Town Hall: Slowly opening campus doors

[Joe Guglielmo]
Welcome, everybody to what has been a weekly School of Pharmacy Town Hall. As usual, I just want to make you aware of the usual tips as it relates to this webcast. Your audio and video will be automatically muted. Only panelists can unmute themselves, the chat function is disabled. And so once again, please use the Q&A feature for any questions. As always, we will answer all outstanding questions via email but if you give it to us and anonymously, we'll do our best to do that at the next town hall meeting. And as has been the case every time, we will hold all questions to the very end of the presentation. So this is our eighth full week of shelter-at-home. And I think you will all agree that the pandemic outlook nationally has changed quite a bit since we last met. Perhaps the most obvious change is that it is now predicted that we're going to have quite a sustained epidemic peak, averaging over 2000 predicted COVID-19 deaths a day for weeks to come. And I think you'll know that there are a number of states with very large epidemics type of trajectory, and some examples include New Jersey, Pennsylvania, Massachusetts. I think you also know that New York is the main exception, with its predicted peak now, and gradually downward trend and predicted deaths from this moment on. In fact you may remember or know, there's a associate professor at UC Irvine, who has shown us data that without New York included, showing that if you take New York out of the picture, that if anything, there is a continue augmentation and death taking place and predicted to be in place for very long time. Again, New York being the exception. They also are highlighting that there are several states that have predicted peaks much later. These are going to include Georgia, Massachusetts, Ohio, Pennsylvania, Texas, and a number of others that I will not time. There are some updates from Governor Gavin Newsom. The first point was the movement of California from what he calls stage two of its four phase reopen plan. And I think you're all aware of that modification of stay at home orders, which has been taking place. Perhaps what is more important at the moment were the reports out of the governor's office today, and I'll quote it that they are expecting that California is going to experience a 54.3 billion dollar deficit over the next year and send the state's unemployment rate well above its peak in the Great Recession. And this comes from a memo released by Governor Gavin Newsom's office. And to just give you a sense of how that compares with the past Governor Newsom's January budget proposal was at 22 billion, and he projected a 5.6 billion surplus through July 2021. So I'll repeat again, as opposed to a projected 54.3 billion deficit over the next year, as per his report today.

Moving to the city and county of San Francisco, the mayor announced just a few days ago, free testing for all essential workers—health care workers, first responders, grocery clerks, construction workers, drivers, childcare workers and others who continue to leave their homes each day to serve San Francisco during the stay at home order. And then on to share some of the data that I do every week with you, and remind you in California last week, there were a total of 48,870 cases 1,982 deaths. As of 1 pm. Today, there are 60,616 cases, predominantly in Southern California, and there are 2,504 deaths. The last thing I always like to point out to you is the oft-used national and otherwise University of Washington, projected peak total deaths and the total deaths in the past was 2,104 by August 4. And that's what they projected last week. As of now, that projection also still by August 4. And I'll repeat again what last week was last week was 2,104. They predict that total to be 4,666 deaths by August 4. And lastly, the UCSF situation last week to remind you, of a total of 64 hospitalized COVID patients to date. Then last week 45 of those 64 were discharged in the hospital and two had died. As of 5/5, there was a total of 78 hospitalized patients at UCSF and the logistics were 31 of them requiring critical care, so that meaning ICU status, and of those 22 of those 31 required a ventilator. Of that total of 78 hospitalized at the current time, 54 of them have been discharged. But we are up to now three deaths up from two last week. Last week also at this moment in time, there were a total of 19 cases at UCSF, as of 2 pm, today, there are 15 hospitalized patients at UCSF. The last piece of COVID data that I wanted to share with you, you may have noticed, literally, in the last hour in the New England Journal of Medicine, reported a study of hydroxychloroquine and it's effects on COVID-19. And this was a large observational study involving hundreds of patients with COVID-19, who had been admitted to the hospital. Now this was not a prospective randomized control trial. Essentially though in this at least observations study, including univariate multivariate analysis, hydroxychloroquine administration was not associated with either a greatly lower or increased risk of the composite endpoint of intubation or death. They conclude what every trial has concluded that randomized controlled trials of hydroxychloroquine in patients with COVID-19 are needed. So that is the other that kind of updates from what you heard last week from Dr. Yang's analysis, where she highlighted remdesivir particularly, I think, where she particularly pointed out the value of the one prospective, randomized placebo controlled trial by NIAID, which did demonstrate some remdesivir effect in that trial.

Moving to the survey results that were requested of those that were part of the webinar last week. Thank you to all who answered the survey. In excess of 60% of you responded to the survey, and we I thought I would tell you what the order of topics were that you wanted covered in future town halls in priority order. Number one, was reopening the school and the campus and it is fortunate that we in fact are going to start talking about that today with our two special participants, Dr. Youmans and Dr. Desai. The second thing in topics was the financial impact of the pandemic. Well, I'm starting to hint at that what I think is evolving from the governor's announcement today, it's hard to believe that will not impact on his decision on money to University of California, but we will wait till we get more information until we get into that. And I'll say to you, I have received nothing from the Chancellor's level in any way on any plans in any way in terms of financial issues impact at all. The third topic that was considered to be our priority was to hear about school research on COVID-19. And starting, I believe tomorrow we will have a list posted to the school website, and you're welcome to take a look at that in a day or two. The last couple were patient care approaches responses to COVID-19 related to the school and lastly, the impact of the COVID-19 on the PharmD program, which we will be addressing today. In terms of outstanding questions from last week, all were answered, there are none at this time. So at this point, I'd like to shift gears and I want to bring in our two distinguished faculty who are going to get down to the reopening of the school and the first one that we're going to hear about is going to be Sharon Youmans, Vice Dean of the School of Pharmacy, who covers all things, education and diversity for us. She is going to update you, as evidence-based as she can in exactly five minutes, on where we are on PharmD education. That will be followed by Dr. Desai who I will introduce in a little more detail when Sharon is done. I will request all questions be directed to them or to me if it's appropriate at the conclusion of both their presentations. So, Dr. Youmans, if you could, please do educate us on the reopening of our PharmD education program, Sharon.

[Sharon Youmans]
Thank you, Joe. And good afternoon, everyone. It's my pleasure to give you some specifics about our plans of reopening the campus or bringing students and faculty back to campus for teaching activities. One of the things that has happened in the last few weeks is that all of the education Deans had a meeting to come up with general principles and guidelines on how we're going to make decisions about reopening, keeping in mind that all of our programs are unique and have unique needs, and that we have a lot of students and we want to be able to bring faculty, students and staff who support our education program back in a safe and orderly manner. All of these decisions will be made and in accordance with our public health officials, the campus leadership, as well as directives from the state and the city. So let me give you some specifics about what is happening. Currently, our curriculum we have our P1 students and back in March, we had to quickly convert everything to remote access. And so far that process has been going well and again, kudos to our Office of Education Instructional Services (OEIS) staff who have supported the faculty In that. And I also want to thank the faculty for being flexible and nimble and revising their curriculum to adjust to the remote access. The campus is moving into what we're calling a midterm phase. And I want to just to give you some context that, that timeframe is from July to December. So all of my following remarks will be things that we'll be doing in that timeframe, July to December. One of the questions that we are getting is that for our incoming class, so these are the students who are supposed to start in July, what is going to happen to them? Should they come back? Well, all of the programs, including ours have agreed that we are asking all of our students to be in the San Francisco Bay area to start the curriculum in July. The next question that we get, well, what is that going to look like in terms of who gets to come when, how many get to come etc.? So we've made the decision that for all large group will lectures, that usually what happened in the HSW rooms, all of those lectures will be made by remote access. Our class sizes are 127, we would have two cohorts on campus. So that would be a total of 254 students. So that is not in agreement with the current physical distancing and gathering numbers that we're working with this Shelter in Place Order. Now we'll move to the small group meetings. We've changed our curriculum where we're doing more of the small group with the critical thinking problem solving hands on skills instruction. So our decision for now is that we will ask students to come to campus to do those activities that require the students to be in-person. Examples of that include immunizations, where they're learning injection technique, aseptic technique, measuring blood pressure. And that will be scheduled and coordinated based on the parameters that we can have in terms of the number of students in a space, how far apart they have to be, etc. What are the things that we're very cognizant of, and we worry a little bit about is about the socialization of our students. And as time goes on, and as the parameters are relaxed, we will we have a plan and bringing back more of those small group activities, you know, where they're discussing cases and solving problems, etc. and that will work out. We'll be coordinating all of this with the other programs in order to, to the extent possible, not overload the campus with too many students and faculty and staff at the same time.

Another question that we get is about assessments. We have been providing those assessments via remote and we will continue to do that. We have secure monitoring in place. And so into the near future, we will continue to provide our assessments via remote access. Now shift gears to experiential education. All of you may have known that we did have a bit of a delay for our class of 2021. And starting there APPEs, I'm thankful to Val Clinard and all of the program directors that the students are scheduled to start their APPEs on May 18. And if all things go according to plan, the Class of 2021 will finish and complete their APPEs in time to graduate as scheduled. Questions around IPPEs, we to cancel the IPPEs for the P1 this year. They still have some time to make up, and we have plans other activities that will help them make up those hours. The second year students are scheduled to start their two week hospital ops experience and those plans are still on track to start, our entering P1s are scheduled to do their community experiences and those are also on track to start this Fall. Once again, I say the caveat of all of this is that it is sort of a moving target. But we do have some specifics that we can share. Our main goal is to ... is the health, maintaining the health and safety of our students, faculty and staff. And we will be moving together with other programs and open up the campus to students as much as we possibly can, given our restraint. These are unprecedented times and so every one is going to have to think differently about how we provide education and we'll do our best to provide the best support that we can for our faculty, students and our staff. So with that, I'm sure they'll probably be questions at the end, I will conclude my remarks. So thank you for your attention ... your attention.

[Joe Guglielmo]
Thank you, Sharon. So now I'd like to move over to the second speaker. And again, the focus of today is reopening. And so in this case, Dr. Desai, Tejal Desai, who's the chair of the Department of Bioengineering Therapeutic Sciences, and also a member of David Morgan's committee on how to in fact move forward. She will be discussing reopening of School lab science, so Dr. Desai.

[Tejal Desai]
Thank you. As many of you know, UCSF labs were asked to suspend all non-essential activities on March 18. So we are coming up on about eight weeks. This process was actually overseen by a research shutdown task force chaired by David Morgan and included both myself and Tanja Kortemme from the School of Pharmacy, as well as faculty members from across the UCSF campuses, Parnassus, Mission, Mission Bay, as well as across diverse departments, including physiology biochem, anatomy, Microbiology and Immunology. Since the order went into effect, we have essentially shut down 90 percent of our research activities, only making exceptions for essential COVID related research. This does include as we've heard previously, many School of Pharmacy faculty members, ranging in areas from drug discovery and drug dosing and PK to new forms of PPE and diagnostic systems. I think what has been really amazing is that every single exception and every single project has been vetted by this group, and really with a thoughtful approach to making sure that safety was ensured as this ongoing research has been happening. So we're now turning towards our plans for actually restarting research, which as you can imagine, will be more difficult than actually closing down the labs. And there's three main principles that are being applied to this process. First, I think as Sharon mentioned, our top priority is the health and safety of everyone and in this case, the lab staff and the community. Secondly, any resumption of activity has to be gradual. And third, we actually may need to turn back. So being flexible and transparent will be key to this process. The other thing for everyone to know is that research going forward is not going to be the same as it has been in the past and we have to be prepared for really doing things in a new way. And so, this committee has spent quite a bit of time putting together a document, starting from April 6, and that now has been vetted by not only faculty, but also EH&S (UCSF Office of Environment, Health and Safety), the leadership and various stakeholders across campus. And I won't go through all of the details that will be released in the next couple of weeks. But I want to talk about some of the most important points. First of all, the key feature of the plan is that we maintain a low population density in the research labs as well as the research buildings. What this means is that in phase one, that density will be limited to about 12.5 percent, or one and eight. If you can imagine every bay have a research lab, having only one person. That doesn't sound like a lot, but in fact, that actually would be approximately 700 more individuals in every building. And so those numbers do add up quite rapidly. In phase two, and this would happen, you know, once we know that things are working in phase one, probably two to three weeks after, that density would move up to about 25 percent. So, one in four ratio, lab benches to people, and or the other way around to people to lab benches. And even with that, what we will be requiring is that workers really enter labs and shifts and work on strict schedules to both minimize the density but also maximize space without, you know, severely jeopardizing the progress of research. This is going to require from every single researcher teamwork, patience, generosity and understanding. We may have to work differently in terms of how we schedule our hours during the day, whether that's the morning, afternoon and night shifts, whether that's working on the weekends. And at any point during this, we also have to make sure that we practice safety, which means face coverings at all times, disinfecting high touch surfaces, physical distancing, and no in person meetings or gatherings, lab meetings, things that are not essential in order to be in the on the premises. And there will although we don't know the details of this be screening of some sort at the building entrances.

So the big question, of course, is when will this all begin? And in terms of the timeline, we don't have a definitive answer. But in talking to Dave Morgan, he seems confident that this will this least phase one will be in effect within two to three weeks, so that could be as early as the end of the month or early June. So we've been really encouraging the labs to start to talk about what will be the best practices within their laboratory setting, to start to talk to the individuals, students, postdocs, researchers, to figure out what would be best given your environment, given the types of work that you do, and the local physical space. Because every lab we know is different. And so this is we're not going to mandate exactly what you do, but really sort of these central guidelines. Some things to consider are how, really thinking about how people commute. Are they able to commute? Do people have other obligations, including family obligations or childcare? To really make it so that people are comfortable in how they come in, when they come in and have the choice to do so in a way that makes them comfortable. We realized that there's a great deal of uncertainty and we will be providing information as we receive it. But I also encourage you to ask questions, both now and later. And actually, there will be further information in terms of the graduate students and how this affects them at 4 pm. today in another town hall that will be following this one. So with that, I will and be happy to answer any questions.

Thank you, Tejal. I would like to maybe start the Q&A with a question for both of you both Sharon and occasional if you could both answer this from your own perspective. It's kind of an inevitable question a lot of people are thinking about and that is, to what degree within each of the purview you have been responsible for today in this presentation, are you or others interacting with like, everybody from the police department, to the shuttle services, to the library, to ... I guess I it'll be great to hear from both of you. To what degree are all these auxiliary services, these very important services, police, etc? How are they integrated in the thought process here for plans as well as timelines? So maybe I would ask Sharon first and then Tejal if she could answer secondly.

[Sharon Youmans]
Sure. So in addition to the education Deans, we have a weekly meeting that includes all those who are in charge of transportation, housing, Student Life services, student health, mental health. And so all those folks, people who are in charge of the scheduling of the classrooms, the library, so all everyone is involved talking about what their individual needs are and how we can coordinate this effort, because we're all competing for the same space and we want to be sensitive to students who require their to complete their training for graduation. So all of those important supportive services are involved in helping us to inform the decisions about how and when we reopen the campus.

[Tejal Desai]
And I would echo that on the research front, I think the most important partner, of course, has been EH&S and they have done an extraordinary amount of work and really looking at every single space on campus and figuring out what and what cannot be done in a safe manner. But they, along with the committee have also been working with security, the police department, also looking at core facilities, so when the laboratories open that the core facilities would also open, because many of us rely on that in terms of pursuing the research as well. So I think there has been quite a bit of conversation across the board.

Joe Guglielmo]
Thank you both. So I'm gonna turn it over. We just have a couple of minutes but I think we only, so Eric and Grant, if you want to pose those questions to our panelists, please.

[Grant Burningham]
Sure Joe, we've got two questions in two minutes here. So we'll move quickly. First question is from Mika Roth. How will research rotations for new grad students look like? Tejal, I know you mentioned that there was a another town hall coming up at four, but maybe you want to cover that.

[Joe Guglielmo]
Yes, this is something that actually is being actively discussed within the graduate programs. I don't think we've come to a conclusive answer about that. I know, our graduate program has talked about everything from you know, thinking about virtual rotations, ways in which they can engage on non-wet lab experiences, to perhaps shifting it slightly, such that the timeline may allow for less density, but we will hear a little bit more about this from Dean Watkins today at 4:00, as well as definitely something that's been actively taught by all the program directors.

[Grant Burningham]
Okay, we have two more but only one minute. So let's just get this last one. In each lab one person is caught in conflict with the policy that a minimum of two persons in lab for the safety reason at a regular time. I personally prefer one person in a lab is the COVID risk is higher other than the safety concern.

[Joe Guglielmo]
Let me answer that quickly. It's not necessarily one person in the lab. It is one person for every eight seats. So yes, if you have a smaller lab, that would be one person but you can also think about other spaces as being separate areas. So whether there's a cell culture room or a microscopy room, that can also have an individual that is associated with that space. We recognize that we would like to ensure safety during these times. But one of the things we've also thought about is perhaps we can have cameras or other means that which people can actually keep track of individuals that are in the lab.

[Grant Burningham]
Okay, I think that's it. We have one more question, but we'll answer it offline.

[Joe Guglielmo]
Great. Thank you, Grant. So I'll close with thanking Dr. Youmans and Dr. Desai, for giving us these updates on reopening these respective parts of our mission. And to that end, I want to let you know the next town hall, we're going to delay it a little bit because we're going to we have decided to focus on this reopening sort of aspect to in concert with what you all wanted. And we felt that it would be important to at least wait a couple of weeks to see how the experiential goes. And at that time we'll have Dr. Youmans and Dr. Clinard to help us out on that. We will also maybe have a little more feedback on whether or not the timeline what the timeline is from the laboratory standpoint and whether it's still is in the same plan that it does right now. So with that said, the next town hall will be Thursday, May the 28th, again from 3:00 to 3:30. So again, there will not be one on May 14, there will not be one on May 21, and Outlook invitations already been sent to all of you. In the meantime, thank you once again for participating. Please stay safe and be well thanks.