we are not reminding people that that is, that where they spend their money actually says worlds, that actually says who we are as a people as a society, if we're not reminding them of that, and then holding them accountable to that because that was another piece that she mentioned, hold me accountable. If we are not holding our elected officials the world over accountable for how we act in this world and how we fund different projects in this world that help the cause of justice. Well, if we're not doing that, again, we are letting ourselves down there by letting down all of those issues that Salam, you mentioned so articulately and thank you for raising those issues. ELSANOUSI: Well, thank you so much Salam, Eid Mubarak to you as well. It's wonderful to hear your voice and the work that you do Salam at the Muslim Public Affairs Council, it's very clear demonstration to the very question that you raised. The better engagement as a religious institutions, that religious leaders we need to have a better engagement with our elected officials and with our branches of government, so that we can really put forward these values that Bishop Curry just mentioned and our own religious virtues. But unfortunately, we see what is happening is that our foreign policy actually guided by interest. That's why we compromise our values. When we are basically talking to global leaders or trying to advance foreign policy, we compromise these values, whether they are religious values, or our own American fundamental values that sometimes we compromise them because of a political interest. So I think we have to have a better engagement for religious leaders, a religious act, or religious institutions, with our elected officials, and from grassroots because really, politics starts local. So we need to encourage our churches and synagogues and mosques, to engage with our elected officials to address these very issues. So our values should come first. FASKIANOS: Thank you. Let's go next to Barbara McGraw. MCGRAW: Hello, thank you for taking my question. I'm the director of the Center for Engaged Religious Pluralism at St. Mary's College of California. And I want to say, first of all, that I am inspired by the beautiful theological vision that all of you are putting forth about, as Bishop Curry said, that we must choose community. Some of you have talked about compassion, love, and justice, and the prophetic voice and so forth. And I want to put what I think is maybe a hard question because I'm hearing this dichotomy religious voices with values and so forth and so on, and our elected officials, and how do we bring this together? I want to ask a question, a theological question, I think. How can you help to oppose those religious forces who interpret COVID-19 through the lens of the battle of good and evil, while they go on to other, other people? And I think it's an important question because this negative theological thread has raised its ugly head throughout history in times of stress, including other pandemics, and its presence in many religious traditions. And so there's a lot of work that needs to be done to bring the rest, that part of the world or that kind of thinking or that kind of theological vision, into the home of the inspirational vision you are all talking about, and how might you help people around the world come in your direction? ROBERTSON: Barbara, an excellent theological question, who would like to to respond first to this? ELSANOUSI: Probably Bishop, the most theologian in the panel. CURRY: But the order of revelation is usually helpful. (Laughs). ROBERTSON: There's also a question though, because we've seen it especially other times we saw with the AIDS crisis in this country. And we saw there a very - it was an immediate and easy jump to the prejudice and hatred that many folks had against gay and lesbian persons in this country. It was an amazing, easy jump that people were making. But we've seen that many ways. And we've seen it, as we already heard, with even now with kind of a tendency towards racism, but there is, you're right, how do we combat that? How do we combat poor theology? With good solid theology? CURRY: Well, I'll take a jump at it. I think we must refuse to swim on the shallows of our faith traditions, and we must go down to the depth of those traditions. Literally as we are sitting here, I think I haven't seen the TV, but I assume the funeral of John Lewis is happening. Part of the reason he is iconic, is that he refused to swim on the shallows of the faith tradition of Christianity, where segregationists long swam - at my grammar is off, but we're swimming, where folks have been swimming and done all sorts of devilment and wrong against all sorts of folk on the face of the earth, and sometimes done it in the name of Christianity. That is the surface but if you go deep into the faith, what are the core values of that faith? If you do the same in Islam, do the same in Judaism, do the same in all of our faith traditions, you will find those values that we're talking about. And we must therefore, I think, challenge in love, challenge, religious and theological voices that are swimming on the surface and will not go down into the depths of the very heart of God. ROBERTSON:  Indeed. CONOVER: Beautiful. So if you will come with me into a scriptural verse that I think is at the very beginning of creation. But I want to try to swim in those depths, if you would have me do that Bishop Curry, that's just a beautiful way of opening. And that is this notion of when God created the first human being, male and female, God created them, and that they were made, Betzelem Elohim, they were made in the image of God. Now, it didn't make sense that a single human being then is referred to them. What does that mean? And so we have Midrash we have commentary that actually says that the first human being was made male and female together back to back. And that actually God passed a deep sleep on that first human being, and then together, then separated them, so that they could actually be in relationship, they could see one another. And that that is actually how creation of humanity happened. And it's all but Betzelem Elohim, in the image of God, that there actually is a plurality in the oneness of God. And the only way for us to conceive of that as human beings is to be in deep relationship with one another to truly see one another. So if we're leaving out a group of people from that essential vision created by God, well, then we're missing something fundamental about not only what it means to be human, but what it means to actually see that each of us is a reflection of the Divinity. And then in treating each other, that's the fundamental that we work from, if we are treating any one group with hate, or saying that God is punishing that people, we're missing the first and most fundamental teaching of our faith. ELSANOUSI: And that is exactly true if we're talking about Islamic scripture. God created every human being in His own image. And just to add here, this situation and the discussion on good and evil. It requires us as religious leaders and religious institutions to have our own interfaith discussion. We have to have a discussion in our own denominations of this question. Because if you don't have that kind of understanding that God is the God of mercy and compassion, so we need to have that. I God's not punishing people because they have done X, Y and Z. But God is always compassionate, always merciful. So we need to have that internal discussion among ourselves to have that kind of an understanding so that we can take it to our people as well. ROBERTSON: So Barbara, I appreciate your original question but I really appreciate what you just wrote in the chat room. And I think that's a question not so much just for our panelists. But I think that's a question for all of the folks who are listening in right now. How can we help spread what we're just hearing right now, what you all are talking about? How do we find a way to spread that to the world and connect it to foreign policy and advocate for this way of understanding and appreciate other human beings and our connectedness and interconnectors? I would rather than make - I don't know if we have an easy answer to that one. But I think that is a question that truly is not simply for the panelists, but really is a question for all who are listening. CONOVER: And also ask that everyone who's listening I'll quote the Hamilton the musical which is, "get us in the room where it happens." Get that, get these voices, not just us but get these religious voices that see this notion of unity, beloved community that get those get us in the room to be able to have these conversations and help to guide policy. ELSANOUSI: And that may be the next theme for the CFR Religion and Foreign Policy Workshop in 2021 pandemic permit. FASKIANOS: God willing. God willing, we'll be able to reconvene by then. Let's, let's keep praying. Let's go next to Steven Gutow. ROBERTSON: Hello, Steve. GUTOW: Hi, it's fascinating to hear five such wonderful people and to realize that I know four of the five and the only person I've never met is you, Rabbi. CONOVER: Pleasure to meet you now. GUTOW: As a rabbi, I just found that funny. I want to take you to where you're going. And then I want you to carry forward this question, why not take this this beautiful moral universe that we're talking about this movement from the best of who we are, and take the world of politics and actually create this new idea, this new world. We can't devote ourselves, just to our theology, and we can't divorce ourselves just to say we shouldn't do it or just the people here should do it. The five of you, and I include you in it because I know you will, should help bring together something we actually - this is a terrible time in the world. We're all living in a trauma. This is a time when we could do something big, something huge, but we have to have our willingness to sit down and decide what that is and then bring faith together from the Philippines to Mauritania. I mean, we have to do something big. And this is a moment and I think that you all are people that could help move in that direction, not just something good, but something good and large an universal. That's my question. ROBERTSON: Wonderful question. It is wonderful to hear your voice, Steve, very much so. Anyone want to respond to the rabbi's question? ELSANOUSI: Rabbi, wonderful to hear your voice just to bring such a pleasure here. But I completely agree we need to find that mechanism that you are calling for, to achieve just what you have said. And I think and that's something that is I know that we gather once a year under the CFR and other places and all of that, but I think it requires us to come up with kind of a very specific solid roadmap, implementable kind of outcomes so that we can try to achieve in our lifetime. And then we'll leave legacy for those who can continue. But it's an important question and important kind of way to find the mechanism to carry that out. ROBERTSON: And forgive me for jumping in here. But I do want to make note of and highlight the really good work that is thankfully going on, behind the scenes. Most of our faith traditions, most of our groups do have offices of government relations, whatever they call them, working on advocacy, some, many of them have UN advocacy arms, and also many of us have even our work with immigration or especially with refugee work. Many of us have refugee resettlement organizations who work, all these working together behind the scenes on a regular basis and advocacy for which we are all very grateful. But I think that you raise the question, how do we how do we use this moment to do something on a large and visible scale? So I appreciate that Rabbi, Bishop, do either of you want to follow in responding to that? CURRY: I think the rabbi's onto something. I'm sitting here and moving on. Yeah, you're right. How? Rabbi Conover earlier said, "How?" There's that word, "how" again. That's worth pondering even as we leave this. ROBERTSON: So Steve, that might be you might have given us something that we need to now work on. So thank you very much so. FASKIANOS: Thank you. Let's go to Barbara McBee. ROBERTSON: Barbara, please say your affiliation. MCBEE: I'm Barbara McBee, Soka Gakkai. We're Japanese Buddhists. And I see for the first time there are two other women here from my tradition. Nice to meet you. ROBERTSON: Welcome MCBEE: Thank you. I've been here for quite some time. Hi, Irina. But it's the first time that I've seen the other two here. I'm in Chicago. I don't know where they are. Thank you, Dr. Elsanousi, Bishop Curry. Rabbi, I'm in your home. Thank you for what you said about Kim Foxx. And I just had this talk last night with a friend about how all of our great religions, Judaism, Christianity, Buddhism, there's a lot of prose and poetry in our writings and the beauty and the commonality between all of us is, at its depth, that we all wish the very best for each other. However, we know that the shallow is upon us. And so there's two parts to my question. I'm noticing in the media there is a new wave to polarize us at the heart of what we're all trying to do is to maintain unity, whatever our faith tradition is, so that we can support so how do we individually collectively battle the polarization of ethnicity, the “otherizing” of Jews and people of color, which is all garbage? Part one of the question. And we know to Bishop Curry's mention, that it's our youth that are out in the streets now. And it's extraordinary how are we encouraging and supporting them to stay out there and keep this up till we make some changes. Thank you. ROBERTSON: Rabbi? Do you want to dive into that one? I think it was you were raising some of those points earlier? CONOVER: Sure. Well, I'll start with the second part of the question. And then maybe I'll let the rest of our panelists take the first part. But as far as supporting our youth, I think part of supporting our youth is understanding that they might go in directions that we have yet to see. Meaning that the future that they can envision is going to be bigger and broader and better, God willing, than we can even envision at this point. And so that I feel like for us, I'll say, you know, specifically with our, with our own community, where we hear that when we started to have some conversations around racial justice several years ago when we started this work with more depth in our community, our youth wanted to be part of it. And so then they were helping us to find where do we have community partners? How can we get proximate? How can we go out into communities? And then build deep relationships? And how can we support them in doing things where they are bringing us to where we need to go, instead of us saying to them, we're going to lead you where we want you to go. And so by being able to empower the youth to take us in new directions and into new places and new territories, I think we're going to get a better world. However, I also believe, I think that Dr. Elsanousi, you had mentioned about this is a time that is so perfect for intergenerational work, that there is wisdom that we can glean from our youth and that they can also glean from us. And I think by being able to let them lead and we follow and yet as we follow them, we give them the wisdom that we've learned throughout our lives and it is a mutual way of being able to go out into the world where we're most needed. Well, then I think we have the right combination. ROBERTSON: Also, I want to give thanks for not just our panelists out there, but also I've seen some comments. Jane Redmont, who wrote in a comment, said a wonderful word about how long this must happen on the local level. That while even while we do advocacy, and even do we do work on the level we're talking about here, that the difference we can make it and I can't help but think about a meeting I was in a few years ago at Chatham House over in London, where they included religious leaders, they said because we have such reach throughout the globe, but our reach is always local. We are global and we are global because we are local. We get into villages, towns, and cities. Right there we're folks. And so I appreciate the comments I saw by Jane and, and also one by Margaret Rose. My dear friend and colleague, Margaret Rose, who talked about also the need for us to lift up figures like John Lewis, who are figures in our midst that we can support and lift up so that we could just both do things on the local level. But also, who are those elected officials that we can encourage and support without getting into all the craziness of, not endorsement or anything, but how are there ways that we can support folks who are making a difference? So I appreciate all the comments are going and I hope everyone's looking at that section as well. Is there anything you all would like to add, though, before we take, do we have time for a couple more questions? FASKIANOS: Yes, we're going to 2:15 so we have a few more in queue. And I would just add on that in your communities too, you should also maybe be reaching out to the local journalists for them to be covering because the local journalists are in crisis now, but they are the ones who are covering what's going on in the community. So that is another area to deepen connections. So, you raised Jane's great comments and she has actually raised her hand so I'm going to  go next to her. ROBERTSON: Great, Jane, welcome. Say your affiliation for everyone. REDMONT: Thank you so much. I'm Jane Redmont. I serve the Episcopal Diocese of Massachusetts as a congregational consultant and also as, here's a mouthful, co-chair of the Bishops' Commission for Ecumenical and Inter-religious Relations. And I served the Diocese of North Carolina when Bishop Curry was there, as head of the Commission for Racial Justice and Reconciliation. Thank you to all. The question I wanted to raise is about how to think about the micro dimension, even as not instead of, what we, how we think about the macro dimension which you're doing, building coalitions is absolutely crucial on the macro level. But part of our job as religious leaders, local and regional especially, is to help people build not just wisdom from our deep tradition, but practices and habits. And some of that, like all practices takes practice and introduction. So that's the first thing I wanted to say is that this is the thing that is often learned first at the local level. What Rabbi Conover said still applies because the youth are leading us I know in Massachusetts, our youth are pointing the way, and pointing the way inter-generationally. The other thing is that this relates very much to issues of racial justice as well, too. The majority, white folks will say, well how can we bring people of color into etc.? That is not the point. The point is how do we listen to those of us who are majority folk, listen to and go to and follow the leadership of already existing efforts that are often quite politically, and religiously, and spiritually astute from those communities that have in various ways, not been on the side of power? ROBERTSON: Excellent, excellent. Bishop, do you want to start? Or Dr. Elsanousi, were you looking to say something? ELSANOUSI: Yeah, I just want to really build on what is already being said. And these are the issues that I mentioned earlier. We have to have that whole of society approach. I'm really delighted to see the youth are leading at the local level. But we need to bring everyone on board. I mean, no one should be left behind in our efforts to address this systematic racism. The whole of society approach is very critical here. And do this locally. If we're able to do these changes at the local level, it definitely could reflect at the national level as well. So that aspect is very important, and also Jane mentioned a very important word, and that's how we can build coalitions. You know, building coalitions is quite critical as well. Inter-religious coalitions and people of faith or people of no faith. Anyone that can contribute to this should be at the table, no one should be left behind here. So that's really the critical part of it. And we're blessed to have religious institutions that are there, as you mentioned, Dr. Robertson, our religious institutions are there. When you see around the world today, whether the situation in Libya or in Syria, and all of this, or in Africa, you will find when government fails, religious institutions are there doing their jobs. So that is very important role that the religious institutions have played. So that's why there is a capacity to change what is going on. FASKIANOS: Thank you. Let's go next to Thomas Uthup. ROBERTSON: Thomas, tell us who you're affiliated with. UTHUP: Yes, I'm with Friends of the United Nations Alliance of Civilizations. Two very specific questions, but before I do that, I just want to mention that the Berkley Center and our Twitter account @friendsunaoc and Religions for Peace, they are doing work trying to spread the good news of religious organizations and interfaith groups working on both COVID-19 and racism. My first question is specifically to Rabbi Conover and Bishop Curry. And that is the impact, sorry to be very crass, but what is the impact of COVID-19 on faith communities' revenue, on contributions because that is a sizable part of the revenue. And if you don't have revenue, you can't really carry out services, whether it's in your congregation, or whether it's  to serve the larger public to work at food bank or contributions. Have there been studies done on impact and has technology helped? I know in my church I attend technology has been significant in addressing this because people just kind of contribute automatically. So whether they're actually passing out envelopes, it doesn't matter if you're not showing up. So my first question is about the impact of COVID-19 on contributions and whether it's been mitigated by technology. My second question is about the segregation, the continued segregation of faith communities by race. We all recall that the Reverend King said that 11 a.m. on Sunday morning is the most segregated hour in Christian America. It's probably very similar in synagogues, and mosques, whether on Friday or Saturday. So what is the role of clergy in education to address racism and prejudice, particularly using religious texts? Their homilies, sermons. I think that this is an example of something that at a local level, could really be helpful in changing people's minds about bigotry, prejudice, etc. ROBERTSON: Thomas, thank you for both questions. I'm not sure how much we will have to hit both of them. But let's at least to the first question far from press, it's a very practical one. And also it's a value question, as we heard. So Rabbi, would you like to go first on that one? CONOVER: Sure. Sure. Well, I'll just say that at this point, we are you know, we've made a budget for this year thinking that our revenues are going to be less. And I'll also say that as we've done so we've also put out materials to really ask on people who have a little bit more this year, to give a little bit more in order to be able to help those in need in our community. And so because for us where we are, we want to be able to support the needs of our community. Lots of different ways. And we know that there are some people who have the means still to do so. And I'll say that some people are now calling on us, calling us saying, how can we give more we want to be able to help in this in this way. But we also know that right now we're on the tip of this, right, that we've not even going into see how this will - how COVID-19 and the effect on the economy, how that will affect all of us. I think we really are just on the tip of this, even though some people are feeling it so much even in this moment, I'll also say that as far as electronically, and whether that's helped, I think you're onto something here because I do also find the same we just we you know again, this is feels like these are some small details within the larger conversation. But I will say that we just switched over to another, a new way of being able to have a platform for how we communicate with our congregation electronically, and it really has been helpful, but I think that there are other communities that are a little further along than we are in this. And so we're trying to learn our best from all of them. And again, it is an avenue. So say electronically, computer, those things, it's an avenue to get the word out for the good work that can be done in in communities of faith. So I see that as a means to an end. And the more effective we can be in those means, the more effective we can be in our end. ROBERTSON: Bishop? CURRY: Yeah, I think Rabbi Conover really kind of gave you a good picture, I think on the revenue landscape, as far as we know it, but it's early to tell, we're still at the beginning of this. And churches, synagogues, mosques, religious communities are going to reflect the economy. But one slight difference is religious people will probably dig deeper and many are, those who have the capacity to do so. Which will balance it but it's going to reflect it. I think on the other question, I can just say quickly, I really do believe that one of the things that we as religious communities can do is to foster the work of bringing people together across differences for real human relationship. I mean, real human relationship, spending time together, sharing and work together, not just talking, but actually bringing people together across differences, not only of religion, but of ethnicity across racial differences. Here's the dangerous one across political differences. We have got to nurture relationships between people, red and blue and whatever, whatever other colors are on that rainbow. Because the truth is, that will be how we begin to knit together, this democracy and this world and learn to live together. CONOVER: How appropriate that you say that wearing a purple shirt. ROBERTSON: Dr. Elsanousi, since we're coming towards the end here, do you want to add something in that one? ELSANOUSI: Just really quickly,  this is again the time for solidarity in our own Muslim communities in the United States, I have seen Muslim organizations that they get together and to find a way to coordinate their fundraising efforts. So that how we can keep our institutions. We also have seen that, as Bishop Curry was saying, in some communities that revenue actually increased. Sometimes people tend to give more at the time of crisis and things like that. So we have seen that as well. So but it's a coordination. And this brings me to a very important point which is also connected to the issue of segregation that was mentioned by Thomas again. This is another - we have to look into our communities. In the American Muslim community now we are looking into how we can build a stronger relationship between indigenous African American Muslim communities and immigrant communities. Some scholars, they call it between suburban Islam and inner-city Islam, how we can bring and build that bridge between these two communities. So I think that the crisis bring a lot of issues in our community, as we said earlier, and it's an opportunity to address those issues. ROBERTSON: Thank you. Thank you, Thomas. And thank you also for alluding to the good work of Religions for Peace and what they've been doing during this time as well. And a reminder to all of us as we wrap up here, that one great sign of solidarity and of respect and care for one another is indeed the thing we've mentioned several times. That mask is both practical and an incredible symbol of care for one another. Thank you all for being a part of this discussion. Thank you to our panelists, remarkable individuals and friends all. Irina, thank you and certainly to all those who have been listening in. Final words from you Irina. FASKIANOS: I just want to echo your note of thanks, this has been a really rich and insightful conversation. There are many, many thanks in the chatroom there so we appreciate it and again we're here to serve all of you please send us an email with ideas and suggestions for future webinars. ROBERTSON: In closing, Irina, is it also fair to say that that for those who want to make use of this and share this with others, this was on-the-record and so this will be available online and through the podcast, correct? FASKIANOS: Absolutely. And we will be sending, as soon as we post the video and the transcript, we will be sharing out the link and you should feel free to disseminate it in your communities and I know, I for one I'm going to go back and read some of the beautiful words that you all said and the thoughts and how what we all need to do in our own communities to advance. ROBERTSON: Again, thank you to all very much. ELSANOUSI: Thank you so much. FASKIANOS: Thank you. Thank you. CONOVER: Thank you.
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    Susan Dentzer, health-care analyst, commentator, journalist, and senior policy fellow at the Duke-Margolis Center for Health Policy, discusses local health systems, including how they are coping with the COVID-19 pandemic and best practices for reporting on the subject. Carla Anne Robbins, CFR adjunct senior fellow and former deputy editorial page editor at the New York Times, hosts the webinar.   FASKIANOS: Good afternoon. Welcome to today's Council on Foreign Relations Local Journalists Webinar. We'll be discussing local health systems and best practices reporting on them during COVID-19 pandemic with Susan Dentzer and Carla Anna Robbins. I'm Irina Faskianos, Vice President for the National Program and Outreach here at CFR. As you know, CFR is an independent, nonpartisan organization, and think tank focusing on U.S. foreign policy. This webinar is part of CFR's Local Journalists Initiative created to help you connect the local issues you cover in your communities to global dynamics. Our programming will put you in touch with CFR resources and expertise on international issues and provides a forum for sharing best practices. So thank you all for being with us. Today's webinar is on the record, and the video and transcript will be posted on our website after the fact at CFR.org/localjournalists. We shared bios with you, but let me just give you a few highlights. Susan Dentzer is a leading expert on American healthcare and policy and a frequent commentator on news outlets including PBS and NPR. She is currently a senior policy fellow at the Duke Margolis Center for Health Policy in Washington, DC. She's held roles as the on air health correspondent for the PBS NewsHour and editor in chief of the policy journal Health Affairs, and she's a member the Council on Foreign Relations. Carla Anna Robbins is an adjunct senior fellow at CFR. She's aculty director of the master of international affairs program and clinical professor of national security studies at Baruch College’s Marxe School of Public and International Affairs. Previously she was deputy editorial page editor at the New York Times, and chief diplomatic correspondent at the Wall Street Journal. So Susan and Carla, thank you very much for taking the time to be with us today. I'm going to turn it over you, Carla, to get us started. ROBBINS: Irina, thank you, as always, and thank you to everybody at CFR. So Susan, thank you for doing this. You bring multiple skill sets to this conversation. Today I'm reporting on local health systems and the pandemic. You've worked in television and magazines. You’ve edited, what was when you were doing it, the leading public health journal, and you started in the business with local newspapers. So you've done it all. You also have deep expertise not only in public health, but also in economics, and this is in many ways an economic story. So in full disclosure for everyone here, you're also one of my best friends, you're probably my best friend. So we’ve got to be clear on this for full disclosure. So as ever, we're going to start out with a few questions from me and then throw it open to everyone here and I really want to thank all the journalists here because the work you guys do is so incredibly important right now. We know how tough the news businesses is, it isn't? I can't even imagine what it's like to report on a daily basis in the current environment, so thank you for being here. So when we talked about you joining us today, I divided my questions into two areas: getting through the pandemic and digging out afterwards. So, what questions and what stories should we be asking in this stage of the pandemic about our local health systems capacity, even though the infection rates and mortality numbers are rising? We're not hearing about crises so much in capacity or shortages of PPV or ventilators. Is that about to come again? Did we learn some key lessons from the first wave in New York and Washington state or from Europe, that local hospitals in Texas, Florida, Arizona, and Nevada are now following? Is it going to get better, or are we about to get hit by another wave in a really bad way? DENTZER: Well, thank you Carla. First of all, thank you for that gracious introduction and secondly, great to be with all of you to talk about this very important topic. I want to echo what Carla said about the importance of you continuing to do your very important work. So, that was a lot of questions. Let me start to unpack some of them. I divide my thinking up into the viability of the health system to cope with a pandemic into its clinical issues. What is it actually able to do clinically now to care for people with COVID-19? And then what are the financial and operational repercussions on the system and its capacity to deal with this? As Carla said, there's what we care about now and then what is going to happen in the future. So thinking in those different dimensions, clinical versus financial, operational, now versus future, that's kind of how I organize my own thinking. If we just take the clinical perspective right now and ask, you know, how our health systems doing in various areas around the country? The first thing, of course, that I learned long ago as a journalist is that almost anything you say about the US healthcare system will be true somewhere. Because there is so much variation around the country and around the system and among hospitals, and across even within the same metropolitan area. There will be big differences among hospitals, depending on the structure of the hospital. Is it nonprofit? Is it for profit? Who does it serve? Who's its population base? Is it primarily Medicaid patients or public publicly insured patients, or is it a more privately oriented system? All of those variables come into play when we ask any question about what's going on in the healthcare system. But if we basically ask, how is the health system prepared today? We think about sort of three S's: space, stuff, and staff. Okay, so the space is, how much space do they have to accommodate patients right now? That space issue, as we have learned across the country, has really been able to fluctuate, because if you take, for example, New York, the governor of New York told every hospital in the state to double ICU capacity within the hospital. So they had to put hospital beds, including ICU beds, and what were formerly conference rooms and what were formerly closets, etc. So for space, has the current system, does it have the current space? And what space has it created in terms of new beds, swing beds, etc, etc. So that's one really important factor, how much space do they have. And that will not necessarily be a fixed number because hospitals have a licensed number of beds that frankly is kind of a fiction, it's not even clear. They're always operating and staffing their fully licensed number of beds. So you always have to be aware of that. It's a dynamic number that that you have to get your arms around. So that’s space. The next thing is stuff, and of course, the most important stuff in the current environment. People have tended to focus on personal protective equipment, or PPE, and that's extremely important. But it's also all kinds of other stuff. We focused a lot early on in the pandemic on ventilators. As we now know, we probably overused ventilators. It now looks as if we put too many people on ventilators, and frankly kind of killed them faster by virtue of doing that. So ventilators are important but you also want to know, are there also BiPAP machines, CPAP machines, other ways of providing oxygen support for people as well. Then there's just the basic drugs, you know, are there enough medications? There's been a lot of attention obviously on remdesivir capacity, but we care about everything else too. And now increasingly, we care about other medications: dexamethasone, other forms of corticosteroids, etc. So whether institutions have all of that becomes really important. And then finally staff. And of course, staff was a paramount issue in the Northeast, in particular, in the pandemic. It's still an issue. If you read now, the stories coming out of some places, I read a piece today about Oklahoma. Now, Oklahoma in a different environment, say if there had been a tornado they could have that had devastated a vast area and hospitalized a lot of people, they could have called up staff from Texas. They can't do that now, right? And it's also going to be really hard to get the flow back across the country that occurred when COVID was really hitting the Northeast. Since a number of providers did come in,  for example, from California. California is not going to be in the business of exploiting healthcare providers anytime soon, right? So how systems are able to put together that constellation of stuff, space, and staff is really, really critical and is going to be highly variable, even within particular locations or localities. So that's number one. Then there is the operational aspect of it. As we know, in the first phase of the pandemic in the Northeast, lots of institutions cancelled elective surgeries. That same dynamic is now going on, of course, across much of the rest of the country. You have to do that for various reasons. You can't take up beds with elective surgical patients. You can't take up staff with that, you can't take up PPE with that. This is a hugely devastating financial impact on hospitals, as many of you will know. Elective surgery accounts for about 50% of overall hospital revenues, and the lion's share of the margin, because very frequently, elective surgeries are compensated relatively well by, especially by private payers relative to public payers like Medicare. So what's going on is the institution pulls back from doing a lot of elective surgery. And frankly, sometimes we call elective surgery, it's not clear it's so elective. Sometimes it's urgent surgery that in a perfect world we'd be doing anyway, for example, for people with cancer. So understanding and getting your arms around all of that, in the here and now is really important. And as we know, going forward, this is having an enormous impact on the financial viability of many institutions. Not all, some of them have plenty of cash in the bank. But others don't and they're going to be very seriously stretched. That's why some of you are probably watching very closely, as am I, the efforts now to pull together the next fiscal relief package. This next package is probably going to have to have some additional assistance to hospitals and other healthcare providers, because of the devastating financial impact that many of them have suffered today. So let me stop there, Carla,that was a stab at taking on some of those really important questions you posed. ROBBINS:  So, in my town, I've got a public hospital, I’ve got a private hospital. How public? How much information is there out there about either of those hospitals? How hard is it going to be to get the information that you're talking about as a reporter? DENTZER: It will depend, right, because some hospitals are being very public about what is going on. They have to report a lot of information to public authorities. And now we know that information now has to go up the food chain to the new protect site for HHS. Most of that information is still being reported on that site in the aggregate, but it does dial back down to individual hospital numbers. So with some digging in, and you can certainly go to the hospital and say, what numbers are you reporting yet, right? About your occupancy, for example. So you you can get it, it's just it will require some digging. And that's true for all hospitals, they all have to report that at this point. ROBBINS:  And so of the numbers that are being reported, what are the most important ones? We hear so much back and forth on the other numbers, you know, mortality rates, pseudo percentage infection, you see all the numbers on the front of the Times every day. But if I want to look at the health and the capacity of a hospital itself, and you went through those very good things, which particular numbers are the ones that I should be paying the most attention to? DENTZER:  Well, I think overall, you really you do want to understand. And it's important to say in most parts of the country, not all, in most parts of the country, what is developing is some way for hospitals to get together and share resources, and if not share resources just work together to address this pandemic. So you will frequently read about patients being transferred from one facility to another. So it's important to understand what's going on in the individual hospital, but it's also important to understand what's going on collectively in the state or the region. Because there's going to be a lot of this going on, there's will be movement of people being transferred when certain institutions get to be overcapacity, or they're experienced shortages of ICU beds or what have you. So understanding what that  looks like in the region and what is the capacity overall of the system regionally to respond is probably the most important thing of all. Because it's highly unlikely that every institution is always going to be able to respond to every element of COVID business that comes to that door at a particular time. It's going to need the ability to transfer patients to other institutions. So understanding what regional capacity there is to do that is important, but also who's overseeing that process, right? Who in the state health department is keeping tabs on this? And have they figured out a way to triage amongst systems that way? ROBBINS: So you talked to a lot of hospital administrators and people from different parts of the country and you also are watching the wave right now. Are there particular parts of the country that you're most worried about in terms of capacity and ability to deal with this? Because it means the lagging indicators are here and things are just really ginned up in the last few weeks again. DENTZER: Yeah. Well, you can first of all look on some of the big sites that are tracking all of this on multiple levels. COVID tracking project, for example, to some degree COVID exit strategy is tracking that, the new protect Health and Human Services (HHS) site, etc. And you can put together a picture, but it's very clear that the worst off areas of the country now are, not necessarily in this order, but it's California, Texas, and Arizona. ROBBINS:  But is that also true about their capacity? I mean, that's certainly true about their infection rate, but isn't that also true about their capacity? DENTZER:  Yeah, if you look at the numbers, they are bumping way, way up against capacity. Now, it's going to be different within different areas of the state. Because the urban centers obviously are much more stressed, relative to most of the rural centers, but some of the rural centers are very highly stressed. And already in California, for at least a month there have been big transfers of patients several hundred miles from various parts of the state into, for example, Los Angeles. So, this is where I was getting at this notion of understanding the overall numbers and also what is what are the patterns of transfer and movement of patients around and who's essentially guiding that process, as various areas become way over capacity. ROBBINS:  So, why did they change this thing with the CDC and the reporting responsibilities transferring it to the HHS? I mean, a lot of people are looking at that very suspiciously, but it's a way, one more attempt to Jedi mind game us on something. DENTZER:  Well, I think there was probably less nefarious stuff going on there then then some have reported. It is true that the CDC had some existing lines of reporting that for various reasons already were confusing for a lot of hospitals. Essentially what is happening now is it's all being inputted into this protect site at HHS, I think that probably was an appropriate thing to do. Could we rule out that people aren't going to try to play games with the data? No. But, in whose interest is it right now to do that? Maybe there's one person whose interest there is to do that, but almost no one else. So I think it's probably not an issue we need to spend a lot of time on. The really important thing, obviously, is getting the data as quickly as possible. And to the degree, I know, there's a lot of confusion right now among hospitals as the shift has taken place, but that should sort itself out. And now there will be this one entry point for the data and that should help the process. ROBBINS:  So I want to throw it open, but some of the things that I'm thinking about. And just one that I want to throw in very quickly right now a big question, which of course, it's ridiculous to throw in at this moment is there are rescue packages, potentially things that people are going to know. I don't know what the reporting requirements of financial reporting requirements are for hospitals, I assume that public and private have different responsibilities. But if I wanted to take a look at the financial health of my local hospital, how would I do that? How often do they have to report it? And how could I figure out right now how close to the edge they are? DENTZER:  Well, there are a couple of ways you can do that. For the larger systems, almost every hospital finances itself by issuing bonds and all those bonds are rated by the major rating agency, Standard and Poor's, Moody's and Fitch. So the first thing to do is if you're talking about a reasonably good size system, call up the rating agencies and ask them are they rating? Not every rating agency rates every system, so they're going to be taking different pieces of the pie. But find out what what's happened to the credit rating. And there have been a lot of credit rating reductions, especially in recent weeks for a number of these facilities. So that's number one. For smaller hospitals, and particularly for safety net hospitals, municipal authorities can often issue bonds on their behalf municipal bonds, and those are those are reported into SEC. So you can go on the SEC website and see what's going on with that level of institution. The other really critical thing is just to call them up and ask, right? Because if you can get the CFO on the phone, you know, hospitals don't have an interest right now in downplaying the degree of their financial duress. They just don't, if anything quite the opposite. And as we know, in the first wave of provider relief that came through to the tune of 175 billion, not all of which has been dispensed, by the way at this point. Because of the formulas that were adopted, both for that part of the program and also for what essentially amounted to loans, some of you who follow this will know that CMS in particular, gave, essentially lent hospitals their future Medicare payment, to help them address any liquidity concerns, and those were structured as loans that are going to have to be paid back eventually. There's a lot of discussion now about the timing of those paybacks, how much of that will actually be required, how much loan forgiveness should there be, and if there's not loan forgiveness, what is the interest rate that hospitals will have to pay if they don't pay that money back on a timely basis? If you put all that together, hospitals right now have an interest in disclosing what their actual financial situation is because this will not only sort out what to do with the first wave of the hospital systems, but also what to do with the next wave of hospital systems, right? And there will be another way. The House passed, its so called Heroes Act back in May that had a big element of financial relief. Now we're going to see what the Senate puts forward, if anything, and then of course, the negotiating will begin. But hospitals really do have an interest right now in being public about what their degree of difficulty is, and so I would start by asking them and get as far down the road as you can with them that way and then you have these backup options as well. ROBBINS:  That's great. Thank you so much for that. So Irina questions from? FASKIANOS: Yes. So thank you both. Let's go now to all of you For your questions and answers, please click on the raise hand icon on your screen to indicate you would like to ask a question and please accept the unmute prompt and tell us who you are and what news outlet you work with, to give us context. So let's see we already have two hands up. So we'll go first to Tiffany Stecker. Q: Can you hear me? FASKIANOS: Yes. Q: Okay, great. Well, thanks so much. This is really interesting. So I'm with Bloomberg Law. I'm based in California and was on a call with the State Hospital Association yesterday. And they mentioned that one issue is that patients that are usually discharged from a hospital and go into a skilled nursing facility for rehab for a couple weeks, and that option isn't available anymore because of the problem that cities have had with containing COVID. So, Susan, I just wanted to see if that's something you've seen in other states or nationwide where there's a backlog of patients that can't go home yet, but can't really go to an acute care facility because of COVID. DENTZER:  Yes, indeed, that's been a problem almost every place. And I'll just point you all to a webinar series that I hosted for the patient center at Outcomes Research Institute. Back in the spring, if you go to pcori.org, go down to the bottom of the site, you'll see, you can click on and get all of those webinars and almost everything. What's interesting is that almost everything that is being experienced in the health system now was exact same stuff that was being experienced two months ago and three months ago in the Northeast in particular, but also Louisiana and some of the other epicenter areas early on. But this issue of patient flow at large has been a real issue. So if you think of it, you had patients getting sick in the community, some of whom were getting sick initially in nursing homes. And so they were having to be admitted from nursing homes into hospitals. So there was one element of flow that had to be taken into account. Then once patients were treated, if they were recovered and had to be discharged, you had to get them out of the hospital. Well, in the Northeast, New York in particular, where did they go? Some of them could be discharged to home unless people at home were sick and couldn't take care of them. So that couldn't happen. Nursing homes initially in New York were refusing to take patients back because of the uncertainty about how long, even after they had recovered, whether in fact they would remain infectious, right? So there was concern about taking them back. And a lot of hospitals in New York and elsewhere, were requiring two negative SARS-CoV-2 tests before they would take a patient back. Well, that could take two weeks to get the results back. So patients were stacking up in hospitals, not able to go back into nursing homes. So that was an issue. And then as I say, they couldn't necessarily go home. And guess what, there wasn't necessarily enough homecare staff because at one point, the visiting nurse service of New York, more than a third of the staff was out sick, right? And then for patients who couldn't have a place to go home, shelters weren't taking them back, so the city essentially had to turn around and read a lot of hotel rooms to house patients. So various versions of this have played out across the rest of the country. And it's been a real real issue and it's only compounded by the disaster of the testing situation in most places, the availability of tests, the time lag for getting tests back, etc. FASKIANOS: Okay, thank you. Let's go to Ann Thompson. Q:  Yes. Thank you. Thank you for doing this. I was wondering about contact tracing. Have we just given up on that? Are there areas of the country that are doing it well? DENTZER: Yeah, there are some. It's becoming less and less of an urgent issue in the high surge areas, frankly, because as you all know, despite the large number of positive tests, we think it's a major understatement, right? I mean, I think CDC director Redfield has said it's probably 10 times the reported rate at this point. Well, if that's the case, you take some of the areas that have had really major surges in infection in recent weeks, the states I mentioned earlier and also Florida. If the actual positivity rate is 10 times what we're showing now, contact tracing does isn't going to really help that much, right? Because almost everybody will have already come into contact with people who are positive. So you know, it doesn't mean that contact tracing is useless. It still should happen for scientific reasons. I mean, we still need to further our understanding of how people become infected. We pretty much know the basic parameters, you know, that you have to be in a more confined area for a certain amount of time and be exposed to either aerosolized virus or droplets. But we could probably refine our understanding further if we have more contact tracing going on for scientific purposes. For the purposes of having people essentially stopping community spread, it gets harder as I say when the prevalence is higher number one. The other thing is with the testing delays. It is probably the case that let's say you got alerted that somebody you had been in contact with somebody who had tested positive. You go out today to get a test, you could wait a week before you get your test results back. So in a perfect world, what would you do, you would quarantine for that week. How many people are actually doing that? Probably not very many while they await their results. And in the meantime, as we continue to refine our understanding, we think people are at their most infectious before they're symptomatic, right? So it means they don't know. They don't want to believe that they're sick. They don't have symptoms, they're probably moving around a lot, even if they've been notified that they've come into contact with somebody who tested positive. So that makes the contact tracing piece a real struggle. FASKIANOS: Thank you, Missy Miller. Q: Hey there, thanks so much for taking my question. I was wondering, do we know what is a normal hospital capacity pre-pandemic? Because Florida now has a dashboard that it shows patient beds and ICU beds per hospital. And at the beginning some of these ICU’s were showing at zero percent. So the hospitals changed how they report it, so now they're reporting all their beds, not only their staffed beds, so it's very hard to judge what the number that we see on this dashboard is, whether they're doing well or reach 90 or 100%, if they’re full. Do you have any benchmarks to compare this with or what questions we should ask? DENTZER:  It's a complicated question, as you suggest, and back to what I said earlier, first of all hospitals do have some surge capacity, right? So they can probably add more beds. As I say, in New York, they were required to do so they haven't been required to in other states, but they, a lot of them do have capacity. So there's a little bit of surge capacity, probably still in a fair number of hospitals. So that would be one question to ask. Okay, so how many beds are you saying you have now and how much of that has been surge capacity that you've added? What additional surge capacity do you have to add? How are you thinking that you would segment that as between ICU beds and step town beds and general floor beds, etc. So that's one piece of it. Historically, particularly in recent years, it has been the tendency of hospitals to try to operate as close to capacity as they possibly can. And going into the pandemic, if you looked at major urban centers, hospital occupancy rates were way, way up in the 80s, or even the low 90s in most places in good times. Okay. Now, admittedly a lot of that is pointed be things like elective surgery patients. So these are people are not there for a long time, but they're there for several days. And the cycle because hospitals were churning through so much like elective surgery, they were trying to keep those beds relatively full because they were trying to do a lot of elective surgeries. So essentially, what we're having to do is compare life before COVID, which was operating under a completely different set of dynamics to life during COVID, which is totally different dynamics with no elective surgeries and lots of COVID patients. And as we know, in some areas of the country, you know, 40% of the patients who are in hospitals or more are COVID patients, they pushed out a lot of the other, in effect pushed out a lot of the other patients. So I wouldn't spend a ton of time asking what the normal world is because it doesn't matter right now what normal was, what matters is what is what's going on now. FASKIANOS:Thank you, let's go to Anastassia Gliadkovskaya. Q: Hi, thanks so much. I'm a data fellow at The City, we’re a digital newsroom that cover the five boroughs in New York. I had a question about finances specifically. You know, hospital systems are all of different sizes and their finances vary widely. Are there certain red flags that we can say definitively across the board, you know, are concerning for all hospitals? So for example, you know, some hospitals may say they lost half a billion dollars, you know, lost revenue on elective surgeries that were postponed. But another hospital may have lost less or more.Does it make sense at all to compare those losses, given how, you know how different they are in size? And I guess the follow up is, apart from the ratings that you mentioned, are there other indicators of health or sort of red flags? Like, for instance, heavy borrowing is that you know, would heavy borrowing indicate health or on the other hand, sort of concerning red flag? DENTZER:  The number one question you want to ask the CFO is how many days cash do you have on hand, right? Because days cash on hand means, can you afford to pay your staff or are you gonna have to lay people off? Can you afford to buy PPE or are you going to have to go without it, right? So days cash on hand, how many days cash do you have on hand? So after that, hospitals are borrowing all the time. But they shouldn't be necessarily borrowing for operational purposes, they should be borrowing to expand capacity and things like that. So, but if you can get it, if they don't have much cash on hand, then they are going to have to work out short term financial arrangements. That's why they need it, these advanced payments from Medicare so badly and from private payers as well. So I would ask them, you know, once you find out what days cash on hand owes, and if it's below 30, they're in big trouble, right? Ask them, what emergency sources of financial support are you lining up? Are you going to have to furlough staff? You know, all of the consequences that would normally follow from a hospital essentially running out of cash. So I would start there and then of course, you could look at their overall credit rating and what happens in that vein. And then, you know, ask them to tell you how many people they've laid off right recently, because they will if they have been really stressed, they will have had to already start taking measures like that to start to conserve cash. FASKIANOS: Thank you. Let's go to Mary Katherine Wildman. Q:  I am a reporter with the Post and Courier newspaper in Charleston, South Carolina. Thank you. The question I have, hospitals are dealing with all kinds of financial stressors right now. But one thing that I'm just a little unclear on is that many hospitals in our state have kind of stepped in to offer or at least facilitate a lot of our state's testing. Is that a financial positive or negative for most hospitals, and if it's possible to say how much does that cost them to provide? DENTZER: It depends, right? Well, as with most things, a lot of hospitals in larger health systems are able to develop their own in house tests. These are known as laboratory tests. For those of you who have covered this in an earlier era, those are what we would think of as tests that are governed under the regulations known as CLIA, right? And hospitals have always had the ability to develop those tests. And many of them have in this environment in particular, they are able to bill insurers for those tests, as we know they cannot build individuals for those tests. That was part of the some of the earlier relief packages that were enacted. So there's no cost sharing now for individuals for COVID related tests that have to do with establishing whether you've got the virus or not. There's a little bit more ambiguity around tests that are done to figure out how to treat you. That's going to be sorted out in the next packages of legislation. But at least if you're in the hospital and you get a hospital device test, you're not going to pay anything and the hospital is essentially going to have to negotiate with insurance companies as to what that test is going to be. And like most things, hospitals will tend to pick a number that they want to bill the insurer for. And then there's an effect of negotiation about what the insurer will actually pay. Okay, so that's that situation. There are other situations where hospitals might be doing either on campus or off campus tests, where they've linked with some other provider of some sort, who is handling the test. It's either a public health authority that is doing it, in which case the public health authority is picking up the tab for that, or it could be partnering, say with a CVS or one of the other major commercial testing labs. And in that case, it's going to be a function of what arrangements were set about who's going to bear the cost of it. Typically, if it's done by a commercial lab that has set up, let's say you've got like a CVS or you've got a lab, Lab Core or Quest Diagnostics, orchestrating the testing facility, the hospital itself isn't going to be on the hook for that or necessarily getting the revenue from that. That's going to be a transaction that's negotiated between the commercial lab company and the health insurer. FASKIANOS: It looks like we have no questions. Oh, we do have another question, Mary Zatina, Q:  I’m with WDET public radio in Detroit, and my question pertains to nonprofit hospitals and their requirement for funding. What do you see happening with nonprofit hospitals reporting their losses from the coronavirus and what they would benefit? And also, what implication might that have overall on community benefit from nonprofit health systems and hospitals? DENTZER: Well in the short run, if I were running a nonprofit hospital and by the way, when we say nonprofit, of course, what we really mean is tax exempt, right? Because they essentially do not have to pay many forms of taxes at the federal or state level. They may have to make payments in lieu of taxes that have been structured in various areas. But you know, every hospital has to have a margin of some sort to stay in business. And whether you want to call that a surplus or a profit, whatever, they've got to have some margin to stay to stay in business and to continue to reinvest. And historically, nonprofit hospital margins have been all over the lot. It really depends on, you know, what is the size of your institution, what is the mix of pairs that you have, etc, etc. So when we say nonprofit, we mean everything from a Cedars Sinai or Northwell Health. I mean, Northwell Health is the biggest employer in New York State, right? And it's a nonprofit system. So we mean everything from that all the way down to a very, very small, much smaller community hospital, for example, or even a rural hospital. So there's huge, huge range there. On community benefit, if I were running a hospital, you bet your life I would declare to at least to some degree, what I'm doing now, as community benefit if it's legitimate to do that. Right now we have a lot of forms of assistance coming in to cover the costs of caring for patients with COVID-19. And there probably will be another wave of that. If we look at the Heroes Act, if that becomes anything close to law, that if any of those provisions are taken up in an overall bill that passes both the Senate and the House and is enacted into law, there's a lot of Medicaid changes in particular there. There are numbers of provisions for Cobra extension, etc, etc. So, a lot of care isn't going to be free care. It's going to be picked up by somebody in particular by Medicaid. To the degree that there are unreimbursed expenses out there, it really does behoove hospitals to capture that and legitimately claim that as community benefit. I think it's going to be difficult to do that because of all of these payment changes that are going on. I think more broadly, you know, when this is over, there will probably be a look back at how hospitals have handled this to understand the situation. And I guess I would not go out on a limb at this point and say that I know what we're going to find. But you know, it this is a complicated exercise and could you imagine that a lot of hospitals are going to try to report things as community benefits that in retrospect, they probably shouldn't have. Yeah, I can imagine that would happen. I can also imagine that hospitals will throw up their hands and say, it's just too complicated. Let's get on with this. And then we'll see what happens with community benefit provisions if they are altered going forward. I don't even begin to pretend I can see that far into the future. FASKIANOS: Thank you, let's go back to Naseem Miller and she's with the Orlando Sentinel. Q: Thanks again, I am curious, how you would view a midsize nonprofit health system that, you know it started laying people off in April/May but at the same time since then they have acquired another small hospital. And the two sort of don't jive with each other, but maybe it works for high level finance, but I don't quite know what to make of it. And of course, the employees are pretty outraged about it. So I don't know what do you think? DENTZER: Well, there has been a trend of hospital consolidation on for quite some time, for the fundamental reason that to some degree, depending on the part of the country before the pandemic, you could reasonably argue that there were too many hospitals, too many hospital beds. That's not an argument many people make today. But before the pandemic, that was true in certain areas of the country. And if you think about it, if you have two hospitals, you've got two CEOs, two boards, two sets of overhead, etc. If you combine them, you streamline all of that. And so your fixed costs relative to your volume fall. So economically, that is a rational move and it is a particularly rational move now, because I can bet you I don't know that situation that you're describing. But I bet you the hospital that acquired probably had 10 days of cash left on hand, right? They probably didn't have a choice. And you should ask what the purchase price was. Because I know for example, up here in Washington, DC several years ago, Johns Hopkins, but it what had been a prestigious hospital in northwest Washington called Sibley for $1. Because it essentially in buying the hospital saved a lot of its debt. Okay. So find out what the purchase price was. If I were the employees, I'd say, you know what, if I want to keep working here, or even possibly be called back to work someday, it's probably better off at these hospitals merged. I know the optics of it look really bad but from a reasonable financial standpoint, I would bet you it was a smart decision. FASKIANOS: Thank you. We don't have any questions right now. But in the chat, can you reiterate, and we will send it around but the website that you mentioned at the outset, Susan, so people can look it up after this call? DENTZER:  Sure. It's the website of the Patient Center Outcomes Research Institute, which goes by the acronym PCORI, pcori.org. PCORI is not a government entity, it was created under the Affordable Care Act. So it's considered a quasi governmental agency, which is why it has that org as opposed to Gov. But go to that page. And if you look down at the bottom of that page, you'll see on the left a tile that essentially directs you to a webinar series. And that's the webinar series that we did back in late March, April, and into May. We did a segment on this whole question of flow within hospitals that I mentioned, including the nursing home piece. We did a segment on how hospitals should set up incident command structures, which is another thing that you might want to look into, particularly for purposes of maybe developing an interesting feature story. We did a segment on telehealth and the very broad use of telehealth that occurred in the early stages of the pandemic in particular. And we did another segment on the emergency room and what was going on in emergency departments. Because of course, those were primarily the receiving areas for the first waves of patients. And in the early, early days of the pandemic, that's where a lot of the really difficult stories were occurring as patients were showing up breathing fine one minute and dead within several hours as their breathing capacity rapidly deteriorated. So there's some fairly gripping stories there. FASKIANOS: Thank you. And we'll circulate that again after this discussion, but I wanted to give it make sure everybody had it right now. So Carla, over to you for more probing questions. I always have questions. ROBBINS:  I always have questions. So Susan, you know a lot about the way Washington works. Let's pitch forward a little bit. Vaccine has developed one hopes sooner rather than later. How much preparation is being made on distribution and on rational distribution? And who's going to make that decision? DENTZER:  Well, really important questions. As we know, what is happening now is the government is signing contracts, there was just one announced yesterday with Pfizer, to commit to buying a large numbers of vaccines, even before we have a proven vaccine, and it is doing that with more than one company. So companies can already start producing the vaccine even before it is approved and makes it all the way through phase three clinical trials. It's because we don't have time, right? I mean, it's better at this point to create the capacity, just building the capacity to produce the vaccines is important. Getting the glass vials, we don't have enough glass vials in the world right now to produce the adequate numbers of vaccines. So, gearing up all of that production capacity becomes really, really important. Then we have results out of some of the phase three trials, which are already underway.  If we have those by early fall, it is theoretically possible that you could get some initial so called emergency authorizations out of the FDA that would essentially say we're tentatively approving these vaccines, and then you will already have a lot of them produced and then able to be distributed. On the question of distribution, there's been a newly appointed panel under the National Academy of Sciences to look at this issue. CDC basically came to the national academies and said, tell us how to figure this out, right? Because it's an extremely important set of issues to figure out, you know, because we're not going to get all the vaccine doses that we need available right away, it's going to just be a drop in the bucket at the outset relative to the need. So figuring out how to roll the vaccines out who gets them first, is it high risk elderly people in nursing homes? Are we going to prioritize those people over, for example, schoolchildren, right, so that we can reopen schools again or universities so we can get universities open again or restaurants so they can open up again? I mean some really, really difficult issues. They will be made less difficult if we have huge volumes of vaccines, or if we have more than one vaccine. And it's theoretically possible that we'll have a couple or a few vaccines, but then even figuring that out on the basis of clinical trials, which, in the in the best of all worlds, we will have tested these vaccines on maybe 30,000 individuals, maybe 50, maybe 60. Deciding on that basis, what vaccines we think are going to work for which parts of the population is also going to be very complicated. So all of this has to be somehow figured out over the next say six months, so that we can come up with some kind of a rational plan. And it will be one of the hardest things I think from a public health standpoint that this country has ever had to do. ROBBINS: But it's not just a public health issue. It's also a political issue. And it's also a question of who's in charge. When you look at sort of the political struggle that's gone on, you know, even who gets to brief at the White House and we trust the CDC. Ultimately, who owns the vaccine and who gets to decide who benefits here? DENTZER:  Well, for these agreements that have been struck by the federal government, in essence, the federal government owns that vaccine, right? And some of  the manufacturers have said, when that price when that transaction takes place, they're not expecting a red cent more. Some have said no, we're going to take a lot of the government money to develop this we're going to see some advanced purchase commitments and we're going to strike those regions, but we're going to reserve the right to continue to sell the vaccine on the outside. So we'll see some variation I'm pretty sure in those arrangements as well. For the as best as I can tell, from reading the detail that Pfizer and MIH have put out and HHS to put out, the government is going to own every dose of the Pfizer vaccine that has it has committed to produce in this certain timeframe. So that means if there is a government decision about how to allocate that, that will be followed. But that's a big if, right? If there's going to be a plan. Now, as we have seen, there hasn't been a top down government plan on anything in this whole arrangement. So what emerges as a top down government plan? I honestly don't know. It could be that what will happen is the government will just say, we're just going to divide this on a population basis. We're going to ship it out to the states, certain doses, for whatever your population is. We're going to send you enough to vaccinate 3% of your population and you figure it out, states. I think if I had to bet, I'd say that is probably, you know, it depends on who of course, is making that decision. What administration and what is the timeline, but if it were today, I would say, I would bet that's how they will do it. They'll just allocate them to the states on a percentage population basis and let the states figure it out. But who knows, this is truly uncharted territory. ROBBINS:  This is the Council on Foreign Relations. Does anybody have a better idea internationally about how to distribute this vaccine? DENTZER:  No. It's a huge issue because obviously the rich countries are the countries that are in a position to put up the money for these kinds of arrangements, these major advance purchasing commitments. There is a movement now to try to structure that on behalf of poor countries. But it's not particularly far along. And it's not clear what how big the pool is ultimately going to be that is set aside to buy these vaccines on behalf of poorer countries. That's another for people who are interested in the global health aspects of that, that is a huge issue that we're just all gonna have to keep watching. ROBBINS:  I see we have one final question, Irina, from Frank Zufall. Less dependency on ventilators, what have hospitals, medical personnel learned about addressing COVID-19 over the last 13 months, have we become more effective in treating patients? DENTZER:  Yes is the word. And that's, you know, if you want to look at any silver linings in this, there is just incredibly rapid learning that went on at the clinical level and very rapid dissemination of the learning that went on at the clinical level. So, again, back to ventilators. As many of you will know, what was clearly showing up in a lot of patients is that their lung function deteriorated very, very, very rapidly. And there's a measure known as oxygen saturation and people would come in with a slightly below normal level of oxygen saturation in the blood and it would deteriorate by 50%, within an hour, just extremely suddenly. And early on people said, holy god, what do we do about this? And so the impulse was get somebody on a ventilator as quickly as possible. In retrospect, it looks like, as people understood that this deterioration that could occur, patients were first of all watched a little bit even more closely, you didn't just assume that if somebody was doing well in one hour that you'd come back an hour later, and they still be in that same situation. And then they were also put on alternative forms of oxygen support, CPAP machines, another kind of machine known as a BiPAP machine. Even things like proning, which is basically, you take a patient and you turn the patient over on his or her stomach, because that just enabled better oxygen exchange in the lungs. And even just doing that it was learned would support the breathing capabilities of a lot of patients. So for those of you who know much about this, what we know is if you put patients on ventilators very frequently they don't come off them, right? They die, right? Because it's a pretty extreme measure to undertake. So if you can basically keep from doing that and do other things to support the breathing of patients in the interim, that really helps. And then of course, we've been able to add things like remdesivir, dexamethasone, etc, other treatments that have helped. So there's been a lot of progress. And in the end, it happened very quickly. It could have happened even faster and we would have saved more lives but thank god at least it finally occurred and it's not over. We're just continuing to learn more and more and use more and more tools to help preserve people's lives. ROBBINS:  Well, a little bit of good news there. We've so appreciate your doing this was really fabulous. Lots of really good stories. Irina, I will turn it back to you. Thank you so much. FASKIANOS:  Fantastic. Thank you both Carla and Susan Dentzer, and that you can follow Carla on Twitter @Robbinscarla and Susan at @Susandentzer. And again, we will circulate these resources along with the video and transcript of this webinar. So again, please come to us CFR.org., ThinkGlobalHealth.org, and ForeignAffairs.com, for the latest developments and analysis on the COVID-19 pandemic, and share your suggestions and feedback for future CFR Local Journalist webinars by sending us an email to [email protected]. And I hope you all stay safe and well. So thank you again. Thank you. ROBBINS:  Thanks. STAFF: This concludes
  • Education
    Higher Education Webinar: Campus Health and Safety
    Play
    Preeti N. Malani, chief health officer and professor of medicine in the division of infectious diseases at the University of Michigan, discusses campus health and safety measures to be taken for the fall term. FASKIANOS:  Thank you, Maureen and welcome to everybody to today's Higher Education Webinar. I'm Irina Faskianos, vice president of the National Program and Outreach at the Council on Foreign Relations. Today's meeting is on the record and the video and transcript will be available on our website cfr.org/academic. As always, CFR takes no institutional positions on matters of policy. CFR Higher Education Webinars bring together college and university presidents, administrators and professors to explore strategic challenges and share best practices for meeting them. We are delighted to have Preeti Malani with us to talk about campus health and safety measures in the fall term as we are still in the midst of the pandemic. Dr. Malani is the chief health officer and a professor of medicine and division of infectious diseases at the University of Michigan. As chief health officer, she serves as an advisor to the president on matters of health and well-being of the university community, including disease management, public health preparedness, and promotion of healthy practices and climate on all three campuses. She is a director of the National Poll on Healthy Aging based at the Institute for Healthcare Policy and Innovation, and serves as an associate editor of the Journal of the American Medical Association. As a graduate of the University of Michigan, she had a master’s in journalism at Northwestern University's Medill School of Journalism, and received her MD degree from Wayne State University. She completed her internal medicine residency infectious disease fellowship at the University of Michigan, where she also received a master's in clinical research design and statistical analysis. So, Dr. Malani, thanks very much for being with us. As colleges and universities race for the fall, can you talk about what you're thinking about and doing at University of Michigan? What your health and safety plans are to reopen the campus? MALANI:  Thank you, Irina. Thank you to CFR for having me. It's really an honor to represent the University of Michigan and to share a bit about our bizarre pandemic planning journey. I don't think anyone really could have predicted where we would be. So, a couple of caveats is this is really hard work. Things are changing. And although I'm the one speaking to you today, this is really not my work. It's the work of hundreds of people. And I've been fortunate to be part of the planning, but this has really been a labor of love for so many of us. As you heard, I'm an infectious disease physician. So, I pay attention to WHO reports and I heard about this cluster infections in January. And on January 20, I sent an email to my boss, the University of Michigan president who happens to be a physician and immunologist and he's always you know, he likes to be kept up to date and I'm just going to read you part of the email. Happy New Year. Quick update. I'm sure you've heard about this outbreak of respiratory illnesses from Wuhan city, China, believed to be a novel coronavirus, so like SARS and MERS. Situation's dynamic, but risk of person to person transmission appears to be much lower than SARS. Lots of unknowns right now. The CDC and WHO are involved along with Chinese public health. And then go on to say, you know, we're going to do this and this and we'll pay attention. And I'll kind of let everyone know, just as an FYI, for situational awareness. Sure enough, the next day, the first case in the United States was identified at that time. It was the first case in Seattle. And here we are now more than six months into the pandemic. COVID has changed everything, not just in healthcare, where I work, but how we interact socially, and how we learn. I think back to March, which really feels like a lifetime ago, within a matter of a few days, every college and university in the United States and really, most places in the world, made a unplanned, rapid pivot to remote learning. And at that moment, it really felt like we flipped a switch. We turned off the lights. We closed the door. And we just said, "Go home, everyone go home." And if you could go home, you left. Health and safety was really the only consideration. And we have numerous considerations about things like equity inclusion, overall well-being. We were very concerned, it's hard to learn remotely. It disadvantages people disproportionately who already are going to have more difficulties in learning environment. Depression, anxiety, loneliness are already at epidemic levels. What is isolation going to do to make that worse? But, the risk of COVID really drove our decisions at that time. And we've learned a lot since then. My state of Michigan was was hit early. It was hit hard and we fortunately came out of it and have reengaged a lot of our economy. Clinically, we've learned a lot of things including the potential for asymptomatic transmission, and the importance of face coverings in terms of prevention. And now it's July and we're poised to return to learning with what is being dubbed, most places a hybrid model with lots of things planned as remote, but some smaller classes and other activities end up in person format. But unfortunately, the fall semester is just a few weeks away. And the pandemic is not under control in the U.S. And in fact, in some places, it's completely out of control, especially in the southern and western U.S. And as a nation, we're seeing about 60,000 to 70,000 cases a day. This is all in the backdrop of still having issues with testing, especially in regards to turnaround time, capacity, it's still taking far too long in several states to get tests. And there's not a clear strategy nationally on how to contain the virus. So, it's really been 50 different countries in some ways, with different states, having different processes and procedures and really being at very different points in the pandemic. In the best of circumstances, I think we all knew that getting back to face to face learning was going to be difficult and it will be difficult. And in fact, several schools that initially planned on being back in residence have rescinded those decisions in recent days, because it is so complicated. But many public health experts, including myself, believe that there is a way to resume residential learning in a careful, thoughtful manner that mitigates risk, with the understanding that there is always going to be some residual risk when you are gathering thousands of people. And there will be cases of infection even with the best planning. But this all can really only happen if community spread is controlled and again, in some parts of the country, that's not the case right now. We don't always talk about the why of why to do this because frankly, the safest thing would be to just stay home and wait this out. And for some people, that's going to be the best option. But there are a lot of whys as to the importance of trying to make this happen and in trying to get back to something that feels more like normal and is the more traditional in residence face-to-face educational opportunity. In late June, the University of Michigan announced plans for a public health informed in-residence semester this fall. And this was met with lots of celebration by students and parents and faculty and everyone, we're really excited about it. And this is going to be a mixture of in person and remote classes. It's gonna be structured in a way that promotes best practices from a public health standpoint, while also fulfilling the university's core mission of transformative education. Getting to that announcement required effort of hundreds of members of the event community it was an extremely detailed process; it included several workgroups and committees. Then, there were several guiding principles with health and well-being not just for campus, but the surrounding community and our state at large being at the top of the list. Another big consideration, and I want to sort of put this out there, is that COVID is unfortunately here to stay. So, one of the principles was also thinking about how can we adapt? How can we reframe and find ways to do some things in person, but have flexibility too? One of my colleagues refers to this as the flexible fall plan. I think that that's a good way to think about it. These advisory groups included a committee that addressed the numerous public health considerations. And this included—I was part of that committee. They were several members of our School of Public Health faculty. And what was great is these are the same people who have been advising our state governor, and other leaders on how to get our state back on track. So, we really had excellent expertise in terms of what we do, what can we scale. Another committee looked at ethics and privacy which are really important when it comes to COVID. The provost organized several subcommittees that considered every aspect of education. Everything from small learning places, studios, performance studios, labs, graduate students, international students, foundational courses, the large courses, academic spaces other than classrooms, instructional planning, and each of these were separate standalone committees that also included student engagement in every one of these, really understanding what the student leaders were saying, and really getting diverse opinions and input from all corners of the student body. And I have to say it was an extraordinary process. I, I started to joke that, you know, we were we were a little bit later than a lot of schools in terms of making our follow announcement, although we were headed in that direction. But I kind of joked that it was like sort of the typical Michigan way where we did all our homework, we did all the extra credit, we wrote this big, long paper, and we handed it in. And so a lot of that work, and actually, I'm going to share in the chat box, the amazing blueprint, a lot of it's there and some of the advisory committee work is also there can be found on these websites for people that are interested. Now, not all of the advisory committee work ended up being incorporated in the end, but it's pretty interesting reading. The university leadership has made it really clear that the semester ahead is going to look and feel very different than anything we've ever seen before. The plan is to conduct an in-person semester that focuses on sort of basic public health strategy. So, things we've all become very familiar with: social distancing, wearing face coverings, washing our hands, monitoring ourselves for symptoms, clinical testing, contact tracing, quarantine, minimizing travel out of the area, and really having shared responsibility for these things. One of the big issues is large gatherings. College campuses are like one big large gathering, and some of the concerns that have been raised in recent weeks by peer institutions have included the fact that there've been large parties on campus and what could that do? Could one bad decision end up really impacting the entire region? So, I like to quickly summarize some of the key components for the fall plan. And again, that amazing blueprint has all the details. One comment I wanted to highlight is the importance of communication. Our communication colleagues and our vice president of communications Kelly Michaels have been there every step of the way with us really since day one. And they've helped us produce FAQs, help find holes where we weren't providing enough information. And they've really just done an amazing job of curating information. So that is one good thing that all of us should use as our communications colleagues and public affairs folks. The name Maize and Blueprint implies that things might change and need to be adjusted as conditions change. And I think that that's also important in terms of managing expectations is that this is our plan, but the plan is subject to change like a blueprint. From a standpoint of instruction, students can choose from an in-person, remote, and mixed-instruction depending on their needs. We recognize that some students are going to need to take courses remotely. And whether that's their personal health or their family's health issues. And we wanted to make sure that that was an option. For decisions about what to teach and how to teach was being done at individual school and department level. In general, large classes are going to be remote, small courses will be in person, and medium will be a hybrid depending on everything else, like classroom spaces and the pedagogical requirements. There'll be other changes to reduce density, fewer seats, limitations on gathering and public spaces. You won't be able to go into every building all the time; you might need an ID card to get in; you might need to be screened to get in; classrooms are going to be reconfigured. There's also a realization that remote teaching is different. And one of the things that the provost and others did was to make sure that there are resources to help improve remote teaching, to understand that there are ways to improve course design and have best practices when you are working remotely, it's not quite the same. The academic calendar has been redesigned to reduce back and forth: we're going to start on time, we're going to cancel fall break, and we'll plan to end before Thanksgiving, with the finals and the rest of semester being done remotely. When we come back in January, it's really hard to know what things might look like. But we're going to also start a little bit later with the understanding that we might need a couple weeks just to get things ready for campus. We recognize that a lot of faculty, staff, students, and parents have concerns about return in-person learning. And we're continuing to develop plans, particularly for those who are medically vulnerable and high risk. We are putting together a dashboard really collating the data we have, and having this in a very transparent and ongoing fashion of who's being tested, how many students are tested, how many are positive, and although some of this information is available in different spaces, we want to make sure it's available in one place for everyone. We've also thought about triggers that It might change what we're doing, this idea of like a yellow, orange and red area. We're finalizing plans and protocols for testing. Testing of asymptomatic individuals will primarily focus on students living in communal housing, whether it's the residence halls or co-ops or fraternity houses. We've also really worked closely with our county health department. And in fact, our environmental health services group is a deputized arm and so they can do outbreak investigation where have more resources for contact tracing. Housing is going to include quarantine spaces, and we've been doing this since March, we've had students get sick, who can't go home, and we have a plan to take care of them: everything from getting them there, getting them fed, supporting their well-being, supporting their academics. So that's going to be something that we anticipate the need for. International students are a special concern. We have an international center that's working on policy and visas. We're going to figure out that need for quarantine after arrival. Our health service has been phenomenal and their ability to take care of a lot of patients with COVID. They've had a lot of practice. And fortunately, we haven't had any students get seriously ill. But if someone does get seriously ill, Michigan medicine is a few steps away—where I work—and we stand ready to take care of people. And we again, we really hope that that's not the case, but we have a lot of experience taking care of patients with COVID. And it's it's one more part of the plan and it helps leverage that expertise. We're developing screening tools and self-monitoring plans that came about supply chain, having enough hand sanitizer, for example. And basically all this combined will be a stackable set of interwoven interventions that can enhance the health and safety of our community. Campus is going to look different. We're working on some of those details. Co-curricular activities will be different. Common spaces like libraries will look different. Dining will probably be grab-and-go for the most time. And again, I just, you know, there's not a one-size-fits-all solution for all colleges and universities to resume in-person learning and some are going to be better positioned to do this than others. And again, I think that the University of Michigan is sort of typical of a lot of large public schools, in that our borders are not set, people come and go from campus. Spaces are different, and the scale of our enterprise is really massive. I want to thank everyone who is listening in for all you're doing to support your campus community. This is really, really hard work, and it isn't going to end anytime soon. We're only halfway through this marathon. So, pace yourself and I hope that you will also find time to take care of yourself while you take care of everyone else. FASKIANOS:  Thank you very much. That was terrific to hear what you're doing and now let's go to questions and comments and sharing best practices. (Gives queuing instructions.) Let's go first to Reynold Varret. Q:  Hello, Reynold Varret, president of Xavier University of Louisiana. The question I would ask you is to ask a more nuanced answer, how you're managing the apprehension of faculty and staff, especially faculty who are older, who do want to teach their students but at the same time, have a sense of apprehension and how you're assuring them of a measure of safety when engaged in person. MALANI:  Thank you, Reynold, for that question. I think that that is such a key question. It's not just faculty but I think parents and students as well and part of this comes down to the communication. We're actually in the midst of doing some smaller town halls and trying to answer questions; trying to be aware of these of these concerns. These are real concerns for folks. And I think, you know, for some folks, it's not going to feel good to come back, it will be unsafe because of their own high risk. We also, one thing I didn't talk about in my introductory comments was this idea of shared responsibility. And having really like a zero-tolerance policy among the students, and we're figuring out exactly what those details look like. But then there's a like a shared responsibility compact among the students that they've helped develop. Now, this idea that I can't go and do what I want necessarily because it's gonna affect everyone else. In the classroom, it's got to be safe, which means everyone's got a mask. No one can come in there who is sick. People have to maintain distance, respect, safety. And we're actually, a lot of our leaders on campus, our deans in particular, are showing examples of this and leading by example, many of them are teaching, but this is an ongoing issue. It's one that we're trying to address through careful communication. But, you know, I understand the concerns. FASKIANOS:  Let's go to Pearl Robinson. Q:  Pearl Robinson, Tufts University. I'm also on the faculty senate. And this morning, we had one of our updates by the president. Similar things though, I think you're more inclusive. The question I actually wanted to ask is: how are you handling what undoubtedly is an upsurge in demands for diversity and inclusion? MALANI:  Thank you, Pearl. I think if I understand that, and again, University of Michigan, the diversity, equity inclusion aspects are really central to everything we do. And it's actually been one of the big initiatives of our president. Part of this, you know, this whole pandemic has not affected people in a uniform way, you know, whether it's clinical outcomes, or economic issues, and a big aspect of all the effort to try to get back to some sort of semblance of an in-person, residential experience really focuses on that. And not just, you know, at every level, it's like the equity in terms of your educational experience, but also what the community looks like because you know, being at home isn't the same. And being home for some people isn't safe. And we saw this play out in our spring, where some people couldn't leave campus and it was quite remarkable to me and I really think about the well-being piece.  I should add, I'm actually a Michigan parent. I have a child who is a third-year student at Michigan. So, this is very personal to me and I am also a faculty member teaching. But I think, really for us, we are thinking about the DNI. The other aspect is that in classes, some students, some faculty, others may need accommodations. And I think being very sensitive and very specific with those instances to make sure that the classroom remains inclusive, and that it is a good place for everyone. And again, our our director of the services for students with disabilities is involved with our operational planning. But I want to say that it's been the lead folks in this area have been involved. They've been at every table, whether it's public health, it's a lead group, or the provost group. Important issue. FASKIANOS:  Thank you. Let's go to Patrick Duddy. Q:  Good afternoon and thank you for doing this. I'm curious to know more about how Michigan is going to handle both faculty and student—especially graduate student—travel, in connection with research, both research within the United States and research internationally. Thank you. I'm at Duke University. MALANI: Thank you, Patrick. This is this has been a good discussion. I also didn't mention that our research enterprise has ramped up during the summer, which we're very happy to see. And it's actually given us an idea of what, of course the scale isn't what we'll see in the fall, but we've actually got all the wet labs back up and obviously some research continued. And there have been some instances where people have had to travel to another state, or even another country, to resume their research. And these have been handled by the case-by-case basis. University wide, we have a suspension on travel. I don't like calling it a travel ban. But that's basically like, it's sort of a pause on travel for multiple reasons, including the just the safety piece for campus. And frankly, I don't think people are really traveling to meetings and things right now they're traveling because they have research obligations or other obligations. So, we do have the ability to allow that. And I think it's especially important for graduate students, obviously, other investigators, but graduate students who have to be somewhere to finish up their work. There is some allowance for that. And again, we have a safety plan, and some of them never came home, frankly, because they're so integrated in that community. What we aren't doing is letting undergraduates and frankly, they're not in the labs at this point either because of density issues, but resuming research, especially has been one of the exceptions to some of the travel restrictions, but it's been on a very limited case-by-case basis and it really has to be reviewed at high levels. So, we're trying to make exceptions and be reasonable. FASKIANOS:  Let's go to Mojúbàolú Okome. Excuse my pronunciation; you can correct me. Q:  Okay, it's Mojúbàolú Okome. And I teach at Brooklyn College, which is part of the CUNY system. So you know, a lot of what you're saying, I think, sounds great for institutions that have resources, that have money. We have a budget cut underway, and we were not flush with money before. So, a lot of this and then we are predominantly commuter campus at Brooklyn College. There's a tiny dorm that is a for-profit person that built it. And I have to also confess I have a lot of underlying conditions. So, I am very, I'm very concerned about people's eagerness to embrace face-to-face teaching. Because it just takes a, you know, one infection to affect some people very drastically, whereas other people might recover very easily. So, what is going to be gained by every institution thinking that they can do this? I think you need resources. Apart from the communication thing, if you can't really maintain social distance, if you cannot clean as well as you need to do, if you can't do a lot of these monitoring, it's dangerous, and it makes absolutely no sense. So that is my feeling. That's my comfort level. However, I also have a child who is in medical school. And he's actually on campus. He has not come home since COVID started. He's able to afford to do all these things that I'm concerned about. But you know, it's a matter of money and we can't, you know, there are these divides in terms of access to resources. So, there are poor institutions and wealthy institutions. And I'm concerned that the wealthy institutions are kind of just making it seem cool, we can do this, it's possible. Poor institutions, we have students of color. We have had faculty deaths at Brooklyn College, student deaths, staff deaths. When this kind of thing happens, it's very different from where nothing has happened, and it's all cool, we have money, we can do this. So, there's a disparity. And I think it's a kind of wake-up call for Americans who are not aware that we have this disparities and they have life. They have impact, significant impact on people's lives. So, I just wonder where are the voices of people who are not, who don't have money, who don't have the resources in this discussion? And that brings the question of diversity. Okay, because it's, there's a race, diversity, and black. Lots of black people have died a lot more black people than, you know, people of color have died. Poor people have died more. You know, so where are these voices in this discussions that we're having? Because I think we are having discussions of people who have voice and resources and power and then they're saying this is possible, but I dare say that, you know, for me I think we need to kind of be more inclusive, be more thoughtful. And America is not doing well, when you compare this country with other industrialized countries in terms of managing this crisis. Thank you. FASKIANOS: Thank you for that. MALANI:  Yeah. Thank you Mojúbàolú. Well, I agree with you fully. And I hope it came out in my comments that this is not something that every college and university can do. I think that Michigan is uniquely suited to do it. And in part because things are better here, in terms of the pandemic right now than they were. I mean, we were one of the hotspots just like Brooklyn and New Jersey and others and like some of the places are right now. We actually, we saw this play out we saw it play out on our campus, we also had deaths on our campus. And this this disease is not proportional. Absolutely there are people who are very vulnerable. And that is one of the guiding principles. And one of the issues is that not everything can be done in person. And, you know, frankly, that idea of the flexible fall. It's not just like, "hey, we're going to be in classes as usual." For some people, it's that that classroom is not going to look at all like what it normally looks like. It may be a very large classroom with very few people and it may be an outdoor classroom. It may be a lab that occurs, you know, in our arboretum or something like that. So, I do think we need to think about that. I didn't mention that the University of Michigan system also has two regional campuses that sound a little more like the CUNY Brooklyn system too, both in Flint and Dearborn, and these issues have been discussed and the resource issues are different on those campuses, not just in terms of enrollment and money and what things look like and what our student body looks like in terms of who they live with, if people live in intergenerational families, many of them with grandparents, and parents and siblings, and others. And the health resources are also different in different areas. And I think that those are all important considerations. This can only be done if everything kind of falls into place. And I mean, you know, some of it has to do with the pandemic; some of it has to do with planning. But, a lot of it has to do with how the students are going to come back and manage their day to day life. Like if they're not going to be responsible, this will end very quickly. And I think that that's very clear, it's been made very clear. There's some schools where the deans have really made very, very zero tolerance statements. And I think those are strong statements because this is why we can't put people at risk with this. But at the same time, I do believe that this is here for a long run. So, thinking about what we can do safely, not that we can do everything because we certainly can't do everything. It's a very small portion that we can do. But I agree with your comments. Thank you. FASKIANOS:  Let's go to Andrew Guertler next. Q:  Oh, good afternoon. I'm Andrew Guertler from James Madison University. I'm the medical director. I have two related questions. You stated earlier that schools shouldn't open unless community spread is under control. I'm wondering how you would define what under control is and kind of addition to that is have you developed criteria for closing campus if certain things occur? MALANI:  Yes, thank you, Andrew. You know, the issue of community spread is a complicated one and the numbers that people talk about, you know, hundred cases per hundred thousand. That's a pretty high number. And some of the states that are having a lot of spread right now are lower than that, but they concern me. So, you know, for me, you could come up with a cut point number, but it's also the trend and where things are going. And this doesn't move fast, like the curve doesn't go up fast, and it doesn't come down fast. I mean, that's what we talk about flattening the curve. And we saw this we actually in Michigan, where we're overwhelmed, and to the point where we thought 3000 people were going to need to be housed in a field hospital. So, this is very real to me. We had many, many patients at the hospital who were very ill. So, we pay attention to sort of what's happening in the region very closely. And we do have triggers, and this is something that our School of Public Health folks are helping develop. And they're doing this for the state as well. But this idea of, you know, even like a yellow, orange, red, and like at what point where we would we say "you know what this is... we can't continue." And we actually have some of those. I don't have them in front of me. But we came up with case counts and percentage increase over several days. But those are important considerations and to have something so that it's not just like a, well, I think this is good, or I think this is bad because you don't want to really make a premature decision either way. Like, if it's sort of a stable, but sustainable count, you know, you might be okay, continuing some things but, you know, clearly when things are going in the wrong direction, you might need to take a pause also. You can send me an email. I'm happy to share some of the materials that we put together on that. FASKIANOS: Thank you. Let's go to Jennifer Collins. Q:  I'm sorry, I just unmuted myself. Yeah, Jennifer Collins from University of Wisconsin Stevens Point. And actually, the previous question just asked my question, which was about whether you have specific plans at University of Michigan for closing, because we at University of Wisconsin are also open. And I think one of the concerns that a lot of our faculty has is that from the system level, there is no clear specification about what would be the point at which we might say, you know, that there might be a call at the system wide level to say, you know, this is not sustainable at this point. So I think that's an important question. Thank you. MALANI: Thank you, Jennifer. And the Wisconsin system is so interesting, because you have multiple campuses and they look very, very different in terms of who is there, how big it is, what the resources are, and obviously Madison is, you know, big, it's actually pretty similar, you know, a lot of ways to Ann Arbor, including the health system and that we've actually spent time thinking about this. We also have really developed a very close relationship with our county public health department because one of the big concerns in all of this is how our campus affects the whole region. And this is something that, you know, there are a lot of things that keep me up at night, but this is definitely one of them is, could we be creating a situation where we make the whole region less safe? Do we do we create it and you know, maybe even unknowingly, it's just a matter of like, there are risks to bringing large groups of people to campus and so, you know, thinking about density and all those things, but we have actually put some numbers down and some triggers down. I actually wish I had had them in front of me. I don't want to tell you the wrong numbers, but it really has to do with the trend of the tests. Obviously, the percentage positive matters and what's happening in the region matters too. But this is something. When we talk about losing campus, I think it really is shutting down remote, you know, shutting down in person learning, having more of a stay at home order, I really hope that Michigan doesn't go back there. One of the other things that we didn't talk about is that a lot of our students are going to be on campus no matter what. And I mentioned my son has been living on campus the last couple months, he went back to his house once the stay-at-home order lifted. And we have a fair number of students, not the full number by any means. But they're here they're kind of doing their student things. They're working remotely or mostly at home because there's not a lot of places to go right now. We're also working closely with the local businesses. So, some of the things about the bars, the bars are closed in Michigan so far, which is good. There are restaurants that have bar-like atmospheres, but you know, that's one thing that in-house dining has decreased. So, it's kind of like a moving target. And we're working with lots of different external partners on this because we don't want the University of Michigan to put the whole region at risk. FASKIANOS: Which kind of testing are you going to be implementing? MALANI: So, this is a good question. Yeah. So, the final plan is not rolled out, but this is likely what it will be. And, you know, I, again, there are pluses and minuses, every school has a different plan. Some of the concerns we have is, we want to have a rapid enough turnaround that it's helpful. We didn't feel like our clinical lab could handle 10,000 more samples over the course of a few days, you know that that was probably asking for too much, especially because they need to prioritize clinical care and their regional lab for other parts of the state. So, what we're looking at right now is a system where we would test students before they get here, like right before they get here with the idea that you'd have a rapid turnaround, you sort of get a clear bill of health. We'll also recommend that they're going to be doing sort of self-isolation before they come in. Some of these details are yet to be announced to the students, but we're trying to finalize these. And the idea is the ones living in congregate housing, so mostly our first-year students in residence halls, that they would need a negative test, a PCR test of some type before coming, but it will be self-administered. Details are not quite final. But I think those principles are important that the clinical lab can't necessarily absorb 10,000 more samples. We also are going to offer testing to some other groups and actually focus on some other large congregate settings, including fraternities, sororities, and co-ops and then other students that are coming from high risk places that might be living in their own apartment. And some of this is going to be self-identification and some of it will be our planning. We're not going to test the entire campus. And there may be a question. So, I'll just go ahead and answer this: it's about testing staff and faculty. This is a tricky question. And I guess the best way I can talk about it is as a health care worker, working in a setting where we have a lot of COVID, we're not testing everyone there, because transmission is so low. And that, again, it's controlled environment and healthcare setting. But if you can wear a mask, if you can maintain distance, that exposure is not felt to be significant enough that it makes sense to do a lot of testing now. If people have symptoms, even mild symptoms, I'm an advocate for doing a lot of testing. Because I think you want to know like, what, what's happening in the background. And then we're finally we're going to be doing surveillance testing. And this will be random surveillance testing. And one of our school public health faculty is going to help with this. And again, it's resource intensive, I think it gets back at the earlier point, this is hard to do. This is not something that every school can manage, or that it would make sense to try, but because of the size of our school, and because we do have a big School of Public Health, that they do this type of work, we're planning to do surveillance, and it'll be like in different places. And we might do 100 swabs one day, one place, and 100 in another place, and then, depending on those results, we might need to go in and do more testing, if we're seeing transmission. So we're trying to get at it from different ways, both the testing as well as the public health interventions, and trying to recreate campus. But there's no playbook for this. You know, there's not a simple way to do this. But our feeling was after a lot of deliberation is that we could do it and we could do it safely. FASKIANOS: Thank you. Let's go to Allen Weiner next. Q:  Thank you very much, Dr. Malani. I'm Allen Weiner from Stanford Law School. A question that I have for you: you noted, of course, that there are risks associated with bringing students back onto campus and in person teaching. And but of course, there are huge benefits as well of doing that. And I'm wondering if you have been explicit in any way about some kind of formula for calculating, for engaging in that cost, benefit, risk reward analysis, and I asked, in part because at Stanford, I'm just a passenger on this bus. But one of the things that I do in my free time is serve as a school board official for a public high school district. And here I'm having to make that decision. And I don't really know what the formula is for balancing the risk to staff and students versus the benefits of having people on campus. Thank you. MALANI: Thank you, Allen, I think it's a complicated calculus. And as you know, there are benefits, otherwise, we would focus as we did in March, and as some regions are doing right now, solely on the risk of COVID, which would be, go remote, fully remote, let's just wait it out. But we didn't feel after doing the homework that that was necessary. And now again, things can change because the pandemic changes from week to week, month to month. I'm not aware of any specific calculus on this. I will say that the risk to staff and faculty and I, you know, people can disagree with me on this but with the kind of plans we have with the kind of contact people would have on a day-to-day basis with students, there's minimal risk. I truly believe that because I thought if I feel like that there's a risk to the community, I wouldn't consider doing this. And again, it requires that everyone mask and that people stay home. And that we have maintenance of physical distancing. Even if people are sick and asymptomatic, they're not spreading if they're masking and that's been shown. So I think that that piece of risk like to the essential work force, to faculty, although I understand why people are nervous about even being on campus and being given an outside space, that risk can be managed, especially on a college campus where you have bigger spaces and you have ventilation and windows, it's going to be harder in a public school. And that's a separate discussion and it's one that in my free time I've also been having conversations with my daughter's school, and they've actually decided to start the year remotely, even though they were positioned to do it well. It would be good to actually have a measure and you know, the one thing I know of is someone who did a calculation of like, what's your calculation of infection? What's your calculation of a poor outcome? Etcetera, etcetera, etcetera, versus what's your benefit? And there are economists and others who understand that, who have done some of that, and you can email me and I can send you a paper I'm thinking of, but in my simple mind, like my simple like doctor mind, where I'm not putting numbers on things, I think of, can we mitigate risk to where it's acceptable? And that's in contrast to being reckless, and you can be reckless. But that would never be acceptable in my mind. And I really feel like we, the way we're planning this is to try to do everything possible to decrease and manage risk while having some of the benefit. I mean, the truth is, there's not going to be a lot of in person coursework. That's likely the case because so much of it for the first-and second-year students is like in large spaces. And because we've gotten good at things like Zoom, but we want to make sure and there are some settings, the health sciences, performing arts, where if you're not in person, you really can't continue learning and it gets back to the issues of equity. It's back to the issues of you know, making sure families know that their kids gonna continue. I'm kind of veering off topic here. But it's a it's a good question, and I sort of look at it as is like, is the risk acceptable? FASKIANOS: Thank you. Let's go to Noe Ramirez. Q: Very interesting lecture. I really appreciate this. Looking beyond the current crisis, ma'am, what do you foresee as the implications for science and so far as perhaps getting on an edge on politics? I see that science has advanced considerably, however, is perhaps not enough since the enlightenment era took hold, and we still see politics influencing decision making that is data driven, that is empirically driven, based on observations, which you have eloquently cited many examples of, ma'am. What do you foresee as implications for science and higher education in so far as perhaps promoting civic engagement for students to take greater note of the importance of science and data-driven decision making? MALANI: Thank you. I, you know, I actually am hopeful for science and I say that not just as a physician, as the chief health officer for the University of Michigan, I say that as a mom of two young adults that are, one is almost adult, and, you know, I think this is such a remarkable time to be a young person and to watch what's happening and the importance of science that it's being played out every single day and, you know, science shouldn't be a political thing. It's, you know, science is science. We talk about, you know, you can have your opinion, but you have your facts. Facts are facts. And science, to me, is less about opinion and more about facts. So, I actually am hopeful that this is going to also generate interest in the next generation around epidemiology and public health and all kinds of science and social justice and all the different aspects of our lives that have been changed and well-being. But, you know, I do hope that the political will will be there to support these things. One of the remarkable things is the progress we have made towards a vaccine. And again, we don't have a final timeline on that or whether it works, but I'm very hopeful. And it's a remarkable thing. It's a remarkable demonstration of what science can do. So I'm going to be optimistic and say that is ultimately going to be very good for science and the importance of science. FASKIANOS: Thank you. Let's go to Dorothy Marinucci next. Q:  Hi, I'm Dorothy Marinucci from Fordham University in New York. And I'm curious to know, what do you advise about fall sports? I don't think I've heard it come up in the conversation here. I would like your take on that. And Michigan's a pretty big football school and playing football this fall. MALANI: Thank you, Dorothy. Actually one of the other roles I've had, it's been really interesting. So I'm a huge sports fan, especially college football, especially my alma mater, Michigan, and I've been part of the team advising our Big-Ten commissioner. You know with sports it's complicated, and I think we don't know. We'll know in the next few weeks what happens in terms of the fall season and those discussions are being had, you know. And again, I have viewed sports in a couple of phases returned to training and returned to competition and we have returned to training at Michigan. It doesn't look like training did last year. But it's actually been a good learning experience for our campus to sort of understand how to sort of reengage a community. And in this case, you know, there are high-risk coaches, there are high-risk staff. There's some students who are high-risk who are athletes. But that next step of competition is complicated and football is one example. Same would apply for soccer and basketball and other big teams because of travel. We're seeing this in the professional leagues now that they're even having trouble with this idea of bubbles and testing and they're having issues with turnaround time. NBA is having trouble with testing turnaround. So how can a college campus do better than the NBA in terms of resources?  So, a lot to be seen. One other issue with sports that's a problem, obviously, is the gathering in terms of spectators. And I don't really envision spectators being like they normally would if football does, indeed, continue. And I think it's a, these are discussions that will be had by NCAA and the conferences in the next few weeks. But right now, it's been about return to competition. And that's been more or less successful. Some places, although a lot of places have had to stall including a couple of the Big-Ten schools; Ohio State and Indiana that I'm aware of, because of some transmissions and new cases that have come up. So in a way it's a good experience to learn what's happening within that space because it's a high-risk space, but also potentially representative of what fall might look like on campus and can we can we manage that, but lots to be seen, but lots of barriers to getting back to sports. FASKIANOS: Can you talk about what you're doing in terms of reconfiguring your art space and your library space to help with social distancing and those matters? MALANI: Yeah, absolutely. And again, I think there may be some full reports on our president's homepage of the committees related to COVID. These are like, sort of the comprehensive recommendations, but not all of them will be followed. But they may be helpful to some of the the folks that have joined us here. You know, in the libraries, a lot of it is about just removing spaces. You know, it's about like, okay, walking around and saying, well, let's move this table, let's move this table, and like we'll have this many people here and everyone has to be masked and creating that distance. Our libraries are not yet open. The plan is for them to open. Our unions also, like I've personally done the walkthrough on the union and tried to help reconfigure the space. One thing I will say is that there are a lot of spaces on campus that aren't going to be used, things like ballrooms and big auditoriums, because we're not going to have big gatherings. So, also re-envisioning how those spaces might be used to help offset some of the lost space. So, the libraries are going to have fewer people a little bit like every other space that's open. The art studios, I haven't been as involved with those discussions. But what I've heard is some of it is trying to have one person at a time, this idea of not having to share equipment, because there's concerns with how close you are. So, it means having the studios open more hours, it means, you know, sort of twenty-four-hour access and kind of rethinking when students work and how they work. Maybe plexiglass could work some of those settings too, but it's kind of a case by case. We had a whole committee that looked at those issues around performance in studios. FASKIANOS: And how have you reconfigured your research labs. I know you've said they've continued to operate, but what measures have you taken to remediate those spaces? MALANI: The biggest issue around, Irina, is density. And what we asked for in the research labs was 144 square feet per person was in the lab. So, you think about that, that's like six feet in each direction. That's a lot. You know, there are not a lot of research labs that can have a lot of people in them. But this is the that was a very conservative look. And actually, because it's gone well, they've actually increased the density just this past week to thirty to forty-five, I think is the percentage. They reconfigured with tape and got rid of common areas, the kind of things that that people like to do in research labs, like they like to kind of sit and have a cup of coffee, like that's not happening now. You're kind of in there, you do your work and you leave, which is good for efficiency, but it's not necessarily good for people's well-being. So, I think rethinking that. But the research labs were very much like walk through, tape off, figure out how many people can be in there. And it's actually gone remarkably well. We've been 99.9% in terms of masking, we haven't had any cases or any transmission. And we've been able to slowly increase to seventy-four buildings that are open, but it is resource intensive. Each building has a greeter and like they, in conjunction with our governor's executive order, there's a screening process every day and people have to fill out a form, but I think people have gotten used to it. And they're very excited to be back to their work. And I think we have looked at the research ramp up as sort of a preview to the fall and if we can do that well, hopefully it will set us up to have a good fall. And you know, I don't compare the two. I think fall is much more complicated, but it at least has helped us work out some of the hiccups. FASKIANOS: Do you have a sense of how many students will opt to come back on campus versus those who feel that they need to stay home and do, you know, to do their classes remotely? MALANI:  Our sense is that most students, a majority, 90% plus will be on campus. I think there are a few considerations. One is that some of the out of state students who feel like well, if I'm not going to really have a normal semester, kind of hard to envision paying that much money, I might as well stay home and take classes locally. I know of some cases like that. Others have already, you know, they have their homes here. They have their community here, some of them never left, and they'll continue. And in terms of our residence halls, they are almost all first-year students. About a quarter of our undergraduates live in residence halls. We also have some graduates but it's a little bit different format and different kind of population. Most of them didn't have any trouble in terms of housing contracts. We were able to, to procure the class that we thought we would. So, you know, remains to be seen; the final details aren't out. But we we didn't have a lot of loss of enrollment so far. FASKIANOS: Fantastic. Well, we are at the end of our time. So, Preeti Malani, thank you very much for being with us and sharing all that you're doing at the University of Michigan, and we will share a link to the video and transcript of this discussion, as well as share the resources that you referenced in your discussion so that people can take a look. You can follow her on Twitter @PreetiNMalani. So, I encourage you to follow the research and things that she's thinking about. So, thank you very much again for being with us. I hope you will also follow @CFR_Academic on Twitter and visit cfr.org, thinkglobalhealth.org and foreignaffairs.com for additional information and analysis on COVID-19. I hope you all are staying healthy and well during this challenging time and we look forward to reconnecting in our next Higher Education Webinar session this summer. So, thank you all (END)