By SUSAN JONES
Prior to 2020, John Williams was plenty busy with his multiple jobs as professor of pediatrics and pediatric immunology and chief of the Division of Infectious Diseases in Pitt’s School of Medicine; chief of pediatric infectious diseases at Children’s Hospital of Pittsburgh; and director of the Institute of Infection, Inflammation, & Immunity in Children.
Little did he know what was ahead when he was tapped by the University in summer 2020 to serve on the Healthcare Advisory Group and to head Pitt’s COVID-19 Medical Response Office (CMRO), which oversees the implementation of virus monitoring on all five Pitt campuses.
“I never envisioned myself as being involved in this all-of-the-university endeavor and being involved with classrooms and dining halls and gyms and dorms,” said Williams, who stepped back from his CMRO role this summer after two years as the face of Pitt’s pandemic response.
In singling out the CMRO this spring for a Special Chancellor’s Distinguished Service Award, Chancellor Patrick Gallagher said: “The CMRO has equipped our University with the tools to safely navigate a pandemic while maintaining — and advancing — our academic mission.”
Williams said they have a paper about the “Pitt approach” that has been accepted but not published yet in the Journal of American College Health. The Pitt approach was right-sized and thought out so that it was successful without being excessive, he said, and hopes this paper will help those facing the next pandemic. “It will be a blueprint for the field to say here’s an approach that worked well. Did it make everybody happy? No, you can never make everybody happy. But it did make the greatest number of people happy while having a high rate of success and keeping the campus open.”
Throughout the past two years, Williams has credited all of the CMRO team for its good work. Taking over for him is Joe Suyama, associate professor in Pitt’s Department of Emergency Medicine and chief of emergency medicine services at Magee-Womens Hospital of UPMC, who has served on the CMRO since its inception.
Williams is ready to get back to his primary work and some “research papers that have been waiting two years to get finished and submitted or resubmitted to journals.” But he’s still an “on-call consultant” for the CMRO as needed.
Williams talked to the University Times recently about how Pitt has handled the pandemic and what comes next.
Rating how Pitt did during the pandemic
Williams admits his bias, but says, “I would give Pitt an A, because I think Pitt did four things that were really critical to having an effective response and I would say as good as possible response. There is no perfect response to a pandemic, given that none of us had a magic wand to wave.”
Those four things included:
Follow CDC guidelines. “The guidelines weren’t perfect, but they were the best source that we had. And this is what I do as a doctor. We try to follow the evidence as best we can.”
Take a very middle of the road, consider-all-aspects approach. “We saw in many of our peer institutions around the country two extremes. Some schools were like, ‘We’re shut down, we’re staying shut down.’ And we all know that has profound impacts on students’ mental health and socialization and educational quality. The other extreme is business as usual, everything wide open, no masks, no mitigation. That didn’t go so well either and led to serious illnesses and deaths. And I think Pitt did a really good job of trying to consider all those things — we have to be safe, but we have to be open. We are here for the students.”
Get lots of people involved. No one person or group were the sole decision makers. Williams said an advisory group with students, faculty and staff helped the CMRO, including people from Student Health, Student Affairs, Facilities, Environmental Health, sociology and economics. “It wasn’t solely a star committee of administrative people who have one viewpoint. And it wasn’t a committee solely of scientists or doctors who have another viewpoint,” he said. “And I think Pitt did a really good job at bringing all those different people to the table.” For example, he said, the CMRO had some ideas about mitigation in the dining halls and dorms that were either completely impractical or would be incredibly disruptive to students. “The collegial environment, allowed our partners in those areas to say that’s not really going to work. What else can we do?”
Trust the students. “The students were the most critical partners. Instead of treating the students like a bunch of miscreants and rebels, we had to clamp down and have all these rules and enforce all the time, we treated them as responsible adults, the vast majority of whom we believed would do the right things. And they did.”
He admits there were small groups of students who were irresponsible and had unmasked gatherings, but anytime the COVID-19 numbers started going the wrong way, the University said, “Let’s work together to get back on track, and every single time the students did it. I give the greatest credit to the Pitt student body.”
“We communicated very actively with the students in real time — ‘Hey, y’all, numbers are going up. And we hear there’s partying going on, please rein it in before things get out of control,” and the students did it.”
Williams said weekly communications from the CMRO had an email open rate of nearly 80 percent, which is highly unusual. “We tried very hard to approach the students in those communications as adults, not shaking our finger, not lecturing, but just saying, we’re all in this together.”
What challenges did Pitt face?
Williams said Pitt and almost all of its peer institutions struggled early on with getting enough testing resources. “And there were other times during the pandemic, where we really hit a testing capacity crunch.”
Williams also noted that all universities were dealing with finite resources. “There were times during the pandemic, a couple of institutions around the country, … invested literally tens of millions of dollars to test every student. Boston University dedicated an entire building, … and they bought dozens of machines and spent tens of millions of dollars and tested everybody every week.” Some people asked why Pitt wasn’t doing the same thing. “Because of everything that I just told you about our approach, the holistic approach, the guidelines approach, the measured approach and trusting our students as partners, Pitt had as good an outcome as these institutions that spent literally 10 to 100 times the resources.”
So why does that matter? “Every million dollars that you spend on testing every student every week, number one, that’s not preventing infections. That’s finding infections that you failed to prevent. And we worked on prevention by communicating with the students.” The other factor is that money spent on testing every student every week, “that’s a million bucks that you don’t have to hire another teacher, or hire another counselor or renovate a dorm or build a new gym or any of the things that you might like to do as an institution.”
Where do we go now?
The pandemic helped break down some of the silos at Pitt, Williams said. “Student life and academics are both super important, and yet they don’t necessarily always engage as much. From the pandemic, a lot of people made those connections in a very practical, working together, hands-on way. And I think that will strengthen the University as an educational institution.”
Williams thinks that whatever the next major challenge is — another pandemic, a vast change in funding, an attack on higher education — “we’re a lot better poised to meet that because of these connections that have been made all over the University.”
He also hopes we’ll hold onto some of the social courtesy of being careful in shared spaces to help not spread disease.
“I think the Pitt community demonstrated that at a very high level, and I hope that continues.”
Williams said he received hundreds of emails from people over the past two years complaining about different pandemic policies, such as masking or not masking, “The vast majority of those emails that we got at the CMRO, even if they were very strong in their feelings, they were virtually all polite, professional, courteous.”
Is getting booster vaccines still important?
Our immune system doesn’t make lifelong sterilizing immunity to respiratory viruses like SARS-CoV-2, the way it does for measles, Williams said. “But the rule for these viruses, not the exception, is that we get reinfected periodically.
“But our immunity from vaccine or prior infection is very effective at reducing the risk of severe disease. So we’re much less likely to get seriously ill. Even for otherwise healthy young people who probably aren’t going to get all that sick anyway, having immunity from a vaccine or a booster shortens the period that they’re sick and that they’re contagious.
“And if you care about people around you — and we all have vulnerable people in our lives that we care about — our chance of giving COVID to those people is much lower with vaccines and boosters.”
What about flu season?
Williams suggestion is to get a flu shot as soon as possible, because health officials have already seen the influenza virus in the area even though it usually doesn’t show up until late November or December.
“I think there’s two bright spots that could help us have a not terrible flu season,” he said. “One is that all evidence so far from the Southern Hemisphere suggests that the vaccine is a good match. … The other thing is … the sort of social masking behavior that we should keep — not universal, but situational. If you’re still sick, stay at home for a day or two and then wear a mask for a few days when you come back out. I mean, give the rest of us some courtesy.
“If you’re worried about getting sick for any reason — you yourself have high risk conditions or you have a final next week and you don’t want to be sick or you’re going home and visiting grandma at Thanksgiving — protect yourself and just wear a mask for the week before that important event.”
Susan Jones is editor of the University Times. Reach her at suejones@pitt.edu or 724-244-4042.
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