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Episode 13 - The Business Case for Pandemic Mitigation
Episode 136th May 2022 • COVID19 The Answers • Dr Funmi Okunola
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Dr Robert C Robbins MD, President of the University of Arizona talks about the Business Case for Pandemic Mitigation.

If you scroll down to the bottom of the podcast section of my website kojalamedical.com/covid19theanswers, you will see the diagram for the "360 degree Solution to Pandemic Control". This solution illustrates the risk reduction measures that we need to put in place, working collectively, to manage this pandemic, future pandemics and to live with the coronavirus safely.

Today we are looking at a real life scenario of how the 360 degree solution to pandemic control can really work! Following on from Professor David Harris in Episode 8 Part 2, President Robert C Robbins of the University of Arizona will talk about the mitigation methods they enacted to combat transmission of COVID-19 on the university campus and illustrate the medical, societal and business case for doing so.

Transcripts

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Kojala Medical presents COVID-19, The  Answers. The show that delivers the

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scientific evidence-based knowledge that can  safely return us all to our pre-COVID lives.

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My name is Dr. Funmi Okunola  and I'll be hosting the show.

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Every week you can listen to me  interview a highly respected professional

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about the science that can reduce your risk  of becoming infected with this Coronavirus.

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Hello and welcome to ‘Covid-19 The Answers’  episode 13. The business case for pandemic

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mitigation. Today I'd like to introduce you all  to Dr. Robert C Robbins the President of the

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University of Arizona in Tucson USA. Dr. Robbins  assumed his position as the 22nd President of the

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University of Arizona on the 1st of June 2017.  Dr. Robbins serves as Professor and Chairman of

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the Department of Cardiothoracic Surgery at  Stanford University School of Medicine, was

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Founding Director of the Stanford Cardiovascular  institute, President of the International Society

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of Heart and Lung Transplantation and President of  the American Heart Association Southwest Affiliate

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in 2016. Dr. Robbins is an internationally  recognized heart surgeon. His medical education

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consists of a BSc in chemistry from Millsaps  college, a medical degree and general surgical

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training at the University of Mississippi  cardiothoracic training at Stanford University

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postdoctoral research at Columbia University and  the national institutes of health and congenital

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heart surgical fellowships at Emory University and  Royal Children's hospital, in addition to his role

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at the University of Arizona. Dr. Robbins serves  on the boards of the Arizona commerce authority

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southern Arizona leadership council, Tucson  metro's chamber of commerce united way of

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Tucson and Southern Arizona and the Greater  Phoenix economic council. Welcome! Thank you.

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So I'm going to move on straight to our questions  as President Robbins has a limited amount of time

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with us today. So on March the 11th 2020 the  World Health Organization declared the novel

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coronavirus, Covid-19 outbreak a global pandemic.  The University of Arizona was then shut down,

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staff were laid off, others were furloughed.  Salaries were cut and the University faced a

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precarious financial future. Professor  David Harris, an immunologist and the

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Executive Director of the University of Arizona  Biorepository, got together with colleagues at

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the University to devise a test, trace, treat,  strategy a form of high throughput screening

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mainly by rapid testing and incorporating the  salivaDirect PCR protocol for staff and students.

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This was fully implemented from August 2020 and by  May 2021, the University went from 45,000 students

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and 20,000 staff forced to work online, to the  resumption of in-person classes with 100 people

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in attendance per classroom within 7 months. You  can hear about the salivaDirect PCR in episode 7

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and about this whole story in episode 8 part 2.  Today we're interviewing Dr. Robert Robbins the

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President of the University of Arizona about the  business case for Covid-19 pandemic mitigation.

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President Robbins, at the time of your plan  the University was exploring a path that had

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not been traveled before could you tell us about  the reasoning behind your full support, support

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of the test, trace, treat strategy? Well I think  your timeline, it reminds me of all that we were

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going through. Things were moving very quickly but  for me because of my background particularly doing

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heart and lung transplant surgery and  immunosuppressing patients for over 35 years

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it seemed to be something that I was comfortable  dealing with and I knew that we had to

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first of all test as much as possible and we're  out in the middle of the desert in Arizona.

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A long way away from Washington DC and  the supply chain to get us testing kits,

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so we went about devising our own test kits  and then of course contact tracing and then

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the treatment phase of our test, trace and treat  3T protocol was to isolate individuals that tested

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positive in and then find the individuals that  contact traced and get them isolated as well

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and I would argue it worked out really well for  us. We also had a very sensitive and specific

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antibody test that was developed and validated  in an international lab for the most accurate

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antibody test for Covid-19 and that's been  instructive during our two-year journey

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but it was easy for me because I knew that the  pathway to getting the University back in business

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was to do all of these things. I would just  add a footnote that we had. We're the number

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one water resource program in the world. Number  one in the world and we've got an individual

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named Ian Pepper. Dr. Ian Pepper. I often say  Dr. Pepper so misunderstood, but Ian has been

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looking in water supplies in Europe, primarily  for over two decades looking for Polio in public

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water supplies and he came and said I think I can  find Covid in wastewater and it was known that

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Covid was excreted from the GI tract into the  wastewater effluent and it happens before anyone

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who's in that building even has a symptom. So we  utilize that as a mitigation strategy as well.

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I had no idea that you were one of the first  organizations to identify and SARS-CoV-2 in

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wastewater. Truly amazing. I knew that you  utilized that technology, but I didn't know

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that you were leading in it. So thank you  for educating me about that. That's amazing.

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Yeah the test, trace, treat, strategy has cost  the University millions of dollars. You are an MD,

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we're not traditionally known for our business  acumen. How did you construct a cost benefit

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analysis to support this process and what were  your key fundamental assumptions in the modeling?

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Well I knew that as I said at the outset  it was the right Public Health thing to do

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and if you think of the University community which  is not an isolated bubble but if you if you think

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about what we had control of then obviously  for the students the faculty and the staff at

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the University we needed to do very aggressive  testing and in contact tracing and isolation

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to be able to deal with this massive Public  Health emergency the other thing that we did was

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we were very fortunate to have Dr. Richard Carmona  the 17th surgeon general of the United States

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on our faculty for 35 years. He was one of the  founding members of our incredibly rec gifted and

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recognized school of Public Health so I asked Dr.  Carmona if he would help lead the effort as the

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Covid Czar if you will and he drew upon his  time as a surgeon general when President Bush

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43 deployed him to New Orleans during hurricane  Katrina to assess the medical health going on

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in New Orleans and he called back and said the  hospitals are flooded up to the second floor.

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We need to move the patients out of the hospitals  and oh, by the way we need to move all the people

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out of these temporary conditions somewhere else  and he led the relocation of 300,000 people from

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New Orleans to Houston, Texas the largest mass  movement and migration of people in the in the

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country's history now many of those people stayed  in Houston because they had a great life there but

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a lot came back to New Orleans but we had Dr.  Carmona is really our ace in the hole and he

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instituted an incident command system here that's  used for all hazards in the Federal government

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I really wasn't that knowledgeable  about an incident command system

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and the faculty and the administration thought  what what is this militaristic approach to this

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you know this virus that that's going  to give us the flu but it became very

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obvious quickly that this was a very lethal deadly  virus and we needed drastic measures and so Dr.

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Carmona really helped us get organized through  an incident command system that is absolutely

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amazing you have the amongst the best minds on  the planet that really explains a lot actually

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this is a fantastic interview raising capital is  never easy and I suspect particularly difficult

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given the groundbreaking path you are asking  the capital to support what was your process

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for raising the capital and what capital profile  for example alumni, non-alumni private government

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came to the table? Well, I think mostly we used  our own operating budget at the University to

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fund most of these initiatives and and there were  a lot there were mitigation efforts about around

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using higher filtration systems in all  of our buildings, cleaning supplies,

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isolation, dormitories that we had to set up  all of the supplies for testing because to take

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this on and test ourselves. We did this at no  cost to any of our faculty staff and students

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so we utilized primarily internal operating budget  monies and the little bit of reserve that we had

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at the University but the federal  government obviously through the

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cares act provided a lot of funds because we  thought that if we invested on the front end

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it was going to be very important for us to  have safety first for our University community

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and we would figure the finances out  later we thought rightfully so that

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the federal government would supply some  funding and certainly the State Government

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and Governor Ducey and the department of health  and human services provided some support for

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our antibody tests and we provided antibody  testing throughout the state including

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some of the prison system as well so it was  a combination of all we got a little bit of

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donor money to help us out but primarily  it was our internal operating budget. Wow,

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I've spoken to Dr. David Harris on quite  a few occasions. He talks about the

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fantastic leadership and support that he and his  colleagues at the University received from you.

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You have a whole host of world-class intelligence  with regards to University personnel what aspects

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of your own character and leadership did you  draw on to make the whole project successful

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well I think I was smart enough to  realize that this was going to take a

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huge team effort and that there were individuals  who were infinitely more knowledgeable about how

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to deal with a Public Health crisis and so  that's why I went directly to Dr.Carmona,

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Dr. Harris, Dr. Mike Dake who is the Senior Vice  President for health affairs I can remember the

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first person I called was the Dean of the  Medical School Dr. Michael Abakasas who

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is a world-renowned transplant surgeon. Liver, kidney and pancreas. Spent most of his career

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at North Western University and he had only been at  the University of Arizona for about a year as the Dean.

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It turns out that his master's thesis was on Coronavirus. So he obviously knew

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a lot more than me. Obviously I'd been through SARS  and MERS, but I had I didn't have the capability

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to deal with this and it took all hands on deck  it took our students it took our i.t department

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our faculty our staff so I knew it needed to  be a team effort and and so I think I drew upon

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my days as a heart surgeon where you could do a  technically perfect heart operation but if your

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anesthesiologist, your perfusionist, your nurse,  your respiratory therapist, physical therapists,

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pharmacists were not on top of their game then  the patient was gonna suffer so I knew it needed

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to be multidisciplinary and all hands on deck and  so we asked everyone to pitch in and you know it

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was going to take all of us working together and  and I'm proud to say that's exactly what happened

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that's wonderful so you drew on your  experiences and attributes as a doctor

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to sort of lead the University out of the pandemic  that's amazing well you you well know that

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it's a it's a team team activity medicine  is a team activity and and that's one of

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the things I really like about how we educate  our pharmacy nursing Public Health students and

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physicians is in that team-based approach  very true and the best doctors know that

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so can you talk about how you involve the wider  the wider community of Tucson into the project

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and why this was important well it was important  because as I was referencing earlier we don't live

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in an isolated bubble we live in a very porous  membrane that has our students our faculty and

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our staff going in and out of the University  into the community so it was important for us

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early on to establish good relationships  with the mayor the city council

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the county administrators the board of  supervisors and absolutely the health department

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and so we worked with the health department on  a variety of different mitigation strategies and

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then ultimately treatment strategies when when  we became a pod a vaccination pod first as a

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as a county pod and then at a state level and we  vaccinated over 240 000 people in southern Arizona

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so it was very much in line with our with our  land-grant mission to serve the community that we

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opened our resources up and and had a vaccination  pod that was running seven days a week usually 12

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to 14 hours a day that is just fantastic I  believe we need more than vaccination to get

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us out of this pandemic and have proposed that we  follow a 360 degree solution to pandemic control

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I'm just going to share the screen with you  briefly so basically the University of Arizona

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has facilitated as has done 80 to 90 percent  of what I said we need to get safely out of the

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pandemic. I think at the moment we're living  dangerously sort of globally so the regulator

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support and finance is you your testing strategy  you implemented your wastewater monitoring

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the infrastructure you educated your students your  staff the wider population of Tucson you supported

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people with isolation. You had IT contact tracing and you implemented air filtration and

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the most important of all, vaccination. So you've  done virtually everything and I think that's why

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you're now nearly back to, well, you're back to  normal aren't you at the University of Arizona?

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We are. I am concerned that there's another  wave coming. So for instance we've kept our

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Public Health advisory team together we've kept  our ICS incident command system together because I

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would like to get through the summer to see  if BA2 is going to have a big outbreak in

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Southern Arizona like it did on the East coast  and I'd like to get another truly quote normal

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disease-free semester under our belts before  we declare mission accomplished that's you know

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that's true humility and yes you're very right  the pandemic is still raging on it's not over

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but this whole interview is about it's kind of  a second part of the interview with Dr. Harris

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it showed how successful you've been I think  you've really set a blueprint for the planet

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on how we should manage this pandemic safely what  do you see as the long-term or ongoing benefits

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from the pandemic risk reduction infrastructure  that you set up at the University of Arizona

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for the University and possibly beyond well I  think that future pandemics and of course there

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will be hopefully not anything as big as there  was in 1918 or in 2020 but I think it's also an

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Esprit de Corps of the whole University community  and the outside community coming together showing

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that we can work together and it's important to do  so but I think early warning and early detection

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of future pandemics is going to be critically  important not to mention the long-term study of

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what happens to patients with Covid the so-called  long Covid but in terms of being prepared for

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the next pandemic I think we'll have a blueprint  we'll know how to do it it's interesting that our

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our University clinic which is ranked perennially  in the top five University student health centers

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in the US was started in the 1918 pandemic so it's  it celebrated a 100 year anniversary just a couple

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of years ago and so I think that we've learned a  lot and all that will be codified and captured for

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those people who come after us who have to  face hopefully not as devastating a pandemic

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but it could be even worse well what a  fantastic University I mean you've set

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a real example you have an amazing ethos dating  right back to the early part of the 20th Century

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and you as President have continued with that  and I really must you know champion you for what

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Would  you like to leave the audience with any lasting

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thoughts of the importance of reducing the risk  of infection from coronavirus in all our lives

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and what thoughts do you have on a universal  worldwide application of your fantastic results?

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Well I think that the fundamental  approaches that we took which was the

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test, trace and treat protocol also  included many other things which are

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very basic things. Washing your hands.  We know this is a respiratory virus.

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Face coverings and distancing from other people.  Just those simple things, along with a vaccination

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would get us 90 percent of the way. Obviously  the most vulnerable population among us

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are the ones we have to focus on  continuously. Now those are the less fortunate

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marginalized populations and also the  elderly and immunocompromised people that

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have immunodeficiency disorders being treated for  cancer or other high risk categories, but I think

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early warning and detection systems in the  future and not waiting not politicizing this

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going straight to the science in the data that  we know will help people and save lives I think

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is the biggest lesson to learn I'm not sure how to  eliminate the political issues that were involved

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here, but it's it's really disappointing and  I'm hoping that the next time it won't be so

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politicized. So the title of this podcast is about  the business case and and what you've just said is

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definitely the reasoning but how is how as has the  University implementing all these things because

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I'm constantly saying we need air filtration we  need ventilation we need testing and people keep

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going on about the costs you know you know so  can you tell me the business case for for doing

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all of this yeah the business case was very simple  if we couldn't run if we couldn't provide a safe

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environment for our students faculty and staff  we couldn't make money as a University and it

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comes down to that simple fact one of the reasons  why we wanted to do all of these things it was

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it was medically the right thing it was from a  Public Health standpoint it was the right thing

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but it also was the right business decision  for us so that we could get our University open

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deliver classes because 40 percent of the  students are from outside Arizona and that's

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a high percentage for a state University and we  depend on those students coming here, because

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they pay a higher rate of tuition and fees. So in  order for us to attract those students, we had to

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be open and having in-person classes. So that's  the business case for this without question.

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So doing all of this not only kept the whole  community safe, save lives but also save the

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help the University to keep generating money.  Yes, that's fantastic. Thank you so much President

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Robbins for your participation today your  achievements at the University of Arizona have set an example that the rest of the world NEEDS to follow.

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Thanks for listening to this weeks episode of Covid-19 The Answers