Healthy Davis Together: A Model for Community Control of COVID-19

[MUSIC PLAYING] Welcome, everyone. You're watching Coronavirus in Context. I'm Dr. John Whyte, Chief Medical Officer at WebMD.

I bet you've heard the phrase, it takes a village. We use that for a lot of things. And when it comes to COVID, those communities, those villages, that have worked together have often had greater success.

So what do I mean by that? Well, today's guest is Dr. Brad Pollock. He's the Associate Dean for Public Health Sciences at UC Davis and has been helping to run Healthy Davis Together.

What does that all mean? Brad, thanks for joining me.

Thanks for having me, John. And I'm happy to talk a little bit about the project. So the Healthy Davis Together project that we envisioned and started planning for last summer, is a partnership between the city of Davis and the University, UC Davis.

And remind folks that aren't familiar with California where that sits.

Sure, yes, the city of Davis is actually just about 20 miles West of Sacramento. So we're pretty far up in the-- actually on the map, in the center of the state, but actually probably the northern most populous city in the state of California.

So how did this all come together?

Well, yes. Last summer, of course, we had been doing a lot of work for the campus to get ready for the fall, that's fall of 2020. And I was part of our campus ready planning process.

In addition to that, I've also been chairing the UC system's COVID-19 public health workgroup for over a year now. And so we were preparing at a system level as well to have students come back.

But in the early part of last summer, while the planning was well underway for each of the campuses, we had the idea that we wanted to do something more than that.

That if you think about a pandemic or an epidemic the borders of the campus do not define where the virus goes. And so we envision doing a kind of a comprehensive innovative project that's going to incorporate the University as well as the community surrounding it.

And really the key elements of this were to combine both epidemiologic approach, so that's doing some of the things that many other campuses were doing with testing, contact tracing, and isolation, and quarantine.

But to combine that equally with the health behavior change. So you know there's that adage that says you can't test your way out of an epidemic. Clearly testing is very important. And that was a centerpiece of our project.

But it was also trying to instill all the appropriate public health practices here to reduce transmission. So it was taking that two-pronged approach and trying to curb the infection. That was really our goal.

And also to help the city of Davis to continue to function at a high level, to return students safely back to the community, those that were away for the summer and coming back to campus. So our goals were really to do that.

And then also as we're learning things in our large project was to hopefully disseminate out useful information to other communities quickly. So we've been involved in knowledge dissemination as we got the project underway. And so that's really the project in and of itself.

Well let's break down each of those factors. So on testing what did you create or do differently?

Sure, well one thing that we did do is we recognized the need to do high volume testing that was not novel.

But we actually back in the early part of the summer through our Genome Center here, we had an idea of applying a technology that was really deployed in agricultural biotech.

And that was doing PCR testing of plant pathogens where they're doing genomic analysis of plant viruses for example. But they used a platform that employs a ribbon type of a substrate. So it uses very small, little micro wells on a ribbon tape. And it allows you to do a much higher volume of PCR testing.

If you can imagine doing fields of crops, you're testing hundreds of thousands of samples so we looked-

So you found a-- for those of us that don't know agriculture or chemistry, you were able to do something quicker and in higher volume--

Yes.

--than most labs.

And at lower cost also. That was really what we were looking for. A solution that was going to be much more expandable, scalable.

And the other thing that was very clear was having to stick a swab in the back of people's nasopharyngeal cavities was not a lot of fun. I know, I've had a few of those tests done myself.

So we were also looking for an alternative, and we actually ended up using a saliva-based platform. So that makes it much easier to get tested but you just have to go in and spit a little bit into a tube.

That combined with the high throughput PCR method really put us on the map. And we deployed that actually as the students were moving back into the dorms last summer in mid-September.

Now what about you also checked for variants where many cities, the percentages are minuscule. It's gotten better, but early on, we're talking in many places less than 1%.

The only reason it's useful is that the whole idea of the project was to take the testing platform that we're using for our students and staff on the campus, and to move it out into the community. And that happened in mid-November.

That's really when we deployed community-wide testing, free universal testing. Not everybody got tested but we've had at least half the people tested in Davis. And the testing was very convenient.

There were three community sites that were set up. It took on average four or five minutes to get in and out. We used a bar-coded system where they registered for-- scheduled the test online. And then they showed up and it was four or five minutes to get in and out and they were done.

And the other thing that was key was getting the results returned back. And we really got that down to turning results back within 24 hours, oftentimes same day. And that's by comparison to the commercial labs available at that time, took three or four days to get the results returned back.

You also did environmental monitoring? Other people were talking about looking at sewage, what can we learn from it? Is it really valuable? We did an interview on that nearly a year ago. But we didn't hear much going on after that. What were you able to do about that?

Yes, this field of wastewater epidemiology has really caught on. People had been looking at wastewater for a long time but it's really come into its own with this pandemic.

So many campuses around the country we're doing wastewater monitoring of things like dorm buildings on the campuses. The University of Arizona actually was doing that last summer when the students were coming back.

All the students were supposed to have been tested and tested negative before they could move into the dorms. They were testing the wastewater from the dorm buildings and one of the buildings lit up, had a signal. They went in then and tested all of the residents of that dorm and two of the students tested positive they were asymptomatic.

So it's another means of detecting virus or a contagion over and above just individual testing. And it may have some great utility in being able to look at large numbers of individuals to see if there's a signal present.

And then to do concerted targeted individual testing. So it's interesting because you had many colleges doing the campus testing. And then on the other extreme you had cities that would have a treatment plant, a wastewater treatment plant, and the city of Davis only has one treatment plant.

So you had people doing wastewater monitoring there for viral detection. If that lights up of course that tells you that in the city somebody has got COVID-19, got SARS-coV2, doesn't tell you where they are.

So one of the unique aspects of what we've been doing is to actually do something in between those two extremes. So we're doing what we call subsewer shed monitoring. We actually have sampling stations set up throughout the city that look at neighborhoods, multiple samplers.

And so we're doing something between the extreme of a treatment plant on one side and then dorm buildings on the other side. We're looking at neighborhoods. And it's still a little experimental.

The idea here is that you may have a early detection warning system if you've got the wastewater working properly. We have had one or two signals that have popped up in neighborhoods and so we've looked at that.

But this is a technology, I think, that will be here to stay long beyond this pandemic. It's a way of monitoring populations in a very cost efficient manner. So again, it doesn't tell you who's got the contagion, but it tells you that it's present, and that's important.

We're going to make some improvements in all of that technology. Tell us what you've been doing with vaccination and what's your strategy there? Because as you point out, Davis tends to be more of a rural environment. And we have had some challenges getting vaccinations in rural communities. What's been your success story there?

What we've been doing is setting up a couple of freestanding vaccine clinics with our Communicare partner there. They are the federally qualified health center in Davis. But we've been working with them to stand up freestanding vaccination sites.

We've also been doing mobile vaccinations, and in particular, we've targeted the migrant farm worker community which comes back seasonally, and they were back in March. And so we actually targeted them.

And just as a sign of success in the County right now as of last week, 83% of migrant farm workers have been vaccinated, which is really a striking proportion. It's the best demographic we have in the County.

In addition, we've delivered doses to harder-to-reach populations. We have a team that went through with backpacks and dealt with some of the unsheltered folks, getting them vaccinated. We've been deploying the mobile vaccination to some of the harder-to-reach elderly community.

And so as a supplement working with the County and with the federally qualified health center, we've been able to help in that regard. So it's been very gratifying. Right now about 59% of residents in Yolo County have received at least their first dose, which is higher than the state average.

Brad you make this sound like it's so easy. And why hasn't everyone done it? But let's also acknowledge in many areas there's kind of this town and gown approach, especially in University towns.

The University tries to control everything, and thinks they're right, and is kind of paternalistic and snooty. Let's be honest, that's sometimes how it's perceived.

And the rest of the County or the city wants to function and tell the University what to do. So there's typically a lot of tension.

So how did you manage to work together, because as I mentioned, this is a joint partnership, so to speak, between the University and the city of Davis, to make it work, when both institutions in and of themselves sometimes are challenging to work on their own let alone with another challenging institution.

So how do you make it work and what can other people learn from this?

Well, John, back in June when we were putting together the project idea, we sat down with the city manager of Davis and several of his staff, and we worked together on this project from the very beginning.

It wasn't an afterthought, it wasn't the University saying we have the solution for you. But we actually sat down with the city staff, we sat down with the superintendent of the Davis Joint Unified School district at the very, very beginning of the planning for this project.

And so they were our partners in how we built this and how we've executed this. I think it's an incredible example of public partnerships that we've been able to leverage greatly.

The County also had a role, so we had representation from Yolo County health. Obviously they are a very important part of what we're doing. So those partnerships were truly ingrained in this project from day one.

And we have a wonderful advisory committee that's co-chaired by our provost at the University as well as by the city manager of Davis. So that partnership is sort of built into the very fabric of Healthy Davis Together.

There must have been some rough patches here and there? Everyone can't agree on everything. Was it an exercise in learning what other people's perspectives are in how do you work together?

Again, what are the teaching points, since you're a professor at a University, that other towns, and universities, could adopt in terms of the strategy of protecting members of the community?

Well one thing, I think, is to be somewhat humble. You know, none of us have lived through a pandemic before. So the old rules don't apply. I think we all recognize that we're in a different world and it required kind of reframing the way we do business.

So I think there's been a certain humility, a certain humbleness, going into this, listening to our partners, having them, sort of share their perspectives. And then just having the attitude of trying to work together constructively.

So we've had some rough patches but really not many. I think it's been a matter of listening and then trying to figure out an optimal solution. I think one of the major success stories is related to our communications.

And so I think that has gone a long way. And there's obviously been a compelling reason to get this right which is trying to save lives, trying to reduce the horrible impact of the pandemic.

So all of us have been very, very hard working at this and realizing that we have to work together. So that's been part of the success for the project.

Where can people learn more about Healthy Davis Together?

We have a website healthydavistogether.org all one string, healthydavistogether.org.

Well, I want to thank you for taking the time today to talk to us about, it really does take a village to combat COVID, and giving us some insights as well, some tips, of how we can all work together to really crush the pandemic and return to some sense of that prepandemic normalcy.

Thanks again.

Thank you, John, appreciate the interview.

And for those of you that have questions about COVID, drop us a line. You can email me at [email protected], or post on Twitter, Instagram, or Facebook. Thanks for watching.

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