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.
Kojala Medical presents COVID-19, The Answers. The show that delivers the
Speaker:scientific evidence-based knowledge that can safely return us all to our pre-COVID lives.
Speaker:My name is Dr. Funmi Okunola and I'll be hosting the show.
Speaker:Every week you can listen to me interview a highly respected professional
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Speaker:Hello and welcome to ‘Covid-19 The Answers’ episode 13. The business case for pandemic
Speaker:mitigation. Today I'd like to introduce you all to Dr. Robert C Robbins the President of the
Speaker:University of Arizona in Tucson USA. Dr. Robbins assumed his position as the 22nd President of the
Speaker:University of Arizona on the 1st of June 2017. Dr. Robbins serves as Professor and Chairman of
Speaker:the Department of Cardiothoracic Surgery at Stanford University School of Medicine, was
Speaker:Founding Director of the Stanford Cardiovascular institute, President of the International Society
Speaker:of Heart and Lung Transplantation and President of the American Heart Association Southwest Affiliate
Speaker:in 2016. Dr. Robbins is an internationally recognized heart surgeon. His medical education
Speaker:consists of a BSc in chemistry from Millsaps college, a medical degree and general surgical
Speaker:training at the University of Mississippi cardiothoracic training at Stanford University
Speaker:postdoctoral research at Columbia University and the national institutes of health and congenital
Speaker:heart surgical fellowships at Emory University and Royal Children's hospital, in addition to his role
Speaker:at the University of Arizona. Dr. Robbins serves on the boards of the Arizona commerce authority
Speaker:southern Arizona leadership council, Tucson metro's chamber of commerce united way of
Speaker:Tucson and Southern Arizona and the Greater Phoenix economic council. Welcome! Thank you.
Speaker:So I'm going to move on straight to our questions as President Robbins has a limited amount of time
Speaker:with us today. So on March the 11th 2020 the World Health Organization declared the novel
Speaker:coronavirus, Covid-19 outbreak a global pandemic. The University of Arizona was then shut down,
Speaker:staff were laid off, others were furloughed. Salaries were cut and the University faced a
Speaker:precarious financial future. Professor David Harris, an immunologist and the
Speaker:Executive Director of the University of Arizona Biorepository, got together with colleagues at
Speaker:the University to devise a test, trace, treat, strategy a form of high throughput screening
Speaker:mainly by rapid testing and incorporating the salivaDirect PCR protocol for staff and students.
Speaker:This was fully implemented from August 2020 and by May 2021, the University went from 45,000 students
Speaker:and 20,000 staff forced to work online, to the resumption of in-person classes with 100 people
Speaker:in attendance per classroom within 7 months. You can hear about the salivaDirect PCR in episode 7
Speaker:and about this whole story in episode 8 part 2. Today we're interviewing Dr. Robert Robbins the
Speaker:President of the University of Arizona about the business case for Covid-19 pandemic mitigation.
Speaker:President Robbins, at the time of your plan the University was exploring a path that had
Speaker:not been traveled before could you tell us about the reasoning behind your full support, support
Speaker:of the test, trace, treat strategy? Well I think your timeline, it reminds me of all that we were
Speaker:going through. Things were moving very quickly but for me because of my background particularly doing
Speaker:heart and lung transplant surgery and immunosuppressing patients for over 35 years
Speaker:it seemed to be something that I was comfortable dealing with and I knew that we had to
Speaker:first of all test as much as possible and we're out in the middle of the desert in Arizona.
Speaker:A long way away from Washington DC and the supply chain to get us testing kits,
Speaker:so we went about devising our own test kits and then of course contact tracing and then
Speaker:the treatment phase of our test, trace and treat 3T protocol was to isolate individuals that tested
Speaker:positive in and then find the individuals that contact traced and get them isolated as well
Speaker:and I would argue it worked out really well for us. We also had a very sensitive and specific
Speaker:antibody test that was developed and validated in an international lab for the most accurate
Speaker:antibody test for Covid-19 and that's been instructive during our two-year journey
Speaker:but it was easy for me because I knew that the pathway to getting the University back in business
Speaker:was to do all of these things. I would just add a footnote that we had. We're the number
Speaker:one water resource program in the world. Number one in the world and we've got an individual
Speaker:named Ian Pepper. Dr. Ian Pepper. I often say Dr. Pepper so misunderstood, but Ian has been
Speaker:looking in water supplies in Europe, primarily for over two decades looking for Polio in public
Speaker:water supplies and he came and said I think I can find Covid in wastewater and it was known that
Speaker:Covid was excreted from the GI tract into the wastewater effluent and it happens before anyone
Speaker:who's in that building even has a symptom. So we utilize that as a mitigation strategy as well.
Speaker:I had no idea that you were one of the first organizations to identify and SARS-CoV-2 in
Speaker:wastewater. Truly amazing. I knew that you utilized that technology, but I didn't know
Speaker:that you were leading in it. So thank you for educating me about that. That's amazing.
Speaker:Yeah the test, trace, treat, strategy has cost the University millions of dollars. You are an MD,
Speaker:we're not traditionally known for our business acumen. How did you construct a cost benefit
Speaker:analysis to support this process and what were your key fundamental assumptions in the modeling?
Speaker:Well I knew that as I said at the outset it was the right Public Health thing to do
Speaker:and if you think of the University community which is not an isolated bubble but if you if you think
Speaker:about what we had control of then obviously for the students the faculty and the staff at
Speaker:the University we needed to do very aggressive testing and in contact tracing and isolation
Speaker:to be able to deal with this massive Public Health emergency the other thing that we did was
Speaker:we were very fortunate to have Dr. Richard Carmona the 17th surgeon general of the United States
Speaker:on our faculty for 35 years. He was one of the founding members of our incredibly rec gifted and
Speaker:recognized school of Public Health so I asked Dr. Carmona if he would help lead the effort as the
Speaker:Covid Czar if you will and he drew upon his time as a surgeon general when President Bush
Speaker:43 deployed him to New Orleans during hurricane Katrina to assess the medical health going on
Speaker:in New Orleans and he called back and said the hospitals are flooded up to the second floor.
Speaker:We need to move the patients out of the hospitals and oh, by the way we need to move all the people
Speaker:out of these temporary conditions somewhere else and he led the relocation of 300,000 people from
Speaker:New Orleans to Houston, Texas the largest mass movement and migration of people in the in the
Speaker:country's history now many of those people stayed in Houston because they had a great life there but
Speaker:a lot came back to New Orleans but we had Dr. Carmona is really our ace in the hole and he
Speaker:instituted an incident command system here that's used for all hazards in the Federal government
Speaker:I really wasn't that knowledgeable about an incident command system
Speaker:and the faculty and the administration thought what what is this militaristic approach to this
Speaker:you know this virus that that's going to give us the flu but it became very
Speaker:obvious quickly that this was a very lethal deadly virus and we needed drastic measures and so Dr.
Speaker:Carmona really helped us get organized through an incident command system that is absolutely
Speaker:amazing you have the amongst the best minds on the planet that really explains a lot actually
Speaker:this is a fantastic interview raising capital is never easy and I suspect particularly difficult
Speaker:given the groundbreaking path you are asking the capital to support what was your process
Speaker:for raising the capital and what capital profile for example alumni, non-alumni private government
Speaker:came to the table? Well, I think mostly we used our own operating budget at the University to
Speaker:fund most of these initiatives and and there were a lot there were mitigation efforts about around
Speaker:using higher filtration systems in all of our buildings, cleaning supplies,
Speaker:isolation, dormitories that we had to set up all of the supplies for testing because to take
Speaker:this on and test ourselves. We did this at no cost to any of our faculty staff and students
Speaker:so we utilized primarily internal operating budget monies and the little bit of reserve that we had
Speaker:at the University but the federal government obviously through the
Speaker:cares act provided a lot of funds because we thought that if we invested on the front end
Speaker:it was going to be very important for us to have safety first for our University community
Speaker:and we would figure the finances out later we thought rightfully so that
Speaker:the federal government would supply some funding and certainly the State Government
Speaker:and Governor Ducey and the department of health and human services provided some support for
Speaker:our antibody tests and we provided antibody testing throughout the state including
Speaker:some of the prison system as well so it was a combination of all we got a little bit of
Speaker:donor money to help us out but primarily it was our internal operating budget. Wow,
Speaker:I've spoken to Dr. David Harris on quite a few occasions. He talks about the
Speaker:fantastic leadership and support that he and his colleagues at the University received from you.
Speaker:You have a whole host of world-class intelligence with regards to University personnel what aspects
Speaker:of your own character and leadership did you draw on to make the whole project successful
Speaker:well I think I was smart enough to realize that this was going to take a
Speaker:huge team effort and that there were individuals who were infinitely more knowledgeable about how
Speaker:to deal with a Public Health crisis and so that's why I went directly to Dr.Carmona,
Speaker:Dr. Harris, Dr. Mike Dake who is the Senior Vice President for health affairs I can remember the
Speaker:first person I called was the Dean of the Medical School Dr. Michael Abakasas who
Speaker:is a world-renowned transplant surgeon. Liver, kidney and pancreas. Spent most of his career
Speaker:at North Western University and he had only been at the University of Arizona for about a year as the Dean.
Speaker:It turns out that his master's thesis was on Coronavirus. So he obviously knew
Speaker:a lot more than me. Obviously I'd been through SARS and MERS, but I had I didn't have the capability
Speaker:to deal with this and it took all hands on deck it took our students it took our i.t department
Speaker:our faculty our staff so I knew it needed to be a team effort and and so I think I drew upon
Speaker:my days as a heart surgeon where you could do a technically perfect heart operation but if your
Speaker:anesthesiologist, your perfusionist, your nurse, your respiratory therapist, physical therapists,
Speaker:pharmacists were not on top of their game then the patient was gonna suffer so I knew it needed
Speaker:to be multidisciplinary and all hands on deck and so we asked everyone to pitch in and you know it
Speaker:was going to take all of us working together and and I'm proud to say that's exactly what happened
Speaker:that's wonderful so you drew on your experiences and attributes as a doctor
Speaker:to sort of lead the University out of the pandemic that's amazing well you you well know that
Speaker:it's a it's a team team activity medicine is a team activity and and that's one of
Speaker:the things I really like about how we educate our pharmacy nursing Public Health students and
Speaker:physicians is in that team-based approach very true and the best doctors know that
Speaker:so can you talk about how you involve the wider the wider community of Tucson into the project
Speaker:and why this was important well it was important because as I was referencing earlier we don't live
Speaker:in an isolated bubble we live in a very porous membrane that has our students our faculty and
Speaker:our staff going in and out of the University into the community so it was important for us
Speaker:early on to establish good relationships with the mayor the city council
Speaker:the county administrators the board of supervisors and absolutely the health department
Speaker:and so we worked with the health department on a variety of different mitigation strategies and
Speaker:then ultimately treatment strategies when when we became a pod a vaccination pod first as a
Speaker:as a county pod and then at a state level and we vaccinated over 240 000 people in southern Arizona
Speaker:so it was very much in line with our with our land-grant mission to serve the community that we
Speaker:opened our resources up and and had a vaccination pod that was running seven days a week usually 12
Speaker:to 14 hours a day that is just fantastic I believe we need more than vaccination to get
Speaker:us out of this pandemic and have proposed that we follow a 360 degree solution to pandemic control
Speaker:I'm just going to share the screen with you briefly so basically the University of Arizona
Speaker:has facilitated as has done 80 to 90 percent of what I said we need to get safely out of the
Speaker:pandemic. I think at the moment we're living dangerously sort of globally so the regulator
Speaker:support and finance is you your testing strategy you implemented your wastewater monitoring
Speaker:the infrastructure you educated your students your staff the wider population of Tucson you supported
Speaker:people with isolation. You had IT contact tracing and you implemented air filtration and
Speaker:the most important of all, vaccination. So you've done virtually everything and I think that's why
Speaker:you're now nearly back to, well, you're back to normal aren't you at the University of Arizona?
Speaker:We are. I am concerned that there's another wave coming. So for instance we've kept our
Speaker:Public Health advisory team together we've kept our ICS incident command system together because I
Speaker:would like to get through the summer to see if BA2 is going to have a big outbreak in
Speaker:Southern Arizona like it did on the East coast and I'd like to get another truly quote normal
Speaker:disease-free semester under our belts before we declare mission accomplished that's you know
Speaker:that's true humility and yes you're very right the pandemic is still raging on it's not over
Speaker:but this whole interview is about it's kind of a second part of the interview with Dr. Harris
Speaker:it showed how successful you've been I think you've really set a blueprint for the planet
Speaker:on how we should manage this pandemic safely what do you see as the long-term or ongoing benefits
Speaker:from the pandemic risk reduction infrastructure that you set up at the University of Arizona
Speaker:for the University and possibly beyond well I think that future pandemics and of course there
Speaker:will be hopefully not anything as big as there was in 1918 or in 2020 but I think it's also an
Speaker:Esprit de Corps of the whole University community and the outside community coming together showing
Speaker:that we can work together and it's important to do so but I think early warning and early detection
Speaker:of future pandemics is going to be critically important not to mention the long-term study of
Speaker:what happens to patients with Covid the so-called long Covid but in terms of being prepared for
Speaker:the next pandemic I think we'll have a blueprint we'll know how to do it it's interesting that our
Speaker:our University clinic which is ranked perennially in the top five University student health centers
Speaker:in the US was started in the 1918 pandemic so it's it celebrated a 100 year anniversary just a couple
Speaker:of years ago and so I think that we've learned a lot and all that will be codified and captured for
Speaker:those people who come after us who have to face hopefully not as devastating a pandemic
Speaker:but it could be even worse well what a fantastic University I mean you've set
Speaker:a real example you have an amazing ethos dating right back to the early part of the 20th Century
Speaker:and you as President have continued with that and I really must you know champion you for what
here. So my final question is:Would you like to leave the audience with any lasting
here. So my final question is:thoughts of the importance of reducing the risk of infection from coronavirus in all our lives
here. So my final question is:and what thoughts do you have on a universal worldwide application of your fantastic results?
here. So my final question is:Well I think that the fundamental approaches that we took which was the
here. So my final question is:test, trace and treat protocol also included many other things which are
here. So my final question is:very basic things. Washing your hands. We know this is a respiratory virus.
here. So my final question is:Face coverings and distancing from other people. Just those simple things, along with a vaccination
here. So my final question is:would get us 90 percent of the way. Obviously the most vulnerable population among us
here. So my final question is:are the ones we have to focus on continuously. Now those are the less fortunate
here. So my final question is:marginalized populations and also the elderly and immunocompromised people that
here. So my final question is:have immunodeficiency disorders being treated for cancer or other high risk categories, but I think
here. So my final question is:early warning and detection systems in the future and not waiting not politicizing this
here. So my final question is:going straight to the science in the data that we know will help people and save lives I think
here. So my final question is:is the biggest lesson to learn I'm not sure how to eliminate the political issues that were involved
here. So my final question is:here, but it's it's really disappointing and I'm hoping that the next time it won't be so
here. So my final question is:politicized. So the title of this podcast is about the business case and and what you've just said is
here. So my final question is:definitely the reasoning but how is how as has the University implementing all these things because
here. So my final question is:I'm constantly saying we need air filtration we need ventilation we need testing and people keep
here. So my final question is:going on about the costs you know you know so can you tell me the business case for for doing
here. So my final question is:all of this yeah the business case was very simple if we couldn't run if we couldn't provide a safe
here. So my final question is:environment for our students faculty and staff we couldn't make money as a University and it
here. So my final question is:comes down to that simple fact one of the reasons why we wanted to do all of these things it was
here. So my final question is:it was medically the right thing it was from a Public Health standpoint it was the right thing
here. So my final question is:but it also was the right business decision for us so that we could get our University open
here. So my final question is:deliver classes because 40 percent of the students are from outside Arizona and that's
here. So my final question is:a high percentage for a state University and we depend on those students coming here, because
here. So my final question is:they pay a higher rate of tuition and fees. So in order for us to attract those students, we had to
here. So my final question is:be open and having in-person classes. So that's the business case for this without question.
here. So my final question is:So doing all of this not only kept the whole community safe, save lives but also save the
here. So my final question is:help the University to keep generating money. Yes, that's fantastic. Thank you so much President
here. So my final question is: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.
here. So my final question is:Thanks for listening to this weeks episode of Covid-19 The Answers