An interview with Chief Health Officer Dr. Preeti Malani

An interview with Chief Health Officer Dr. Preeti Malani, facilitated by Executive Vice President and Chief Financial Officer Kevin Hegarty
Audience Q&A facilitated by Dyan Jenkins Ali

B&F Leadership Forum
August 4, 2020

Remarks have been edited for clarity. To watch the video recording please see here or watch below.

Executive Vice President and Chief Financial Officer Kevin Hegarty: Welcome to everybody out there in cyberspace. We’re going to be learning a little bit about the university’s public health informed COVID-19 management plans with our Chief Health Officer, Dr. Preeti Malani. 

With people like Dr. Malani leading our planning and our activities and our discussions, I have great confidence that we will adjust as needed and come out of these circumstances as best we possibly can. Dr. Malani, is sharing her personal time away with her family with us, and I very much appreciate that. As everybody knows, I try to guard my time away very judiciously and encourage everyone to. But, Dr. Malani understands that these are very tough and trying times for all of us. I am thrilled to have her this morning with us.

Dr. Malani is the university’s chief health officer and she’s also amongst many things, a professor of medicine in the Division of Infectious Disease. Dr. Malani is a clinical researcher and her research interests include infection control and prevention and infections in older adults. She also recently launched a national poll on healthy aging. Based at the Institute for Health Policy and Innovation, Dr. Malani has published more than 100 peer-reviewed journal articles and editorials and has edited five books in addition to all this. 

I recall in one conversation I had with Dr. Malani about my mother who is in assisted living. She is a wonderful (and calming) resource about the various life stages and what people go through. So I really appreciate Dr. Malani in so many different respects.

In addition to carrying two other titles, wife and mother, Dr. Malani has offered more than 125 interviews, published papers, webinars, and presentations pertaining to COVID-19 pandemic since just February of this year, and she also co leads the COVID-19 Campus Health Response Committee, which is focused on helping the university reopen campus. 

Please join me in welcoming and thanking Dr. Malani for being with us this morning. I’ll kick the interview off with a question: what are the responsibilities of a chief health officer? What personal or professional interests led you to pursue this role?

Chief Health Officer Dr. Preeti Malani: Thanks, Kevin, for having me and thank you to everyone for all that you’ve been doing here. The chief health officer role is an unusual one. It’s not one that most universities have. If you look at the website, it says the big picture things which is I’m an advisor to the university’s president, on all aspects of health and well-being, as well as executive officers. I get to work quite a bit with Kevin on things like benefit design. One of the interesting things about the job is that I am involved with everything, but I don’t own anything, I don’t oversee anything directly, which is nice. I get to have a lot of conversations on health and well-being, in a holistic way. 

This is something that has fit with my interest in communications, in health, in public health, and, of course, infectious disease. But prior to COVID, which is hard to remember now but, prior to COVID, a lot of my interest was in what employers can do to improve health equity. There have been many examples at the university with thoughtful benefit design and I hope one day I can get back to some of that work.

Kevin Hegarty: Very good. Dr. Malani, we know you’re part of the incident response team, which we know comes together at various points to help the university dissect, understand, and deal with emergency situations. You’re also part of the COVID-19 public health committee that is guiding the University about reopening campus and what that might look like. Could you tell us a little bit about these teams and their role in the pandemic? What are the criteria that are being used to make some of the difficult decisions and recommendations to the president?

Dr. Preeti Malani: This is a really important question and there’s lots of pieces to it. Now that we’re into the pandemic in the United States, COVID has really changed every aspect of our lives, not just in healthcare, but how we interact, how we’re having this meeting, as well as how we do research and how we learn. 

Back in March, which seems like a lifetime ago, within a matter of days really every university and college in the country made a rapid pivot to online or remote learning. And at that moment, it was like flipping a switch. Health and safety were really the only considerations that we had at that moment. The committee spent some time known as the incident response team (which evolved into what we’re now calling the Emergency Operations Center). They’re continuing to meet many months later. I actually gave up attending a while ago because I was in so many meetings that I ended up taking a step back from that committee. 

But the fact is that COVID has touched every aspect of this gigantic enterprise. So, bringing people together in these different groups has been helpful, both on day-to-day issues as well as thinking more broadly. And again, these decisions, as everyone here knows, have touched every aspect of the university. Besides health and well-being, there have been a lot of concerns around equity and inclusion. It’s really hard to learn remotely. It’s hard to work remotely and as we know, depression and anxiety are already at epidemic levels. How is isolation going to make that different? Is it going to make it worse? Is it going to create new issues in terms of loneliness? So the risk of COVID drove the discussions, but we really wanted to think more holistically about the planning. 

As Kevin notes, there are numerous committees and there’s the COVID lead group. Kevin and I got to spend many hours together with the executive officers and a few others thinking about how we get back on track. The advisory groups did include numerous public health considerations. Others looked at ethics and policy – the provost had, I believe, seven committees, looking at all aspects of learning and all different spaces. In terms of the process itself, it was extremely detailed. It was a very diverse set of people. I think I’ve never been involved with anything quite like that. And again, the public health aspects,  with the idea of thinking about what we can do to get back on track (assuming things are safe with COVID) has been the leading process and a guiding principle.

Kevin Hegarty: Very good, thank you. Well, I know as a result of that, the President has announced that the upcoming semester — and perhaps the full academic year — we’re going to have a public-health informed academic year. What does that really mean? What does that look like to most of us?

Dr. Preeti Malani: I have a couple of comments. One is that this is a hard situation, it’s very, very difficult. What I described it as is trying to make a boat out of a car — it’s an imperfect idea. The other aspect that I think is worth noting is that things are changing. Even in the couple days that I’ve been away from work, things have changed. 

Although I’m speaking to you today, this is really the work of hundreds of people. I wanted to highlight one person, which is my good friend of 25 years and colleague, Robert. Dr. Robert Ernst, who is leading the COVID-19 Campus Health Response Committee. The actual operations piece of this is massive, as you can imagine. The details are coming for it in the next couple days, they’ve been getting updated on the Campus Maize & Blueprint website

Back in March, things happened very, very quickly. It was like turning off the lights, shutting the door and just getting everyone out and home. We’ve learned a lot of things since then. I’d say a couple of big things that stand out to me are the potential for asymptomatic spread and the importance of face coverings in terms of prevention. I think those are really key to how we go into the fall semester. It’s now August and we’re poised to return to learning in what is being dubbed a hybrid model. Most things are planned to be remote, including a lot of the large classes, but some of the smaller classes and activities will be in an in-person format. And, there’ll be students living in the residence halls. 

Unfortunately, the fall semester is just a few weeks away and the pandemic is not contained in the U.S.A., and we’re seeing surges around the world as well. We continue to see 60,000 – 70,000 cases a day in the country, and this is all in the backdrop of still having issues around testing and turnaround time and without a coordinated national strategy. So things vary a lot by state in terms of how the virus is being contained. We did know back in the spring that getting back to in person learning, even in the best of circumstances, was going to be complicated. And it’s worth noting that several schools and colleges who initially had planned for in-person learning have rescinded those decisions because it is really difficult. Now, I’m optimistic. There are ways to do this in a public health informed way. It’s not going to be without risk, but it can be done in a thoughtful manner where you mitigate risk, share responsibility and understand that there will be some cases. But, we want to protect vulnerable individuals. We want to prevent outbreaks. And, that’s where we’re at with our planning. 

We don’t always talk about the why, but the why is important. As Kevin noted, this isn’t a fall issue. This is not a September issue. This is an issue that’s going to unfortunately be with us likely for several months and likely most of 2021. So in June, the university announced plans for public health informed in-residence semester.  As noted, this will be a combination of in person and remote classes. Again, it’s a very, very detailed process with lots of guiding principles around health and well-being. 

I just wanted to share a few thoughts. One is this idea of flexibility is really important. We’re calling it a “flexible fall” in that some things might change. The calendar has changed, which is part of the approach trying to prevent people from traveling in and out too much. One thing that is for certain is that the semester is going to look really different. We will be relying on things like social distancing, wearing face coverings, washing hands, screening people for symptoms, and contact isolation. We have quarantine spaces set-up. We’re minimizing out-of-area travel and limiting large gatherings, which is one of the hardest things to do on a college campus. We’re working very closely with students on this issue. The students are very motivated to be here and the details on all these issues can be found at the Campus Maize & Blueprint website, so I won’t go into all of them. One thing that’s important to note is the students can really make a choice for themselves on whether they want to be in person, remote or mixed. Very few people would be completely in person, those classes are reserved for the performance spaces or some of the health sciences spaces. For example, you can’t really learn to be a dentist virtually. So this is being handled differently in each unit. But, in general, large classes will stay remote, small classes will be held in person, and medium sized classes will be a hybrid of the two. 

We’re thinking about the residence halls in different ways, how academic buildings are set-up. You’ll note that there’ll be different issues in terms of accessing buildings. This is already the case; you can’t walk into most buildings on campus. I want to note that remote teaching is different; it’s not just getting on a video camera and recording your lecture. There’s been a lot of resources put into making remote teaching and remote work as robust and productive as possible.

Kevin Hegarty: Very good. You know, the vast majority, if not everyone on this call are staff and some of us have to be on campus to do our work. Many of us don’t have to be on campus, at least continually, as we begin to think through what this flexible academic year might be. What would your advice be to us, as staff that don’t have to be on campus every day to do our work? We’re getting used to working remotely after six months. Many of us have gotten used to that. But what would your advice be particularly in light of the fact that, let’s face it, there are going to be cases of COVID-19 on campus?

Dr. Preeti Malani: Yeah, so there will be cases of COVID on campus.The public health measures offer protection, but the reason to not be on campus isn’t just about COVID risk. It’s about the overall density of people, and that’s something that is kind of hard to think about sometimes. It’s actually the number of people that are in the space that matters. 

There’s been a wonderful ramp up to research led by Dr. Rebecca Cunningham, our vice president for research. And it’s been a very, very stepwise dial up process for those of you who’ve been involved with that. All of this is really about planning — I think of it as dialing up or dialing down. Even at our state level, where we might be at phase four now, but we could go to phase three if there are a lot of cases. Or, if it’s good, we could go to phase five. So, flexibility is something that I advise. I think the uncertainty is something we’ve learned to live with. 

And Kevin, as you know, people who can work remotely will continue to work remotely. Now this is not ideal for anyone. This doesn’t mean people who could work better on campus should come to campus. It just means that if you’re essential, and your role can’t be performed remotely, then you’re going to be on campus. There’ll be people in student-facing roles who will be on campus. So we’re going to see more people on campus, which is nice to see, but of course it does increase some of the risk. This has been something that is unimaginable for folks. And I think being creative in terms of how we can be productive as teams is something that we all have to work with every day. So I would say for most of you, your lives will remain a bit different and you will continue working remotely.

Kevin Hegarty: Very good. Well, thank you. We’re very focused on this and will continue to be focused. We’ll talk more about this as a leadership team on what we have learned thus far in the last six months. How do we optimize and make better what we want to make better, and how do we change and alter in those spots where working remotely has been a bit rough? We are very focused as a portfolio on some of the silver lining of this. We’ve already seen across the Earth some of the benefits of people having slowed down by working remotely, not getting in that car and driving to work, etc. Some of this impacts the environment in a positive way. I’m a sailor and I watch a lot of sailing shows. It’s astounding to me that places where the reefs were dying are all of a sudden seeing the fish coming back because the big cruise ships are not coming in and dropping people off, etc. 

We’re very focused on how we can help the parking situation on campus. Think of it — if only a third of the thousands of employees in Business & Finance on any given day are physically on campus — what that two thirds relief really looks like. Think of the taxing of our internal transportation systems that we put on campus and what it looks like without us there. I think it is important that we all think about not just the negatives, but also the positives of what we’re generating out of this. So, I really appreciate your comments. 

You have a very expansive role and you’re also playing a big part in what’s happening across the state of Michigan and what’s happening even within our own city of Ann Arbor itself. Can you share your view on the state and the city’s situations and what you are hearing about? What is the governor or people around the governor thinking about what the future might hold — especially as it might impact our university or campuses like ours?

Dr. Preeti Malani: Thank you. Our state has been really an interesting place because we were hit very hard, very early. If you remember back to March and April, some of the discussions we were having on campus were about having a field hospital and having such a big surge of cases that we would be unable to manage it with our usual resources. And, since that time, our state has actually been a model for success. 

Our governor has reached out to many experts across our campus, as well as others. And I think many of you know, a number of our faculty are involved as close advisors, particularly from the School of Public Health, but also from the Ford School of Public Policy and the law school. I was fortunate to speak with Governor Whitmer early on to talk a little bit about a shelter in place order and the timing of that. And more recently, I’m one of about a dozen folks who are named to a state Task Force on Nursing Home COVID Preparedness. And so, Kevin, we were talking a little bit about this. This is sort of my two worlds coming together. Our charge is to come up with recommendations to the governor on what would happen in a second surge. And this is important because nursing homes have been a place where outbreaks could derail all the progress. Again, although our state was hit early and it was hit hard, the restrictions were also kept in place longer. But, human beings have to be with other human beings. And you can only do this for so long. Our numbers have gone up. I think some of you probably follow these numbers. Hospitalizations are also starting to creep up a little bit. Fortunately, the death rates have been stable. They’ve been sort of in the single digits the last few days with the overall caseload in the several hundred a day range. Some of that is a reflection of testing. But my friend, Dr. Emily Martin from our School of Public Health, calls it the rising water around us. What we all worry about is back to school and for the University of Michigan, back to campus, and how that might affect the region, how it might affect the state. 

We’ve heard these reports from Michigan State, at the bar Harper’s Restaurant there was a big outbreak — 150 people or so. There was a house party in Saline that also had a lot of infection. One event can really derail an area that is contained. So it’s continued vigilance. And it’s protecting our economy, particularly manufacturing, while waiting for a way out of the pandemic. And getting back to living with some of this. I think our state is in a good place, but it really requires all of us to continue to be vigilant.

Kevin Hegarty: If you turn on the news these days, depending on which channel you’re watching — or worse yet, if you’re a flipper like me you’re going back and forth — literally your head can spin around on axis just trying to figure out what all these statistics mean. I heard somebody the other day who raised the question about why this is so much different or so much more important than influenza. The statistic, as I recall, was that nationally we have [tens of thousands] of people die annually from the flu. So, you know, the death rate seemed to be a little higher. Why is this any different? Can you kind of compare and contrast what we’re dealing with with COVID and the flu?

Dr. Preeti Malani: The flu is important. And, I just want to take one minute to say that this year it is particularly important because the seasons will overlap. And this is a good year to make sure you get a flu shot because things could get very complicated if we’re dealing with flu and COVID surges at the same time. Flu deaths vary year to year. Some years it’s worse. It really depends on the vaccine. Flu is also different in that we can treat people, we have good antivirals and we have an effective vaccine. It’s not a vaccine that eliminates flu, but it definitely can prevent hospitalizations, it can prevent severe illness. 

The numbers suggest that COVID is about 20 fold more severe in terms of hospitalizations and deaths. There’s a lot of focus on deaths. But one of the things that is not quite as clear and may not be clear on the news and in other discussions is that COVID makes you really sick. And it makes young people very sick sometimes. We don’t fully understand the nature of this. This is something that is brand new. So, there’s no immunity in this community and in all of the world. The suggestion is that COVID, even with all the mitigation that we’ve done, we’ve only had infections in 1-2% of the population and yet we’ve had death rates of more than 150,000 people. We’re in the 160,000 range now, and those are just deaths that we’ve been able to capture. There’ve been others that we haven’t, so the two viruses are several fold different in my mind.

Kevin Hegarty: Okay, let’s talk a little bit about a vaccine. In your opinion as a medical doctor and somebody that studies these diseases, how realistic is it that we will have an effective vaccine, and what does that timeline look like? As a public health official, how do you get that out to hundreds of millions of people? We seem to have a problem with just getting testing out there. How does that affect the situation?

Dr. Preeti Malani: These are the big questions on all of our minds and I appreciate you asking. I’m actually pretty hopeful about an effective, safe and effective vaccine. This is something that normally would take years. But, there’s been a very deep, coordinated campaign — a very big effort. Not just with pharmaceutical companies, small or big biotech, but also the government. This is where the NIH has been central as well as BARDA. There’s been money given to companies to really help speed this process. And we’re one of the sites for the Astrazeneca vaccine. This is one that came out of England. It showed great results with the early studies. And so we’re going to be one of the places, hopefully, that’ll help contribute to this.

With vaccines, initially you start with safety and what we call immunogenicity. Do you produce the kind of response that you would want to see that, at least in the lab, can protect against infection? We’ve also seen some evidence in non-human primates. So the question is, is it going to work in humans? What you need to see to get approval is actually elimination or decrease in infections — that’s complicated to do and it can take a long time. This isn’t just a quick process of: you developed an antibody so we can move forward with it. The vaccine needs to show immunogenicity and actually show a difference in acquisitions of new infections. I imagine that the vaccine is not going to be like a measles vaccine, where you have very, very high vaccine efficacy, but more like a flu vaccine where you help eliminate the most severe cases such as death and hospitalizations. 

And then, Kevin, your point is well taken. Let’s say, in November, December we do get good results from one of the many vaccines that’s been moved forward. So one of the good things here is that I’m talking to people who are in Business & Finance. It’s sort of like hedging your bets. This idea that you’re moving several vaccines forward at the same time hoping that one or two of them is going to end up being successful. And then the question is, how do you distribute hundreds of millions of doses? Those doses are being made now at risk with the idea that when there’s approval, you can’t wait another six months for vaccines to be developed. And, there are thoughtful people from industrial engineering and from urban planning and other places who are really thinking about how to distribute the vaccine. I believe that a lot of it will vary by state, just like testing. But, because we actually have some time now, we really need to think about how to distribute this because nothing like this has ever been done.

Kevin Hegarty: Well, I did not realize that we were part of the testing of the drug that you mentioned. And it’s another pride point. I think that we can all feel very proud that we’re all working to support an organization whose research has actual application and is hopefully going to prove to be beneficial to the rest of the world. Dr. Malani and I sat through a presentation yesterday by our own Dean Alec D. Gallimore of the School of Engineering. The School of Engineering has been front and center in working with Steve Dolen and his group in modeling how vapor that we expel as human beings, when we breathe, cough, etc. are dispersed on a bus when thinking about how we can keep people on buses and our driver safe. It’s absolutely fascinating to see what they’ve come up with and how they apply their expertise to real world situations that could benefit not just the University of Michigan, but any of the transit systems throughout the world. So I know Preeti and I enjoyed that presentation yesterday, as did the rest of the COVID lead team. 

I know something that is a keen interest to you, and all of us, is the whole idea of health inequities. I was astounded when the death rates in Detroit started to emerge. It’s just one example of what appeared to be inequities that result in these kinds of situations. Why are some populations more at risk and others? Why do we see those sorts of things? And, as not only human beings but people that work at the University of Michigan, what do you feel we can do to help address these kinds of inequities, to the extent you feel that they exist?

Dr. Preeti Malani: Now, this is one of the many big questions. The United States is interesting because compared to a lot of the world, and really, the entire developed world, we have a huge number of people that lack health insurance and lack access to health care. And, we’re not a healthy country as a whole. We have a lot of medically frail people and that’s a complicated issue in terms of why we’re like that and what we can do. But one thing that’s been really clear with COVID is that there are certain groups that have increased risk for poor outcomes. And although this is a new illness and it’s still not fully understood, I would say age has come out as one of the biggest factors. It’s been a consistent factor, certainly for hospitalization and death. Other chronic health issues have also been linked for outcomes like diabetes, heart disease, obesity. We’ve seen large disparities in race, including in the state of Michigan. If you look at the portion of African Americans in our state versus the ones who have died. It’s many, many fold beyond what you should ever think about seeing. So, there’s something there, whether it’s genetics, environment, long standing health issues, or the type of work that people are doing. 

A lot of the people exposed early on were essential workers. Working on the front line, we saw this at our university as well. So, if this is a complex issue, it requires complex thought to address it. From the standpoint of the university, there’s a lot of work that is being done around issues of health equity. We have good benefits and good programs here, but they’re not used equally and that’s been something that has been deeply interesting to me. I’ve talked to Kevin about that — you know I’ve mentioned things like paid time off to make sure that people go and get a health maintenance exam. That’s something that maybe you or I don’t think twice about. But people who are busy, who maybe don’t even have a doctor — we can do some basic things to make sure that people are connected. One of the things I’ve asked some of my colleagues in HR and Benefits to help with is to help with messaging. To just say, “if you got sick today, who would you call?” I think there are a good number of people who would probably go to an urgent care or go to the emergency department because they don’t have a personal health care provider that they consider somebody that they could call. So those are things we can do. 

From the University standpoint, in terms of individual risk, we can also try to limit risk to people who fall into these high risk categories. This could be done with remote work with reassignments. For example, at the health system, we’ve had some of our older physicians who have had health issues do more virtual visits to support the Transfer Center. We can think creatively about making sure that people who do fall into these high risk categories are not put unnecessarily in a position where they’re not safe. This gets back to the issue that all of us need to share responsibility and keep this pandemic under control, because it is not equal in terms of who’s at risk.

Kevin Hegarty: One of the things that I’ve realized is that I came up in business at a time where the attitude was, “I don’t care if you’re well or you’re sick, you need to show up for work.” You need to be there because you need to act tough, otherwise you’re going to get left behind. It’s very clear that this is exactly the opposite of what we should be doing — some of the basic things, like those learnings, we ought to toss out the window. If you don’t feel well, you should stay at home. You are doing more to benefit the organization and your colleagues than if you were to come to work because you are not putting them in a situation where you might expose them to what’s going on. It’s very hard to break those kinds of – they’re not even habits, they’re mores or social mores that we derive a lot of satisfaction from working. It’s part of our therapy and so we’re not likely to take that away from ourselves. But, we need to realize that taking time off when we’re unwell isn’t a deduction, it’s a contribution.

Dr. Preeti Malani: I think that’s a great point. And whatever you might feel in business, it’s probably 100 fold worse in medicine. I think that we’re the worst in terms of going to work when we’re sick. This has been something that in recent years we really have worked on. And, I think it’s the same for kids going to school, or, for that matter, students going to classes at the university. We need to be making sure that people understand that if you’re not feeling well, this is a time to stay home.

Kevin Hegarty: A lot of what you’ve provided us with falls deeply along the lines of our pursuit of this whole philosophy of building a positive environment and a positive leadership environment. Taking time personally to take care of yourself, to take care of your family. Again, that’s going to make you a better, stronger, greater contributor to the organization, not a lesser contributor. Those are the kinds of things that we’ve been very focused on that happened to benefit us personally and benefit the organization. Our task as we move forward will be to meet the challenge of how we can extend these concepts across the University of Michigan enterprise. Is there anything else that we should be asking you and haven’t yet asked that weighs heavily on your mind, before we go to the open questions?

Dr. Preeti Malani: I think there’s a couple things. Thank you again for this conversation. A lot of things are on my mind right now. One thing is to understand that things are not going to go back to “normal’ quickly. It’s hard for me to say that because it’s heartbreaking. The human toll of COVID is enormous. All of us should think not just about weeks and months and when the vaccine is going to be available, but really think even longer term. And, Kevin, you noted that there are some benefits to this. There’s some silver linings. We can focus on that and really innovate around that. 

The other thing I wanted to say is that although COVID doesn’t affect everyone equally, the response to COVID also doesn’t affect everyone evenly. This is a very difficult time for families, particularly families with young children. There’s working at home, and then there’s “COVID working at home.” For people, particularly those who have young kids in the K-5 age range, especially as we’re hearing more and more school districts will not be going back to the classrooms in our state, this affects people greatly. Daycare is not available for everyone. And I think, as an enterprise, I hope we could come up with creative solutions. I know that this is a big problem and also a huge equity issue. On the academic side, this is something that we’re already seeing disparities and it is not surprising that it’s mostly women that do end up being affected with the childcare issues. And, there’s also caregiving issues on the other end where people have to try to travel and take care of family members who need their help. So, this is an enormously stressful time for people.

Kevin Hegarty: Well, thank you for sharing that. I think with that, Dyan, I know we’ve got a number of people that have submitted questions. Could you take us through those questions, or one of the time?

Dyan Jenkins Ali: Good morning, Preeti. It was very refreshing to hear these answers. Again, I am always amazed at your knowledge and depth of involvement. So again, I thank you for joining us. We do have a couple questions that have been asked in the chat. This question is from Julia: there seems to be emerging research indicating that young children are actually quite efficient spreaders of the virus which is contrary to what researchers have indicated, until now. How might this new information impact children on campus and the work of the children centers?

Dr. Preeti Malani: Every day there’s something new. Again, a lot of this is based on studies, small studies or studies from around the world. Initially, the thought was that kids didn’t get the virus at all. Now the thought is that they actually get it but they manage it okay. But some kids get sick and we still don’t fully understand. In terms of the Children’s Centers, one of the other successes is that they are open. It’s important that daycares are open and we can learn a lot from daycares. These are essential activities for all the reasons I mentioned and others. For example, people working in the health system need child care. So, what are we learning so far is that we’re doing okay with the Children’s Centers. They’re using smaller groups and are trying to keep people in what I like to call “social pods.” Part of that is so that if there is spread you’re spreading to fewer people. I actually give the same advice to my own kids, the idea of staying within your group. I have one kid who’s a student at University of Michigan. It makes it harder if you’re in a middle school and you’re moving from class to class, but the thought is that the younger kids probably are able to spread this efficiently. So we just need to learn more. It’s one of the unknowns, I don’t think it changes anything at this moment. Stay home if you’re sick and wear a mask. Young kids can’t mask, but people who work with them can, and that does offer some protection. Wash your hands, keep the environment clean and try to limit numbers. 

Dyan Jenkins Ali: Excellent. A question from Kelly: can you explain how the statistic for the number of people who have recovered from COVID-19 is determined? What is the basis for being considered ‘recovered’?

Dr. Preeti Malani: I actually don’t know. I actually look at that statistic very carefully. Patients who are recovered and deaths don’t add up to the total number. There’s people in between. In general, what we think of as recovery is usually 10 days after the onset of symptoms, and a resolution of fevers without any medication to reduce fevers. There are some people that end up lingering, they have coughs and fatigue or sometimes they have shortness of breath that lingers. But, I actually don’t know how that’s determined, but I look at it with interest. I can inquire and find out. 

Dyan Jenkins Ali: Great, and sort of tied to that is the question from Lisa: can you speak more about the current understanding of COVID-19 on long term health of survivors and non symptomatic carriers?

Dr. Preeti Malani: Yeah, that’s unknown. I would say we have six months of data total, maybe seven months if you include the early cases in China, but our entire understanding of this disease is based on a really small amount of time. So, we don’t know. I will say that we don’t understand the denominator, we don’t know how many people had very mild infections and no consequences. We also don’t understand immunity. I’ll probably get a question on that, whether that’s a long standing or it’s short term. The advice is to act like you can get it again, although that doesn’t fit with most infections. We just don’t understand it. There are individuals, including young healthy people who end up with some long-term effects, particularly with heart issues and lung issues. But, it may be that we’re just picking out the exceptions. I think we just don’t know. I will say at a personal level, I do take precautions to make sure I don’t get this because it worries me. But there are also people who probably do just fine with it. And again, this is one of the things that l will know more about in the months to come.

Dyan Jenkins Ali: Excellent. A question from Frank: is there a reason why the U.S. is seeing COVID-19 impact our population greater than the population of other countries? Could this be related to the fact that we are testing more of the population of other countries?

Dr. Preeti Malani: The U.S. is seeing more cases. Testing picks up more cases but testing does not account for the differences that we’re seeing. Part of it is that the United States is like 50 countries and there are certain states where the caseload is a lot higher than others. There are states where COVID is not a major issue. These tend to be the sparsely populated places. And, there are places that have done a lot to contain COVID. California is a good example, but it’s still burning out of control. And some of this has to do with the density of people. It has to do with the cost of housing. It has to do with the kind of ways that we live. It also has to do with people’s willingness to do the mitigation strategies. I think we’re a little different in different parts of this country, but it is not only testing that has made the difference. It is clearly a lack of good mitigation in some places.

Dyan Jenkins Ali: Excellent. We talked about the flu in various aspects and I know that the dissemination is going to be sort of a massive undertaking. So the question from Felicia is: how will the regular flu vaccine be disseminated in this COVID 19 environment?

Dr. Preeti Malani: That’s a good question. One of the things that we’ll need to do is make sure we start early and offer more opportunities to get vaccinated because there are issues in terms of turnaround time, PPE, and protecting people coming in and out. But, we’ve gotten used to a lot of those things. This has become our new normal. And we have people to help distribute the flu vaccine. We should have plenty of flu vaccines. So I suspect it will be done in big wide open places. It might even be done outdoors., if the weather permits. Part of this is trying to decrease density, but it’s also trying to be reasonable and practical on campus. The Unions will probably be sites to get vaccines and obviously the health system has its own distribution system with this.

Kevin Hegarty: I must add too that, even pre-COVID, Preeti and I have been strong advocates for getting your vaccinations. Both students as well as staff. And so, my advice as a non-doctor, but I think Preeti would agree, if a vaccine should exist and you need your shots, get your shots. It’s not worth getting the disease. Flu, in particular. I know flu vaccine has been more controversial to some than others. As a finance person, putting a vaccine out there where you’re somewhat more guessing as to the strains and trying to prevent those, from an economic perspective is less efficient, but this is not an economic issue. This is a public health issue. This is a personal issue. 

I know we’re just about out of time, Dy. Do we have time for one question?

Dyan Jenkins Ali: She’s been efficient with these answers, so I’m going to throw one more at her. What are the top three to five most important messages we here on this call can deliver, to be consistent and align with the university messaging, to our staff that we manage, to the community, to our personal friends and family? What are the top important messages we can deliver to be consistent and align with the University?

Dr. Preeti Malani: Number one would be to follow the public health guidance. That covers many messages. Number two would be this is a marathon, this is not a sprint, so be good to yourself. And number three, be kind to everyone around you because this is extraordinarily hard.

Kevin Hegarty: Very good. And I think the last point is one that I think just speaks volumes about who Preeti is and how fortunate we are all at the University of Michigan, as well as personally, to have her front and center in guiding discussions around these kinds of issues. The thing I appreciate most about Preeti is while she’s a very noted scientist and researcher and understands her stuff, she makes sure that the discussions around the table are not from a particular orientation. Meaning the academic side, or the medical side, or from the perspective of faculty or staff or students. It’s about us and it’s about us as a community, us as human beings looking after each other and caring about each other. Being kind to each other. So, I thank you so much — you were not only sharing your time, but sharing your very personal time today. I really appreciate that. Thank you so much for joining us.

Dr. Preeti Malani: Thank you. It’s my pleasure. And thank you, everyone, for what you’re doing.