Working with departments across the University, Brown’s student-facing health care providers developed innovative ways to provide COVID-19 care while protecting the broader community from the infectious disease.
PROVIDENCE, R.I. [Brown University] — In the 15 months since the first COVID-19 cases were identified in Rhode Island, members of the Brown community have worked in tireless collaboration to protect the health of those who live, work or study at the University and in the adjacent Providence neighborhoods.
While those efforts — from establishing a campus COVID-19 testing program to orchestrating socially distanced moves and meal pickups to designing online and hybrid courses — have called on the full University to adapt creatively to an ever-fluctuating public health situation, staff in Brown’s Health and Wellness departments have been among those most directly responsible for maintaining students’ well-being. For example, BWell — Brown’s health promotion program — co-launched a campus-wide public health campaign, while Counseling and Psychological Services (CAPS) increased outreach efforts during a time when the pandemic has caused an increase nationally in mental health concerns among young people.
But for Health Services — the department within Health and Wellness that delivers medical care to students — the pandemic demanded an immediate, complete shift in priorities and procedures. Its physicians, nurses and administrative staff devised ways to provide care for students with COVID-19 and protect the broader campus population from exposure to the infectious disease, all while continuing to address the many other health needs typically arising among students.
To meet the most immediate challenges at the outset of the pandemic, Health Services needed to address two spheres of concern, said Dr. Adam Pallant, the department’s clinical director. The first — managing the health care needs of ill and potentially exposed students — was self-evident. But COVID-19’s infectiousness also required that the University quickly establish an approach for effectively isolating ill or exposed students and supporting them while in isolation, he said.
“We found ourselves asking: ‘How will we take care of the basic needs of students who are ill or in quarantine?’” Pallant said. “Who will feed them, where will they stay, and what will happen if their laptop dies or they run out of toilet paper?’”
“Health Services, EMS and their collaborators have adapted to constant changes and new challenges while keeping up with the drumbeat, every day, of managing and treating the virus within the Brown community. It’s an extraordinary feat how staff have worked together to set up these many systems to work in concert with each other — like an intricate ballet being orchestrated behind the scenes.”
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To address these concerns, Health Services worked with Brown leaders to mobilize a tight network of campus collaborators to ensure that the health needs of the entire student population were met. And the steady commitment and ongoing adaptability of Health Services and its campus partners have been at the heart of Brown’s successful efforts to manage the pandemic on campus during the 2020–21 academic year, said Dr. Vanessa Britto, who leads the department as associate vice president for health and wellness at Brown.
“Health Services, EMS and their collaborators have adapted to constant changes and new challenges while keeping up with the drumbeat, every day, of managing and treating the virus within the Brown community,” Britto said. “It’s an extraordinary feat how staff have worked together to set up these many systems to work in concert with each other — like an intricate ballet being orchestrated behind the scenes.”
Providing quality care with public health in mind
Shortly after the first COVID-19 cases were detected in Rhode Island in March 2020, Brown required that all students, except those facing exceptional circumstances, return home for the remainder of the semester. With the student population strictly limited for those initial months, a key priority for Health Services was devising a system for identifying, isolating and treating infected and exposed students.
As its first order of business, the department quickly set out to create a space on campus where they could safely test and provide care to students with COVID-19 symptoms, Pallant said.
“To manage the health and safety of all students on campus, we needed a place where we could isolate students from the moment they flipped the switch from ‘well’ to ‘might be sick,’” he said.
The team chose Minden Hall, a residence hall on Waterman Street that was a hotel before being converted to campus housing in 2002. Its living space — which includes private bathrooms and many single rooms — offered the opportunity to house infected or exposed students (living on alternating floors) in a space where they would be easily isolated. Because the building’s spacious lobby provided an ideal location to create a clinical annex, the students isolating or quarantining in the residence hall could be tested and treated while remaining isolated from those without COVID-19 diagnoses or exposure.
To ready Minden for its new purpose, the University replaced old furniture with easy-to-clean plastic furniture, installed new lighting appropriate for a medical care facility, and added a negative pressure flow system to continually cycle out the air in the lobby. The new space was ready, Pallant said, in a matter of weeks, and opened at the start of the Fall 2020 term.
“The space works, and it works amazingly well,” Pallant said.
The next priority was establishing a way to identify students infected with or exposed to COVID-19. By the summer, a pilot COVID-19 asymptomatic testing program was identifying students who tested positive for the virus, but a system needed to be established to identify others who may have been exposed before the infected student tested positive.
The nursing staff at Health Services took the lead. Last summer, all nine members of the unit — as well as nearly a dozen staff members from other offices, including University Human Resources and Athletics — became certified COVID-19 contact tracers through a program run by Johns Hopkins University. They also completed the contract tracing training offered through the Rhode Island Department of Health. The team has served as the University’s primary student contact tracers since Fall 2020, with trained staff from other divisions on standby.
The nursing team has also provided health care support for diagnosed students and their close contacts during their isolation or quarantine periods — monitoring their symptoms daily and conducting follow-up check-ins for students in need of support — while continuing to meet the needs of students who visit Health Services with ailments unrelated to COVID-19.
“The greatest challenge has been how fluid the response has been,” said Christine Benvie, director of nursing. “Every day is a new adventure, and the landscape is ever-changing. We never knew from one day to the next what the caseload would be, so we have really learned how to anticipate what may happen on a given day and pivot our focus as needed.”
Creating a campus-wide support network
The immediate need to identify, contain and treat COVID-19 infections on campus has been at the center of Health Services’ pandemic response since day one. But this critical work would have been impossible without close, constant collaboration between the physicians, nurses and administrators in the department and a wide range of other teams — including Emergency Medical Services (EMS), Student Support Services, Computing and Information Services (CIS), Dining Services, Facilities Management, Residential Life, the College and others.
Many of those units met daily during Summer 2020, when they worked to establish the systems that would keep Brown’s student community safe during the 2020–21 academic year. They continued to meet several mornings a week — increasing the time commitment as needs arose — for the duration of the fall and spring terms.
“We are in constant communication with each other about clinical care, systems and supplies — all of the stuff we need to do the work we’re doing,” said Tanya Sullivan, assistant clinical director of Health Services. “At this point, it feels synergistic.”
As Health Services began identifying and preparing spaces for infected and potentially exposed students, they soon faced a new question: How would the University meet the day-to-day needs — including meals, basic health and hygiene supplies — of the students in these spaces, while maintaining their isolation or quarantine restrictions?
EMS took the lead. While a handful of emergency medical technicians continued to answer emergency calls, many of the team’s approximately 40 undergraduate EMTs temporarily shifted responsibilities to manage isolation and quarantine housing.
In this new capacity, students have been critical to keeping Brown’s isolation and quarantine spaces operational. Since December, the EMS FLY car — a small medical transport vehicle traditionally used to respond to lower-risk health emergencies, such as calls for basic first aid care — has been dedicated to transporting students infected or potentially exposed to COVID to the spaces. The EMS staff who have participated in these runs wear full PPE, and the car itself has been outfitted with plexiglass between the driver — a non-student staff member — and passenger areas, with seats covered with disposable sheets that are changed between passengers.
Student EMS staff have also prepared rooms for students entering isolation or quarantine and delivered meals and other necessary supplies — from computer chargers to toilet paper and tissues — to on-campus students in quarantine, as well as off-campus students in quarantine who have requested meal delivery or emergency services. With a logistics van on loan from the Haffenreffer Museum, they will continue to provide through the current summer term.
The comfort levels of each EMS member have been taken into careful consideration when refocusing their role to support the campus-wide COVID-19 effort, said Amy Sanderson, director of emergency management for Health and Wellness. Before beginning, students were asked to have conversations with their families and podmates about their relative risk tolerance. Each was required to disclose their comfort level, with students with lower risk thresholds then assigned contactless tasks, like supply runs.
“We spent a lot of time thinking about how to use our staff optimally while making sure each person was contributing to the effort in way that was comfortable to them and their families,” she said.
EMS collaborated closely with an array of offices to successfully manage the isolation and quarantine spaces. Facilities Management and Residential Life have helped to manage the inventory of available rooms. Dining Services staff have prepared three to-go meals each day for EMS to deliver to students in isolation.
To help orchestrate these intricate collaborations, CIS worked with Google-MTX to design and implement a temporary resource management system — dubbed TRM — that allowed each of these units to keep up-to-the-minute records of which students were in isolation and quarantine and to coordinate transportation, room preparation and meal delivery.
While some elements of TRM resemble those used by hotels to manage room turnover, CIS customized the application, with input from Health Services and EMS, to meet the unique needs arising from housing infected and exposed COVID-19 students on a college campus. That customization, Sullivan said, was “a tremendous gift.”
“The fact that TRM was built and designed by us made the work we did possible,” she said. “We could not have housed the students and provided clinical care and ancillary support to them without that system.”
Close collaboration with colleagues outside of Health Services has also helped to keep the campus’s symptomatic and quarantine testing programs — which are run through the clinical annex at Minden Hall — running smoothly and safely. As assistant director of operations and administration in Health Services, Kristie Sullivan has worked closely with Tim Shiner, director of student services, to orchestrate students’ moves from the campus-wide testing program to the Minden annex program, and then back into the campus-wide program once they can safely reintegrate.
“Health care really is holistic — it is mind and body and experience and environment — and we’ve really had to use all of those aspects to do our best to keep each other and our students healthy during the pandemic. I hope and expect that this won’t go away when COVID-19 does.”
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These collaborations, both among Health and Wellness divisions and across the University more broadly, were critical to the success of Health Service’s pandemic response, Sullivan said.
“The pandemic has pushed us all to a new level of collaboration in order to make sure that our campus and its students are safe,” she said. “Not everyone has the skills or the background to take care of every challenge. You need a team.”
Pallant agreed. “It really has been about adaptability and sharing the work and burden and joy with others,” he said. “This can’t be solo work — it just couldn’t function that way.”
A lasting impact on health services
As the number of vaccinated Rhode Islander continues to rise and COVID-19 cases decrease, the pandemic that has affected all aspects of student life at Brown for the past 15 months appears to be entering a more manageable phase — there have been no positive COVID-19 tests among students on Brown’s campus since mid-May. But the innovative health care and support services that Health Services provided in tandem with its University partners will have a lasting impact on student health care at Brown.
For Benvie, the systems and procedures developed as part of the pandemic response — from the adoption of telehealth appointments to the deepened working relationships between Health Services and its collaborators — provide a valuable blueprint for future public health challenges that may arise.
“We’ve laid a great foundation for improving our campus-wide response to a pandemic,” she said. “Once the rush has passed, it will be helpful to revisit everything we have accomplished and formalize our campus procedures for managing such an event. I don’t even think we have an inkling yet of all that we have learned from this.”
These deepened collaborative relationships will also prove valuable post-pandemic during a wide range of situations in which multiple units are called upon to address a student’s needs, Sanderson said.
“From an EMS standpoint, having had the opportunity to build communication across these departments will allow us to approach even day-to-day situations that have nothing to do with COVID-19 from a team standpoint,” she said. “I’m so glad we have these relationships now, so that if someone has a need, we can come together to meet it as efficiently as possible.”
On a broader scale, the innovative and integrated approaches that Health Services has developed during the pandemic have foregrounded the importance of taking a holistic approach to student health and well-being, Pallant said.
“Health care really is holistic — it is mind and body and experience and environment — and we’ve really had to use all of those aspects to do our best to keep each other and our students healthy during the pandemic,” he said. “I hope and expect that this won’t go away when COVID-19 does.”
According to Britto, that holistic approach to student care embodies the spirit of the University’s new health and wellness center and residence hall, which opened its doors to its first student residents at the start of the Summer 2021 term. In the fall, the building will bring together in the same space services and programs instrumental to students’ physical and emotional well-being — including Health Services, CAPS, Brown EMS and BWell.
“I can’t think of a better expression of what an amazing group of people we have — and how committed they are to offering this high level of integrated care and support to students,” she said. “We’re excited to pour all of their great work into our new building.”
For the staff of Health Services, it will be a welcome culmination to the 15 months spent addressing the continuously changing health priorities arising from the pandemic, Britto said.
“They have adapted constantly to new challenges while keeping up with the drumbeat, every day, of managing and treating the virus within the Brown community — all while continuing to coordinate the everyday student health needs that have continued to need attention over the course of the year,” she said. “And they have done all of this while carrying the emotional weight of keeping our campus safe during a pandemic. If you have to go through something like this, these are the people you want to go through it with.”
Correction: An earlier version of this article suggested that student EMS were involved in transporting students to quarantine and isolation. These transfers were executed solely by non-student EMS staff.