Monaco vows to house patients, respond to local needs as coronavirus outbreak worsens

University President Anthony Monaco announced his plan to relieve increasing strain on local hospitals by opening up Tufts’ residence halls to quarantine patients with low-level cases of COVID-19, the disease caused by coronavirus, in an op-ed published in The Boston Globe on Wednesday, March 18. In the op-ed and in a subsequent interview with the Daily, Monaco promised to work alongside Tufts’ host communities of Somerville and Medford, as well as Greater Boston, to assess medical needs and respond to them. 

Military fellows, students and faculty from The Fletcher School of Law and Diplomacy advised Monaco and Executive Vice President Mike Howard throughout their decision-making process, beginning when a student tested positive for the illness, Monaco told the Daily in an interview.

Around the same time as that presumptive positive case was announced, the university began hearing more and more needs from Tufts Medical Center,one of the hospitals affiliated with Tufts University School of Medicine, which serves as a primary teaching hospital for medical school students. Its needs change daily and are ever-increasing.

This response is personal for Monaco, who was a medical student at Harvard University in the late 1980s, during the AIDS epidemic. 

“I understood the tension in the hospital at that time, worrying about the ability to care for ever-increasing numbers. Fortunately, they didn't end up having an overrun because the outbreak ran a different course. But what I did learn from that is the importance of preparation, and also the loneliness of isolation," Monaco said. "Many of these patients ... were young individuals who felt shut out by society and government. We as medical students spent a lot of our time talking with them, keeping them company during our breaks. And I think there's a lot that students can do in the future when we're needed to help alleviate that. We may be physically distancing, but that doesn't mean that we're socially isolated.” 

Relieving the strain: Tufts steps in to provide beds for patients

Monaco said that the university is preparing for an outcome similar to what has happened in Italy, with health care facilities stretched to a breaking point at the peak of the virus’ surge. 

The university said it will work to mitigate the crisis in five ways, according to Patrick Collins, Tufts’ executive director of media relations. One is to provide access to storage and laundry facilities on campus. The university will also collect and donate extra personal protective equipment (PPE) from its research operations.

Tufts will open up university residence halls to be used to house low-risk patients occupying hospital beds that could be used by patients in need of more critical care. 

“We’re talking about low-level medical help, such as wound-healing care, physical therapy for hip replacement,” Monaco said. “I think that could be an early area where we could relieve [strain on hospitals] and make space for those who are most vulnerable when their usual place of care is not available to them.” 

University facilities will also house medical personnel from those testing sites who may have vulnerable family members to whom they cannot return without risk of exposing them to the virus.

To decrease community spread, the university will also prepare residential units to isolate patients who have tested positive for COVID-19.

Collins said Tufts is also planning to serve as a testing site and isolation unit when hospitals run out of capacity. Monaco said he has heard of a need for testing sites from both Somerville and Medford city governments.

“We have to be coordinated. We can't be operating on a varying set of rules and actions. We need a tightly coordinated, collaborative [and] synchronized approach to this. And it is urgent. Time is running out. We don't even have days,” Somerville Mayor Joe Curtatone told the Daily. 

Curtatone said that Tufts’ response is prompting him to mobilize other resources in the city. He said that he is speaking to hotel operators to use their spaces for more beds. He added that, in the absence of much guidance from the Commonwealth or the Massachusetts Emergency Management Agency, many municipalities in the state are coming up with independent plans for combatting the outbreak.

“I want to applaud President Monaco. He's leading the academic world and the teaching hospital world and he deserves a lot of credit,” Curtatone said. 

Medford Mayor Breanna Lungo-Koehn expressed a similar respect for Tufts' handling of the pandemic.

"Tufts then really stepped up and are working on being a potential test site and a location for our first responders to quarantine. As of now they are in the beginning stages of planning this," Lungo-Koehn wrote in an email to the Daily. "President Monaco also reached out [Saturday] and we were discussing protecting our most vulnerable populations. Medford has already set up ward captains to do this with over 100 volunteers, but we are going to try to add a few questions after the discussions with Tufts to figure out which seniors don't live with a relative and which don't have thermometers."

Military task forces help Tufts address ‘large-scale community issues’ 

Several current and former military members from the Fletcher School volunteered their time to advise the president’s office, leveraging their military experiences of operating in complex crisis situations to provide advice and recommendations on how to best utilize Tufts’ resources to help contain the epidemic. Graduate students at Fletcher also offered up their personal knowledge and expertise to assist the university. 

Sue Gannon, the year-long military fellow at Fletcher who heads the coronavirus task force supporting the Tufts Medical Center, clarified that these military personnel are working in a strictly personal capacity and not on behalf of the Department of Defense. Gannon is a Civil Affairs military officer based out of Maryland.

“This crisis and the way in which the military fellows have been able to respond and the utility that they’ve brought double-underlines why we’re so fortunate to have them and why we treasure them,” Rachel Kyte, dean of The Fletcher School, said. 

Kyte explained that the university’s traditional leadership structure had to change under new circumstances. 

“It becomes clear that the normal, horizontal decision-making processes that are standard within academic settings are not very well-equipped to these kinds of emergency moments,” she said.

Kyte clarified that Fletcher’s team of military advisors are intended not to replace the leadership of the president’s office and the office of the executive vice president, but rather to provide support. 

“The plan was to stand behind those who … know how to do their jobs, know how to run the university … and be a separate set of eyes looking over their shoulders, helping them build decision-making structures,” she said. 

Wesley Hester, a year-long military fellow at Fletcher who has served as an operations officer and chief pilot for the U.S. Coast Guard in Cape Cod, Mass.,led the task force advising Howard.

“Tufts University did a phenomenal job organizing coordinating groups for how they were going to deal with this ... crisis,” Hester said. “The way we were brought in was initially just to help look at the processes. We’re taking in an inherently horizontal structure in a university and trying to make it more vertical. What we found was that our experiences as military members were really beneficial.”

Hester explained that his military training has been helpful in establishing logistical processes and frameworks for the university, stressing that military fellows, along with Fletcher volunteers providing their own knowledge and expertise, have worked purely as advisors for Tufts’ senior leadership. 

“Just by helping provide templates and frameworks, and a little facilitation, we’re able to let the experts at the university do their best work,” he said.

The university is anticipating bringing in new personnel. Hester and his team helped Howard talk through these logistics, explaining that every fall, the Tufts administration does something similar with a new class of first-years. The team is also working to plan for alternative futures or worst-case scenarios. Hester gave the example of planning for a scenario in which Tufts’ janitors contract the illness, creating a need for backup personnel. 

Nick Duncan, the director of emergency management at Tufts Medical Center, said that he called on the military fellows to do a resource request for the eventuality that Monaco would put resources on the Medford campus to use. 

“If we have to keep staff on campus or close by, we have to make sure we have adequate space for them. Part of that is dormitories. Part of that is food and restrooms,” he said. “Universities are only accustomed to housing their students. Medical centers aren’t accustomed to housing their staff. So we’re trying to leverage what [universities] do best.” 

Hester also stressed the importance of leveraging the university’s extant resources. 

“Universities are already really good at bringing people together, getting them oriented to where they live, feeding them, taking care of their health needs, taking care of their everyday life needs,” he said. “The infrastructure is there. The people are in place. The processes are there. We’re just helping them modify their thinking so that it’s applicable.” 

Duncan said that other resources that Tufts Medical Center may need from Tufts include storage facilities for PPE and transportation for patients.

“The university … did an excellent job of catering to our requests in absolutely supporting the medical center to their fullest extent,” Duncan said. 

Tufts students, along with students from Harvard University and the Massachusetts Institute of Technology (MIT), are collaborating to retrofit a shipment of 6,095brittleN95 masks. 

Gannon said her military training uniquely prepared her to help Tufts Medical Center respond to the pandemic.

“It’s almost an innate way to respond for me,” she said, “Being used to working in environments that are not always certain and having to make decisions based on operations ... Finding how to solve problems, how to think through problem solutions … is where my experience in the military has helped the university go through this crisis.”

Kyte said the response to this pandemic has reached many corners of the Fletcher student body, including economics experts who have explained how this health crisis has turned into a financial one.

“As a school of international affairs, we have [continuously] talked about existential threats including zoonotic disease,” she said. “What’s been really interesting is the way in which disparate people within the school have been asked to help the world understand the pandemic.” 

Most Fletcher students live off-campus. The school worked with students in Blakeley Hall, the school’s sole residence hall, to accommodate the 30 students who needed to stay, according to Kyte. 

“The virus is going to come in waves,” Kyte said. “The more we learn about the spread of the virus, … we’re going to see that this will continue to peak … We have to wear what I would call progressive lenses, ... to look at the here and now … we have to be looking at the summer, and start planning through September on the basis that the world will still be disjointed in some form.” 

Planning for students’ futures

Monaco noted that students might be concerned about academic continuity at this time.

“We've got that all prepared and we're hoping to go live on Wednesday,” he said. “Of course, there are going to be problems. We need people to be patient and understand that everyone here is working as hard as possible, training faculty, but I would like you to focus on getting your distance learning up and running so that later, when the semester’s over, and many of the hospitals in your area need student help, [you can volunteer].” 

The Jonathan M. Tisch College of Civic Life is preparing to use its online platform, Tufts Civic Impact, to organize and train volunteers — Tufts students and staff who could be deployed to support response efforts on campus and in partnership with Medford and Somerville based on community need, according to Diane Ryan, associate dean of Tisch College. 

“We anticipate having tasks that can be done virtually by students who may be at home,” Ryan wrote in an email. “These tasks may be online or over the phone, including supporting those who might be homebound, lonely or recovering and who would benefit from outreach from students. This is a time to think creatively about human connection and about all the ways we can support each other.” 

Undergraduate student responses 

Undergraduate students are expressing mixed responses to Tufts’ strategic responses to the coronavirus crisis. The decision to open up Tufts’ beds to patients came just eight days after a university-wide email asked students to move out on Tuesday, March 10. 

“I wouldn't call this an explanation for our rushed campus move-out, nor their intention all along,” senior Charles Bunnell said of the plan to house patients in a comment on the senior class’ Facebook page. “I think that this sort of plan may have come out as a consequence of our absence, rather than being the reason for it.”

Some undergraduates, however, are concerned about Monaco’s move to open up residence halls. 

"I think it's really frustrating that not even a portion of on-campus housing was used to house students who were most in need of [it]," Nikhil Nandagopal, a senior who has organized to help housing-insecure students with Tufts Mutual Aid (TMA), said.

Nandagopal said that TMA received several emergency requests from students who felt they had been abandoned by the university.

"We know that the university has ... made some very wrong decisions that have negatively impacted students because of the requests we have received, saying 'Help, please help, I don't have a place to stay, I don't know what to do. My academic success is in jeopardy,' and so many other things like that," Nandagopal said. "That wouldn't have happened if Tufts had allocated the spaces that they needed to."

Several students authored an unpublished op-ed responding to Monaco’s words in The Boston Globe in which they stated that the president had chosen patients over Tufts’ most at-risk undergraduates. 

According to Dean of Student Life and Engagement Chris Rossi,Tufts originally granted about 300 of approximately 600 requests for late stay. Of those, 95 canceled their requests and left campus.

Students who were granted late stay at Tufts will be housed in Harleston Hall,Monaco said. 

Some students experienced difficulty getting their own requests for emergency housing approved. 

Olive Baerde, a senior who worked on the unpublished op-ed, lives in China but holds U.S. citizenship. Without a visa she can not travel home. She is also currently seeking medical treatment in Somerville, further restricting her ability to leave the area. Tufts granted her an extension of just three days, which has posed challenges for her. Baerde lives in Tufts’ Community Housing (CoHo) development, a group of university-owned wood-frame houses. 

“They asked us to move out of CoHo, and if you get an extension, you are going to move into ... Harleston, which is … how you get infected. If off-campus students, people who normally live in Somerville and Medford, can stay, why can’t we?” Baerde said. 

In response, Collins said that it is important both for student health and safety and operational efficiency to de-densify the student population and consolidate those students who remain.

"The University made available as many rooms as were needed to accommodate the number of exemptions that were approved. There was no set quota or upper limit to the number of exceptions that could be made," Collins said. "In the interests of the health and well-being of students, faculty, staff and our larger community, each request was reviewed individually in order to identify all possible solutions to the student's issue so that our campus could reduce residential density - which facilitates further spread of the virus."

Collins went on to refute allegations that the administration did not adequately consider all types of extension requests by students, a key issue raised in the unpublished op-ed.

"Also, it is inaccurate to suggest that only students with extenuating circumstances related to travel were accommodated and that those with financial need were not. That’s simply untrue," he said. "[The] Dean of Student Affairs, First Center, and other staff worked with hundreds of students to accommodate their needs for housing, travel funds, computer and wi-fi access, and many other needs."

The students’ op-ed received 129 signatures from alumni and students.

Nancy Thompson, interim dean of student affairs, learned of the op-ed when a member of her team forwarded her a Facebook post about it on Friday night. She subsequently contacted the students who had worked on it.

"I made clear that I was NOT calling to tell them what to do or talk them out of anything; rather, I wanted to share information about the University's process and timeline that I thought might help them make an informed decision," she wrote in an email to the Daily.

The students are no longer moving forward with publication.

Thompson added that she believes the community need Monaco anticipated will become "very real, very soon."

"Knowing the depth of his commitment to our students and the Tufts community, I admire his leadership in recognizing that Tufts can support our students and the Boston area during this extremely challenging time," she said.