The early days of a campus COVID-19 response: pivot and pivot again

When Lisa describes her early days on Dartmouth’s COVID-19 response, she asks people to recall their “first COVID-19 moment,” that instant when they realized this was not a drill, that this was going to be something big and life-altering. For her, that was on Jan. 31, 2020, at 5 p.m., when her health department colleague texted her three words: “Check CNN. Unprecedented.” The colleague was referring to the travel ban that restricted entry of non-U.S.-citizen travelers from China into the U.S. Thinking of Dartmouth’s students and colleagues in China, that’s when Lisa understood this virus was going to change everything.

Looking Back on Campus 

During summer 2020, the Dartmouth College COVID-19 Task Force worked overtime to make plans to receive half of its undergraduate, graduate and professional student body back on campus. With almost daily changes in the available data and statistics, we had to pivot quickly to address the concerns of our faculty, staff, students, their families and the surrounding community. Dartmouth’s COVID-19 case record speaks for itself in terms of averting a major outbreak across our campus and successfully managing and containing a single burst of student cases during the winter 2020 term. We also worked hard to manage the expectations and concerns of our many constituencies while continuing to fulfill our academic and research missions. As with many peer institutions, Dartmouth’s leadership had to step up quickly to assess the emerging science and set (and then frequently revise) myriad institutional policies. What follows are some of our lessons learned from managing an academic institution during the early days of the pandemic.

New Hampshire’s first COVID-19 patient was announced on March 2, 2020. Identified as a Dartmouth-Hitchcock employee, this individual had recently attended a social event while symptomatic and had many workplace and social contacts, including our clinical faculty, hospital trainees and students from both our business and medical schools. Suddenly, Dartmouth’s COVID-19 Task Force, which had only been formed that morning, was thrust onto the front lines of its first contact investigation. Given names by the state health department, we made late-night calls to notify contacts and explain how to quarantine in a household of roommates or family members. We had hotel rooms at the ready, but most students chose to quarantine in their off-campus residences if that was feasible/reasonable.

Since there was no workplace screening at that time, dozens of health care workers and students who were potentially exposed were placed in a two-week quarantine. A second case was identified a day later. Fortunately, a large outbreak among health care staff was avoided, likely by the quick action taken, but subsequent cases indicated community transmission had been established. The pandemic had arrived.

Earlier on the same day that this index case was announced, I had been called into the provost’s office and asked to co-chair Dartmouth’s institution-wide COVID-19 Task Force. My co-chair was the vice president for campus services, which meant I could focus on the health and epidemiology recommendations — tracking the local and national data and conferring with colleagues in student health services, infectious disease and epidemiology — while my co-chair could focus on the logistics, facilities management and execution of our policies.

Reporting directly to the provost, our goal was simple: to deliver on Dartmouth’s academic and research missions while preserving the health and safety of our community by adhering to current state and federal guidance while considering our unique setting and circumstances. We rapidly brought together an executive “core group” and larger task force with broad institutional representation. We began meeting immediately. Our task force composition evolved over time as we shifted our focus from bringing students on overseas programs home safely to adjusting operations on campus. Over time we subdivided into several key working groups to address specific issues, and seconded a representative from the Office of Communications.

Planning in the Midst of Rapid Change 

To understand how quickly events evolved, four days into my role as task force co-chair, I received a call from a CDC colleague who indicated this pandemic was more serious than many realized and that we should consider shifting to a fully remote spring term (Dartmouth is on the quarter system). I was stunned by such a bold suggestion, anticipating that senior leadership was not ready to make such a drastic call. As we watched the impact of unchecked viral transmission locally and nationally, it was only seven days later when we announced that our spring term would shift to remote delivery. While this impacted all students, medical students faced unique dilemmas, with a complete stop to their in-person clinical training.

Our faculty rallied to meet the challenges. They had only 10 days to adapt their planned courses to remote delivery. Various educational offices supported this rapid transition. All employees who could work from home moved to remote work, with only our custodial, facilities and dining staff (to provide meals for the roughly 100 students who needed to stay in campus residences) working on campus. With the decisions made to have first our spring term and then our summer term transition to online delivery, our attention quickly turned to re-opening for the fall term. Overarching goals were to:

• De-densify the campus population;
• Reserve adequate rooms on campus for quarantine and isolation;
• Reduce capacity of all common spaces on campus;
• Develop a robust testing strategy to include pre-arrival, arrival and ongoing screening for both students and employees.

Many in our local community feared disaster in anticipation of our fall reopening. Throughout August, several large universities had sizeable outbreaks that required campus lockdown. In August 2020, three weeks before the start of our fall term, an editorial in the local paper declared that Dartmouth was “endangering” the local community by reopening and asked the college “to reconsider their dangerous gamble.” Several task force members started questioning whether we could prevent a major outbreak and eventual campus shutdown.

I recall a final senior leadership summit discussion to review our reopening plan one last time before the provost and president decided to proceed. We knew that our success would depend heavily on our ability to test and identify infected students and employees, act promptly to isolate those individuals and identify and quarantine all contacts. Our testing strategy had several critical features. In a future post, we will discuss what those were and how we approached testing to ensure our campus members and the local community stayed safe.