Dear Duke: More Transparency Please

So many people at Duke University (including the Health System that the University owns) have and are continuing to work so hard to address the SARS COV 2 pandemic. The Duke University Health System (DUHS) has remade myriad care delivery processes in real time while caring for Durham and the State, and demonstrated that it can be done safely for workers.

The unprecedented shut down of the Duke University lab facilities and research buildings, and the reopening of same in rolling fashion over the last 6 weeks has been a herculean effort, and there is internal evidence that has been described to me that shows this has been managed without much, if any, transmission of SARS COV 2 in Duke research buildings (there have been cases, but they have been traced to community contacts in virtually every case, as described to me).

In less than 6 weeks, the first year students are set to return to campus, and there has been so much planning, and there are so many plans. Everyone is exhausted. When I review the plans, and since I know about the Health System and research building success in controlling the spread of SARS COV 2 I think “maybe that can work.” And then I think of my 19 year old son who will be a sophomore at another University in the Fall.

I am skeptical, but willing to listen and hear my faculty colleagues with expertise, talk.

To my many exhausted Administrator colleagues who are also my friends, I have a simple plea: broaden the discussion about what we do in the Fall by being fully transparent about the data that Duke has gleaned from our health care delivery and reopening of research lab experience about preventing the spread of SARS COV 2.

And then lets be a University and talk publicly about what the data means, thereby allowing Duke’s leaders to make a fully informed decision after hearing what the faculty and staff think about our plans. Several questions are at the top of my mind:

What type of testing program should we have for students, staff and faculty? The CDC currently says widespread testing is not required for students, faculty or staff for reopening a University, but their credibility has been greatly shaken by their performance in the pandemic (Duke has committed to testing students once, when they return to school) and the politicization of the issue. I have recently begun working with a handful of infectious disease physicians at Duke as we have written research grants to address SARS COV 2. The most surprising insight for me is the disagreement among infectious disease physicians at Duke about the efficacy of widespread testing. And most say after giving their opinion that no one really knows. I want to hear this conversation in public, and in writing from our Faculty colleagues who are the most expert in this field. Communicating uncertainty is at the heart of being a scholar, so no one expects perfect predictions. The disagreement of experts is at least part of the point.

What epidemiological model(s) of SARS COV 2 spread at Duke University and in Durham, N.C. is being used to simulate different scenarios to plan for the Fall semester? I would like to hear from my Faculty colleagues with expertise on this matter as well.

What are the behavioral assumptions/evidence that Duke is using to extrapolate the success that Duke has had in preventing transmission to and among health care and lab workers to undergraduate students? The experience of football teams nationally with SARS COV 2 transmission is troubling; I assume football teams will be more closely controlled than a general student population will be. Duke has not brought any student athletes back, so we have no direct evidence on this front.

Finally, Duke should commit to publicly dash-boarding the key items of evidence that are informing our decisions. This can easily be done in a HIPPA-compliant manner that protects individual privacy, and is the essence of knowledge in the service of society.

I do not write this with a spirit of attack, though I know from being a leader at Duke that in the midst of a crisis it can feel that way, and I am sorry if it does. What I am saying is let us reason together and then decide.

About Don Taylor
Professor of Public Policy (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute), and Chair of the Academic Council at Duke University https://academiccouncil.duke.edu/ . I am one of the founding faculty of the Margolis Center for Health Policy. My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

3 Responses to Dear Duke: More Transparency Please

  1. Dawn Gross says:

    Your clarity and thoughtful questions are deeply appreciated well beyond Durham, N.C.

    Naming uncertainty is critical. Being transparent builds trust. Together, they create a practice of agility and innovation. Isn’t that at the very heart of higher education?

  2. Pingback: Duke releases COVID19 testing for athletes-what does it mean? | freeforall

  3. Pingback: Duke releases COVID19 testing for athletes-what does it mean? – Health Econ Bot

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