Three members of the University of Oregon faculty, who are currently living in Italy as that country experiences a massive coronavirus outbreak, are warning that Oregon has a "short window of time" to take action.

Italy has been among the countries hardest hit by COVID-19, and is currently under a nationwide lockdown. More than 800 people have died. Harrowing accounts of hospitals overwhelmed with patients have emerged from that country.

Three Oregonians are warning that what's happening in Italy should create urgency here about how to address the ongoing spread of the virus.

"To date, the state and the university have not recognized the seriousness of the situation. There remains only a short window of time to be proactive rather than reactive," write Professors Melissa Graboyes, Alfredo Burlando and Eleonora Redaelli in a letter that has circulated on social media.

"We have been following the UO response, and the wider state of Oregon's, and decided that we must speak out to address what we see as glaring shortcomings in the current response," the three write.

"Our lived experience has taught us some sobering lessons about this crisis: lives are upended with unprecedented speed; events occur in quantum leaps; government responses that seemed either courageous or draconian one day become case studies of 'too little, too late' mere days later; and public opinion about the risks and how to personally respond has not kept up with the pace of the disease's spread," they wrote.

They recommend that university shift to online classes, end any university-sponsored travel, call off any meetings or conferences that can't be held online or virtually.

Graboyes, who is a professor of medical history, confirmed to WW that she and her colleagues wrote the letter.

"All three of us are currently based in Italy," Graboyes, who is a professor of medical history, emails WW. "We were inspired to write after seeing the frustrating daily emails from the UO about their lack of concrete COVID response (despite much planning on their part) and how this did not match with what we were witnessing here in Italy."

The university did not immediately respond to a request for comment.

Full letter below:

We are three University of Oregon faculty members writing because we are in a uniquely "privileged" position to talk about the risks of COVID-19 by being based in northern Italy for the past months, where we are witnessing first hand the expansion of the infection and the Italian government's unprecedented response to try to stop the epidemic. At the same time, we have been following the UO response, and the wider state of Oregon's, and decided that we must speak out to address what we see as glaring shortcomings in the current response.

In two short weeks, we have lived through the beginning of local transmission of COVID-19 in Italy, followed quickly by an explosion of cases around us in Milan and the larger Lombardy region. Our lived experience has taught us some sobering lessons about this crisis: lives are upended with unprecedented speed; events occur in quantum leaps; government responses that seemed either courageous or draconian one day become case studies of "too little, too late" mere days later; and public opinion about the risks and how to personally respond has not kept up with the pace of the disease's spread.

Since local transmission of the disease was announced on February 22, government officials have taken strong action in consultation with respected epidemiologists, infectious disease experts, and scientists. They determined that in order to adequately respond to the virus, entire communities would need to be quarantined. What started with 11 communities and 50,000 people shifted after two weeks to a quarantine of 15 million people across most of Northern Italy.

Two days later, the Italian government implemented a nationwide ban on movement, effectively closing international borders and having individuals remain in their towns unless they show proof of the necessity to move for work, grave health concerns, or family reunification. These quarantine measures will be in place until at least April 3rd. At the same time, tens of thousands of retired doctors and nurses have been rehired. Medical schools are sending their students to work in hospitals to try to staunch the shortage of staff and to prepare for the wave of patients that will arrive in the coming weeks needing intensive care. Schools, universities and all public events–including sport, religious, and cultural events–have been cancelled for the past three weeks. While this approach may seem extreme, we see these as necessary and appropriate steps.

As the first quarantined "red zones" were established, there were fierce critics of what people called the government's over reaction. At the same time, public spaces including downtown areas, bars, restaurants, and clubs became noticeably emptier. With each passing day, as reality settled in, more and more people began following the government's guidance for less socializing of all kinds. These shifts toward safer behaviors only occurred thanks to aggressive, consistent, scientifically-accurate government messaging that didn't sugarcoat the situation. The goal was not to cause panic but to nudge people toward personal behaviors that could keep them healthy and help reduce new cases overall. Part of the challenge of this disease outbreak is not just to keep individuals healthy, but to keep communities as a whole healthy to make sure health systems and intensive care units are not overwhelmed.

While we live through this situation, we cannot help but notice the profound disconnect between the response in Italy and the response being taken by the Oregon Health Authority, the University of Oregon, and the larger community. To date, the state and the university have not recognized the seriousness of the situation. There remains only a short window of time to be proactive rather than reactive.

We recommend that the University of Oregon take in consideration three vital steps to safeguard the overall health of the community. We consider these steps as absolutely necessary based on our personal experiences living through the COVID-19 response in Italy, reinforced by the professional knowledge in the field of global health of one of us.

1. We strongly recommend that the University of Oregon shift to online classes ahead of diagnosed cases of COVID-19 in the university community or the larger Eugene area.

Because of Oregon Health Authority testing policies, it is virtually guaranteed that the number of cases in Oregon is being dramatically undercounted. Testing is currently only available for people who are sick enough to need hospitalization due to pneumonia, and people who have been in contact with confirmed positive cases. Epidemiological data from China and Italy show clearly that many cases—perhaps up to half of the total—have such light symptoms that people do not recognize they are sick and will continue with their normal activities. In one of the Italian towns (Vo) where 95% of residents were tested, the vast majority were without symptoms. Yet these cases remain contagious and can infect other individuals. Here in Italy, even with highly restrictive public health measures in place for the past two weeks, each confirmed infection is causing roughly 2.4 new cases. Moreover, hospitals here are reporting growing numbers of otherwise healthy adults under the age of 60 needing intensive care in order to recover. Assuming that most of our students, staff, and faculty are not "at risk" or "high risk" is a risky assumption to make.

Italian universities shifted entirely to online teaching at the very beginning of local transmission being detected. Top universities, such as Bocconi, based in Milan, are recommending that faculty break down lectures in short 5-10 minute videos covering specific topics, and fully utilize the chat and posting functions built in to Canvas and other platforms like G Suite. Contingency plans already delineated by the University of Oregon should be activated right away, so they are in place for the start of Spring quarter. This is also smart from a logistical perspective as advance notice to both faculty and students will allow for a smoother transition as the shift to online classes is likely inevitable.

2. All University sponsored and related travel, including study abroad programs, conference travel and invited lectures should be suspended for the foreseeable future.

In this area, the university must take cues not only from public health agencies like the World Health Organization (WHO) and the Centers for Disease Control (CDC), but also other universities and public health. Despite the strong leadership of the WHO in this time, they strive to remain a largely apolitical organization on good working terms with all countries, which means they are unlikely to recommend broad travel restrictions. The CDC is also unfortunately hamstrung in their public recommendations as they are a federal agency that must follow the tone of the larger government response.

3. All University meetings and large conferences should be suspended or shifted to online platforms so people can begin to work from home without needing to be in direct contact with each other.

As much as individuals can minimize direct contact with each other—both people who are sick and those that appear healthy—it will help keep the number of new infections caused by each existing infection low. Even two weeks ago, many Italian government officials in the hardest hit areas began to shift to online meetings in order to protect themselves, their staff, and their wider communities. If governments coordinating a complex emergency can do so without meeting in person, we are certain the University of Oregon can continue to function.

COVID-19's rapid spread through Italy shows that actions that seem courageous today—the idea that the university stays open to serve its students in the midst of this difficult time—may seem foolhardy and needlessly risky when viewed just a few days later. Conditions are changing constantly in Italy, just as they did in China. It is unrealistic to assume that the United States is uniquely protected, and that what is playing out in the rest of the world will leave the US or Oregon untouched.

While we recognize that an epidemiological disaster like this one will not affect every place in the same way, now is the time to be prudent, thoughtful, and safe. The times are not normal, and the three of us are witnessing first hand the importance of timely collective action.

Melissa Graboyes, Ph.D, MPH
Associate Professor of Medical History & African History
University of Oregon

Alfredo Burlando, Ph.D.
Associate Professor of Economics
University of Oregon

Eleonora Redaelli, Ph.D.
Associate Professor of Planning, Public Policy, and Management
University of Oregon