Butler Health Services causes chaos with dubious back-to-campus plan

Collegian file photo. 

BRIDGET EARLY | MANAGING EDITOR | bfearly@butler.edu

ANDREW FAVAKEH | ASSOCIATE SPORTS EDITOR | dfavakeh@butler.edu

This is a multi-part opinion series about Butler University’s back-to-school plan amidst the COVID-19 pandemic.

When Mikaela Schmitt and her family began their eight-hour drive to Indianapolis from Kansas City, the interminable cornfields and drab, iron-grey sky did not annoy her the way they usually did. In fact, the junior arts administration major couldn’t help but feel buoyant, her excitement filling the car — she and her family had tested negative for COVID-19 in the days prior to their trip to Butler. There was nothing hindering her move-in process, and Schmitt felt optimistic, even in the face of a pandemic-imbued semester.

Schmitt and her family arrived in Indianapolis on Aug. 7 and stayed in a hotel in Carmel for the night. Schmitt would move in the next morning, after testing at Butler’s Efroymson Gym. She went to sleep early, content in the knowledge that her family’s recent negative tests meant she’d come through with flying colors.

But the next morning, under the glaring, fluorescent lights of the basketball team’s backup gym, Schmitt tested positive.

Before she’d fully wrapped her head around what’d happened, Schmitt found herself back in the car. She was heading home to Kansas City to isolate. This time, the cornfields seemed to mock her.

Schmitt’s case is just one COVID-19 fiasco in an array of mishandlings at Butler. The university’s COVID-19 testing, response to test results and overall communication with students has been dangerously haphazard, and the repercussions of their contemptible Health and Safety Plan are upending the emotional and physical wellbeing of Butler community members everywhere.

For many students, entry testing proved a chaotic, inconsistent procedure with little followup support from the Health Services staff; in Schmitt’s case, after testing positive, she was told by Interim director of Health Services Rhonda Jackson that the positive test result was all the information the university could provide.

As a student whose hometown is 500 miles from campus, Schmitt’s abrupt banishment from campus was the harshest consequence of the testing procedure, and perhaps the greatest shock. Jackson said in both the Aug. 11 Butler University Parent Webinar Fall 2020 and an Aug. 23 urgent fall semester update video that students who test positive for COVID-19 would be run through an “exemption process,” in which students who may struggle to return home would be offered the option to isolate in Ross Hall. Even Frank Ross, the Vice President of Student Affairs, was in concurrence on the matter, per an Aug. 6 communication with students, but Schmitt said she does not recall Jackson mentioning an exemption process after her positive result and was certainly never offered refuge in Ross’ “limited number of isolation rooms available for students.”

“‘Your test came back positive, so we’re going to need you to follow the instructions on the sheet that was provided to you,’” Schmitt said Jackson told her. “She said to follow the instructions on the sheet and that was it.”

The next Monday, Schmitt and her family went for a second test at St. Luke’s Hospital in Kansas City. Like her initial test in Kansas City, the results came back negative.

Schmitt said her doctor told her the test at Butler was “most likely a false positive.”

Immediately, Schmitt called Butler Health Services, told Jackson that she had had a negative test and asked whether she could return to campus the coming weekend. Although Jackson had initially told Schmitt that she would have to isolate for 10 days regardless of any further test results, this time Jackson told Schmitt she could leave isolation and return to campus.

Schmitt’s third eight-hour drive of the week was nothing like her first trip back to Indianapolis. The air of frustration in the car was practically palpable, a far cry from Schmitt’s initial elation to be back at Butler.

The issue with Schmitt’s case was timing — or lack thereof. Previously, Ross wrote in a June 29 email entitled “Return to Campus Updates” that students only needed to “successfully complete health screenings, which include taking temperatures.” But on Aug. 6, two days before move-in day, Butler overhauled its requirements. Students needed to arrive 30 minutes prior to their move-in appointment time and receive a COVID-19 test on top of the original temperature check.

“It was frustrating because there was a general lack of communication about what was happening,” Schmitt said. “And because they let us know that we were getting tested the day before my family left, we didn’t have time for my parents to take an extra day off work just in case or anything, to stay in the area to get tested. There was just not enough time to really be prepared for all that happened.”

Brent Rockwood, the Vice President and Chief of Staff for President James Danko, refused to comment on specific scenarios, including Schmitt’s.

False positives and faulty guidance

For two weeks, Abby Souder’s only engagement with other human beings was in the narrow stairwell of her senior house. When the loneliness of her tiny bedroom reached suffocating levels, Souder sat at the top of the rickety staircase to talk with her housemates. As a COVID-19-positive member of the household, Souder was isolated as thoroughly as was possible within the walls of their little home.

Before heading to her boyfriend’s lake house in Michigan for Labor Day weekend, the senior digital media production major planned on getting tested to protect the family from potential exposure to the virus. Her Aug. 23 entry test had been negative, and she hadn’t been around anyone with COVID-19 in the days since, so Souder’s Aug. 31 trip to an immediate care center was anxiety-free.

The results were a blow: on Thursday, Sept. 3, Souder learned that she had tested positive. Her boyfriend tested negative. Souder dutifully notified Butler Health Services, then messaged her friends. Meanwhile, her boyfriend tested negative again.

 Souder’s confusion ate at her. Despite spending time together, and despite being perfectly asymptomatic, Souder was positive, and her boyfriend was not. She went for a second test at Indiana Immediate Care.

Negative.

The same day, she received a rapid test at Walgreens. Negative.

The contradictory results spurred Souder into a hunt for answers. She called the Center for Disease Control’s COVID-19 hotline, and a CDC representative told her that the first test was probably a false positive. Since she’d tested negative twice in over 24 hours, the CDC told Souder she was free to leave isolation.

Hoping to leave the confines of her minuscule bedroom, Souder called Butler Health Services, and was transferred three or four times before reaching Rhonda Jackson. Souder told Jackson what the CDC told her.

Jackson’s response: “‘The CDC gave you wrong information,’” Souder said.

“‘You can’t come out quarantine yet, and neither can any of your close contacts,’” Souder remembers Jackson telling her. “And so that’s why I was confused — because I had literally just gotten off the phone with the CDC at that point.”

 Jackson’s orders made no sense to Souder, primarily because Butler bases many of its protocols on CDC guidelines. On Butler’s “student-return-to-school plan” page, the university lists the CDC’s recommendations as one of its “guiding principles.” On its “Resources Related to Coronavirus” page, the CDC website is listed as the first “external resource.” On Butler’s “COVID-19 information” page, it says: “This website will be updated regularly to reflect the latest developments. Visit the Centers For Disease Control and Prevention for the most up-to-date information about the status of COVID-19.”

In other words, Souder was trapped. She stayed in isolation at her senior house for 10 days, until Sept. 11. She never made it to the lake house. 

Per the back-to-campus procedure, students were required to undergo testing at the university, which were conducted using a type of test called an antigen test. According to the FDA, antigen tests are fast, but not especially accurate. Known as “screening tests,” they’re meant for casting a wide net in a preliminary wave of testing — like a back-to-school entry test, for example — but antigen tests do not always detect the virus, and can conversely be falsely triggered by other proteins in the test sample.

To verify a test result in instances of faulty tests, the FDA recommends that a different kind of test, called PCR tests, be used to check whether the original test was an error. Trying the same thing twice but expecting different results, as the adage goes, will get you nowhere.

Butler, however, did not use PCR tests over the first few days of entry testing. Instead, the university used the same product — rapid tests — for secondary tests. 

Anne Lightwine, a lab supervisor for Indiana Health West Hospital, said if Butler were using secondary tests to confirm the initial ones, it could not use the same kind of test the second time.

“You shouldn’t be running two antigen tests in a row, that won’t work,” Lightwine said. “You need to have Sofia [antigen tests] for screening, and then you would send them elsewhere for confirmation.”

Only after Butler noticed students were expressing concern about the initial entry testing did the university change course and purchase more PCR testing kits. Butler now uses PCR testing kits to confirm initial antigen tests provided to students — though students must specifically request a PCR test to confirm their antigen test.

“I believe within the first couple days of when testing started, we decided to do that as well because students were concerned,” Jackson said. “When we saw that, we knew we had to pivot and, say, add an additional layer to the testing.”

The cost of the PCR test is subsequently billed to their student account, Jackson said, meaning students who may not be able to afford the more advanced tests will not have access to them. It’s only the Community of Care if you can pay for it, folks.

Part of the explanation behind the lack of testing is the national shortage of tests. Jackson and Rockwood said Butler ordered testing kits — both antigen and PCR — in April, but did not receive them until Aug. 8 because Indiana prioritized government agencies, hospitals and nursing homes.

This explanation makes perfect sense — after all, state governments everywhere have been commandeering tests from private entities. But if similar issues have been happening for months, then why did the university return students to campus in the first place? 

And more importantly: was it ethical? Rockwood sidestepped the question in an interview on Sept. 18. 

“It was a decision that was based on a desire that — we heard students, faculty, and staff alike — that we wanted to be together for an in-person semester and we know that we’re better when we’re together,” Rockwood said.

Rockwood’s definition of “better” seems to be a dizzying spiral of illness, isolation and stress headaches, but since students and professors were never actually consulted en masse, how could he and the other administrators possibly know better?

Dashboard disaster

On Aug. 28, Butler debuted its COVID-19 dashboard, which administrators said would be updated every Friday at noon. The university’s plans for the dashboard, however, have been inconsistent and poorly communicated to the student body. In short, nobody knows what Butler’s case rates actually look like.

The structure of the dashboard itself is confounding; the layout comprises a myriad of vaguely-labeled boxes displaying the university’s current count. But the boxes and numbers themselves are difficult to interpret, and the layout has changed several times since its debut. For something so crucial to the community’s understanding, the nebulous organization is a major hindrance for students and faculty seeking to keep tabs on the state of the university.

Designing a clearly-ordered dashboard, which seems beyond the scope of Butler’s capabilities, should be a baseline expectation for the administration. Other universities, such as the University of Missouri, have well-organized, easily accessible COVID-19 case counters on their websites.

 For students like Shannon Mitchel, a junior theater and creative media and entertainment major, Butler’s COVID-19 dashboard is a digital representation of the general lack of communication between administration and students and faculty on campus; if Butler students cannot monitor the safety of their own community, it makes every choice a risky one.

“Decisions are being made that I think probably lack the input of professors and people who are face-to-face with the student populace every day,” Mitchel said.

What’s quite concerning to students like Mitchel is the fluctuation of numbers that should not be fluctuating. The total number of implemented tests, for example, should never decrease – you can’t undo a test, obviously.

But that number has, in fact, decreased. Between Thursday, Sept. 3, and Friday, Sept. 4, the total number of tests pinned on the dashboard dropped by over 30 tests. 

Jackson said upon further review of the data, Butler Health Services found the numbers included in the original count had been double-counted in a particular category, which she declined to clarify.

In a Sept. 19 interview with The Butler Collegian, Rockwood said that a “communication later today informing students and faculty that as we get new information, [the COVID-19 dashboard will be updated] throughout the week.” Rockwood and Jackson both cited a need to shift with the changing environment — the shift, of course, being the entirely-predictable uptick in cases that bloomed in the wake of campus returns.

“We kind of changed the strategy because we felt like it was important for the community to not have to wait a week for updates. So we’re going to be updated more often than a week,” Jackson said.

Since then, no such message — neither a mass email nor a website update — has been communicated to Butler students.

 What did change was the header above the dashboard. Before, the disclaimer read “updated every Friday at noon,” but starting on Sept. 25, the header was deleted. It now only reads the date it was last edited.

The last update was made on Tuesday, Sept. 29. 

The COVID-19 dashboard has been reformatted several times. See below for captions. 

Between bungling the testing data and obfuscating its representation beyond recovery, the university’s inability to clearly communicate with the Butler community creates a precarious situation. Should a spike occur, there is no reliable way to disseminate the information, meaning nobody will have any clear sense of what to do and who to avoid.

“If there is potentially a large outbreak that happens on this campus, what are, what are they going to do?” Mitchel asked. “There’s no communication about any plans for the future. They’re like, ‘we’re just going day by day.’ Yeah, all of us are, but you are the people who are supposed to help reassure us that we’re not going to go home tomorrow.”

The dangers of disorganization 

Kolbie Mason was halfway to Indianapolis when her throat started hurting. She and her mom had gotten an early start on their drive from Charlotte, North Carolina, and after a quick stop for coffee at Dunkin Donuts, they filled the hours talking. But when her throat started hurting, Mason started questioning her own health. Was her car’s air conditioning not working, or did she feel feverish? Did her muscles ache, or was her body feeling the effects of a 10-hour car trip?  

Mason could feel tears prickling in her eyes. All she wanted was to go back to school. Her throat hurt worse than ever.

“When I was driving there, I really felt like I had [COVID-19] symptoms,” Mason said. “I feel like that’s kind of typical before you get tested, that you feel like you have it. But they were really obvious symptoms, I thought.”

Her mom reassured her; all their chatting had made her throat hurt, and the rest was just her mind playing cruel jokes. Still, Mason couldn’t help but worry. 

 After getting tested at Butler, Mason and her mom waited for the confirmation phone call over lunch at a little restaurant downtown. She received a notification on her phone that her results were in around an hour later, but unlike most students, Mason was asked to return to campus to receive her results in person. Her nagging fear returned in full force.

Then, things got worse. When Mason and her mom arrived at Hinkle Fieldhouse, her results were missing.

The Butler Health Services nurse, whose name Mason does not remember, shuffled through the papers to find her results. After a cursory flip through the messy stack of testing information, she called it quits. “You’re good, you’re good, actually,” the nurse assured Mason. “I can’t find you right here, but I know you’re good because everybody has been negative.”

The nurse then slapped a wristband on Mason, shelved the papers and waved the next student over.

Since she had noticed students in front of her receive a paper that confirmed their negative result, Mason was confused. On their walk away from Hinkle Fieldhouse, Mason and her mother couldn’t help but question the absurdity of the situation.

“I kind of wanted to see that I was actually negative,” Mason said. “It was a weird experience; I didn’t definitely know that she had my results.”

Mason moved into her sorority house that afternoon, and though she thought about it, she did not get tested elsewhere. Fortunately, she never exhibited any symptoms after testing.

In the rush to integrate students back into campus life, situations like Mason’s are a demonstrable indication that things are slipping through the cracks. A clear issue with understaffing is likely at the roots of such instances.

Despite committing to testing thousands of students in the back-to-school plan, the university only employed four Butler nurses and one medical assistant from Dr. Aziz Pharmacy, all of whom were tasked with reading, collecting, processing and transporting Butler students’ COVID-19 tests.

The same group, plus six more Butler nurses, doubled as Butler’s contact-tracing team. During the entry-testing phase of Butler’s return-to-campus plan, Butler Health Services was “understaffed,” Jackson said, so it wouldn’t be able to process as many screening tests.

Now, with in-person classes in full swing — and with positive cases on the rise and exposure rates climbing in conjunction — their job becomes dramatically more difficult.

Ogbonnaya Omenka, an assistant professor in the college of pharmacy and health sciences and expert epidemiologist, is a consultant for Butler’s contact-tracing team. In one meeting, Omenka suggested drawing upon Butler’s pharmacy students to build a network of contact tracers, but he said Rhonda Jackson, head of the contact-tracing team, had “reservations.”

The contact-tracing team, Omenka said, underwent a cost-benefit analysis that ultimately ruled out hiring pharmacy students as contact tracers. Jackson wanted to use trained contact tracers, those who didn’t have to balance schoolwork and contact tracing, and did not want to risk HIPAA privacy violations. Unlike most universities, Butler Health Services also declined the help of the state and local county health department because, as Rockwood said in a Butler Collegian article published on Sept. 8, Butler could conduct contact tracing “more effectively and more efficiently.”

But as Butler’s COVID-19 cases spiked right before in-person classes were supposed to start on Aug. 23 — and the administration decided to switch over to online learning — the Butler nurses started feeling “overwhelmed,” Omenka said.

“In an ideal world, we need more people contact tracing,” Omenka said.

The musings of a mathematical modeler

Sporting a Hartford Whalers jersey, A. David Paltiel, a Yale University public health professor, leaned back into his red futon and sighed.

Having just been informed by a reporter of Butler’s COVID-19 testing plan — one entry test for all students, 5% random asymptomatic testing and the punishment resulting from failing to abide by Butler’s strict albeit unclear rules — Paltiel paused to collect his thoughts.

“We explored thousands of scenarios and we failed to find even a single scenario where sitting around and waiting for students to develop symptoms before springing into action would be sufficient to contain an epidemic,” Paltiel said. “You know, it just makes no sense. You gotta actually get ahead of this thing.”

On July 31, 2020, Paltiel published a mathematical model tracking the spread of COVID-19 on college campuses. 

Butler, for its part, has not followed a path that would align with Paltiel’s model. Instead, the university has committed to a plan that contradicts recommendations from a veritable army of government officials and medical professionals, all working overtime to produce updated guidelines for universities nationwide.

Since the shutdown in March, the idea of returning to campus has sat center stage as both the largest and most pressing unknown for university officials everywhere. Even with months of preparation time, Butler’s lackluster attempts to prepare for the influx of thousands of people resulted in what could only be described as Paltiel’s worst nightmare.

While frequent testing is the most thorough method of monitoring case numbers, a larger contact tracing team to track case spread would suffice as a substitute, Paltiel said. His mathematical model did not account for contact tracing; given the frequency of tests, tracing would be rendered obsolete. Since Butler has neither the tests nor the contact tracers to match the model, Paltiel likened Butler’s plan to “a fire department that only responds to calls once the house is known to have burnt to the ground.”

“You’re overtaxing [Rhonda Jackson], I get it,” Paltiel said. “You’re not putting enough money into it. If I had an extra dollar to spend at Butler, I’d use it to buy more tests. One way or the other, it’s the worst of both worlds: it’s not enough testing and it’s not enough contact tracing.”

Deploying enough tests to negate the need for a strong contact tracing team would require 195,000 total testing kits for a school with roughly 5,000 students, according to Paltiel’s mathematical model. The numbers make his recommendations infeasible, mainly because it would not be affordable, Jackson said.

Rockwood said he and his staff worked with Bruce Arick, the Butler University chief financial officer, to “carve out a separate budget” for all supplies related to COVID-19: personal protective equipment, cleaning supplies, testing kits, etc., but he declined to specify the details. When asked how many testing kits Butler received from Dr. Aziz Pharmacy and for what price, Rockwood also declined to specify.

In two separate meetings with the administration, Omenka asked if more contact tracers or tests could be implemented. But both times, Omenka said, he was turned down; in each meeting, cost was the deciding factor.

“Contact tracing is not even cheap,” Omenka said. “You pay for each person to get designated as a contact tracer … at the end of the day, there still would be an executive decision, right? No matter what I recommend, or the ideas that I have, because I’m not the one cutting the check, there still needs to be a natural consideration.”

Paltiel understands that bringing his mathematical model to fruition is a “heavy lift, expensive,” but added that “if it really is too expensive, I get it, and I’m sorry about that, but then, you really need to ask yourself, university president, if you have any business reopening.”

 

Photo 1: In the first week, there were four rows — “Total Tests (Students),” “Active Positive Cases (Students),” “On-Campus Isolation Space (% Available)” and “Active Positive (Employees).”

Photo 2: The next week, Butler added one row: “New Active Positive Cases (Students).”

Photo 3: Two weeks later, Butler swapped “Active Positive Cases” with “Total Active Positive Cases” and swapped “Active Positive Cases (Employees)” with “Quarantined Students.”

Photo 4: Most drastically, Butler inserted a new column below the original column, containing: “New Active Positive Cases (Employees), Total Active Positive Cases (Employees), Cumulative Positive Cases (Employees), and Quarantined (Employees).”

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