Veteran epidemiologist and ethicist is fearful university leaders have not learned vital lessons from last year
As students return for the fall semester at UNC-Chapel Hill Wednesday, Dr. Jim Thomas is having a sense of déjà vu.
“I’m very uneasy about what I’m seeing,” said Thomas, a professor emeritus in the Epidemiology Department at the Gillings School of Global Public Health. “Or what I’m seeing again.”
Once again, students are returning to classes and dorms in the middle of a surge of COVID-19 infections, this time driven by the more virulent and dangerous Delta variant.
Though 86% of students and 78% of faculty and staff have attested to being vaccinated, the university is not requiring verification.
Last week, the day before students began moving in, the school announced a cluster of six infections related to an event at the Eshelman School of Pharmacy. The announcement came as Chancellor Kevin Guskiewicz was telling a skeptical Faculty Executive Committee he believes the school is taking the needed precautions to navigate the return to campus safely.
The campus community heard similar talk from Guskiewicz last fall. In the first week back, the campus was overwhelmed with so many clusters of infections students were sent home and instruction was moved largely online.
This time, Guskiewicz told faculty, there is no plan for a similar “off-ramp.”
With more than 100 students and employees testing positive so far this month, faculty members this week launched a petition to move classes online for 4-6 weeks. Nearly 500 have signed, as of Wednesday.
It seems, however, to have had little impact on the leadership of the campus or the UNC System.
That’s disappointing, Thomas said. But no longer surprising.
The third pandemic in a distinguished career
Last year, Thomas postponed his retirement to be at Chapel Hill as it struggled with how to react to the pandemic. He figured the university could use his expertise.
“COVID is the third pandemic I have been a part of,” Thomas said.
The first was HIV/AIDS. Thomas got his Ph.D at UCLA, where he was trained in outbreak investigation and epidemic control. While working for the Los Angeles County Health Department doing outbreak investigation, he was part of the team that created HIV surveillance in Los Angeles.
The second was H1N1, an influenza epidemic that threatened to spread worldwide. During his three-year stint as ethics advisor to the head of the Centers for Disease Control and Prevention, epidemiologists braced for what they feared could be another pandemic similar to the one that killed as many as 50 million people in 1918-’19.
Thankfully, Thomas said, H1N1 was not that pandemic. But it did lead to further work in creating frameworks of ethics for pandemics – including work with the World Health Organization.
When COVID-19 proved to be the pandemic epidemiologists had long feared, Thomas decided retirement could wait. He had worked in public health for 40 years, across 35 countries. Surely UNC would need his expertise.
“I figured this was a time for all hands on deck,” Thomas said.
Pandemic ethics, Thomas’s area of expertise, is about more than measuring or tracing infectious disease. It’s about finding solutions to public health crises that are not just politically palatable but morally defensible.
As Thomas learned, however, most of those in power – from the federal government to the UNC System, down to campus leadership – were not interested in those discussions.
Not just a math problem to be ‘solved’
“I tell my students that often times it’s not that you find the right answer,” Thomas said. “It’s that you find a morally defensible answer. There can be a number of them. A morally defensible answer often comes from a process in which numerous voices have a chance to participate. This is called procedural ethics. It’s how decisions are made. That was my principal concern at UNC. The decision making was opaque. We couldn’t see who was in the room, who carried the most weight, what were the ideas that were discarded, why they were discarded.”
It was apparent to Thomas that the Chapel Hill campus – and the UNC System as a whole – were looking at the COVID-19 pandemic as a technical problem to be solved. But a pandemic involves public health, human lives, and very difficult decisions about what is prioritized. It can’t be reduced to math, Thomas said, and can’t be fought solely with face masks, hand sanitizer and measuring tape.
Sometimes it means fundamentally rethinking how people or organizations operate in order to address a crisis and reduce further harm. But large organizations are often slow to adjust and resistant to large changes, Thomas said – particularly those subject to political and financial concerns.
Thomas was on a committee in the school of public health that looked at how to address its own measures for COVID. He was part of multiple groups advising the state government and North Carolina Institute of Medicine on questions of testing and vaccination. He was sought out by national media for interviews.
But at his own university, despite multiple faculty members explicitly urging the chancellor to bring Thomas into the school’s planning, he could not get through to the school leadership.
He was ultimately moved to write to both the UNC-Chapel Hill Board of Trustees and the UNC System Board of Governors.
“I felt that someone needed to ask them some very straightforward questions about their involvement,” Thomas said. “Because it was often said that the chancellor really had his hands tied and it was really the Board of Governors that said what was going to happen on campus. That, for example, the students were going to come back in the fall. But it was always the chancellor’s voice we heard. It was never the Board of Governors. They were silent. It was kind of like the Wizard of Oz. They were the man behind the curtain. Perhaps naively I felt they should answer to some of these things.”
Thomas got no reply from either board.
He continued to press the point, writing a series of essays on Medium that got more attention and bringing together the ethical issues at play on a website he developed called the Pandemic Ethics Dashboard.
Thomas did eventually get an audience with the chancellor. It was a pleasant conversation, he said. But it was obvious to him that the university was on rails, headed toward a full re-opening with face-to-face instruction and full capacity dorms. There was no altering that course.
“I should say that I am not wired for complaint,” Thomas said. “In fact, quite the opposite. I’m allergic. I don’t want this to come off as ‘you didn’t listen to me, this is what happened, and now I’m ticked off.’”
“But that is what happened,” he said.
Déjà vu all over again?
Now in retirement, Thomas sees it all happening again, and he’s again sharing his concerns in the hopes that this time they’ll be heard.
“The authority of the chancellor to make decisions for COVID control on the campus is unchanged since last year,” Thomas said. “This could have been adjusted for the special case of COVID over the last year, since that disconnect was so disastrous last fall.”
That’s a problem at every UNC System school, but particularly at Chapel Hill, where Guskiewicz has faced heavy criticism from leaders of the North Carolina General Assembly’s Republican majority and their political appointees on the UNC Board of Governors.
“Last year, the Chancellor appeared to be hesitant to push the BOG for permission to have the students not come to campus, or to have fewer come in order to decrease the density,” Thomas said. “This year, he appears to be hesitant to push for vaccination as a requirement, even while other colleges and universities have this requirement.”
The chancellor does have the authority to take other steps, Thomas said, but has not.
“For example, he could allow, or even encourage, more online teaching to reduce contact and transmission,” Thomas said. “It wouldn’t have to be all courses, as it was last year – just providing a greater mix of teaching modes could reduce the opportunities for transmission.”
In September, Thomas will teach a course in France. It’s intensive, so students are in class all day for two weeks. The university is dividing the students into two groups. Half will attend in-person in the mornings while the other half will watch and participate online. Then in the afternoon, they switch places.
“This cuts the density in half while preserving in-person interactions,” Thomas said. “Creative approaches like this could be promoted at UNC for classrooms, dorms, and other gatherings.”
There is also the question of who is making decisions and informed by which information and concerns.
“The key advisors to the chancellor continue to be a select few infectious disease experts,” Thomas said. “Last year, he was encouraged by the Faculty Executive Committee to add other perspectives to this select group. I respect his ID advisors, but their perspectives are limited, as is true in any profession. Those who are most familiar with the virus biology will approach the challenge as a biological one. They are less equipped to view it with the lenses of psychology, sociology, or ethics, for example.”
There also persists a sort of “toxic positivity” that has been discussed by students and faculty since before the pandemic, Thomas said. Every failure is framed as minor or even as a victory. Cluster infections overwhelmed the campus and overran its quarantine spaces last year, Thomas said. But the campus community was told that when the plan to abandon on-campus living and in-person instruction was finally implemented, it meant that the school’s “off-ramp” plan worked when it was needed.
“Similar to last year, the posture is one of determination,” Thomas said. “The narrative is ‘we have considered all of the contingencies and our plans are what they need to be.’ Last year, the circumstances under which the plans would be changed were unclear, as were the contingent plans. The same is true this year. Thus, with the determination comes a lack of transparency.”
“As with last year, there is also an unrealistic optimism that Carolina students are special and will fully comply with required practices,” Thomas said.
Last year, the concerns were crowding and masks. Students gathered for parties and fraternity and sorority rush events though they were warned not to. Anyone who has actually dealt with students could have predicted that, Thomas said. But optimism trumped reason.
“This year it is masks again – let’s not forget off-campus – and vaccination cards that are not faked,” Thomas said.
Thomas trained most of his life for dealing with pandemics. But there was something on which he and many other epidemiologists didn’t reckon.
“Nobody trained us to deal with the politics,” Thomas said. “The political context of the pandemic at the national level, of course. But also at UNC. There was and there is a political divide that makes for an un-unified country, a country that wouldn’t work together to fight the pandemic. And in fact, one half of the country was fighting the other half of the country in interpretation and direction.”
“I think at UNC we have that same sort of dynamic playing out,” Thomas said. “At the national level, the conservative element – I would say the non-scientific element – was quite vocal and loud. At the university level, it was behind the scenes, it still had that sense of powerlessness because of these political forces that we were not paying attention to.”
It’s a difficult lesson, Thomas said, and one that will likely be studied long after the current pandemic has passed.
“I hope we’re going to learn something from this,” Thomas said. “I keep hoping we’re going to learn something.”