In the midst of our national struggle to reckon with centuries of institutional racism, two civil rights icons died in mid-July on the same day: Representative John Lewis and Reverend Cordy Tindell “C.T.” Vivian. Both worked alongside Dr. Martin Luther King, Jr., putting their own lives on the line. If you haven’t seen the documentary Good Trouble or read this op-ed by Representative Lewis in the New York Times, I highly recommend taking the time.
All the while, the pandemic grinds on, and it’s hard not to feel whipsawed. The key to this tortuous time is flexibility. Don’t get too attached to one particular method of doing things. Maintain an open mind and be ready for anything.
At least, that’s my mentality. I feel I moved quickly through the Kübler-Ross stages and arrived at something resembling acceptance (although I do remain frustrated that so many people around the country, including key policy-makers, seem stuck on denial). I generally try to take things as they come, and it seems from talking to many of you, that people at UCSF are highly adaptable. Remember, keep checking the UCSF’s coronavirus website, which not only has up-to-date information, but also includes many helpful resources for coping, including self-care.
I’m highlighting a few examples of UCSF’s adaptability during COVID-19 as this month’s Expresso topics:
- From Room to Zoom: Academic instruction during COVID-19
- Tightening the Belts Another Notch: Precarity of UCSF’s financial future
- Yours, Mine, and Ours: Cybersecurity – we can really get burned!
In the good news department…I add my voice to the chorus of welcomes to UCSF alum, colleague, and friend Michael Drake, who had a career of over twenty years at UCSF before reaching greater heights, most recently as president of The Ohio State University. Last month we learned that the Regents selected Michael as the next president of the University of California, succeeding the excellent Janet Napolitano. I am over the moon to see him return to the Golden State in this extraordinary position.
Also, have you seen the new UCSF Magazine microsite? The most recent installment is a special issue devoted exclusively to UCSF’s sweeping response to COVID-19. “We Thought It Was Just a Respiratory Virus” has received over 400,000 webpage visits since it was released just a few weeks ago, and award-winning science writer Steve Silberman has declared it’s “one of the best, most informative, most comprehensive, and most authoritative articles I’ve read on #coronavirus.” You’ll also read 15 mini-stories from the front lines – extraordinary first-person accounts from across UCSF – clinicians, researchers, students, hospital staffers – showing the grit, determination, and heart that is emblematic of who we are at UCSF.
One last update – UCSF’s plan to revitalize its oldest campus at Parnassus Heights is entering a crucial phase. After years of planning, outreach, and work with both the UCSF and the local community, an amendment to UCSF’s 2014 Long Range Development Plan to incorporate the Comprehensive Parnassus Heights Plan’s proposals will go before the Regents in early 2021 for approval. Join UCSF leadership for a virtual Town Hall on the CPHP to learn the latest updates and how you can get involved: Thursday, August 20, noon-1 p.m. Register online!
As Robert Frost said, “In three words I can sum up everything I’ve learned about life: it goes on.” How is life going on for you? Drop me a line at [email protected].
To your health and well-being,
From Room to Zoom: Academic instruction during COVID-19
In early March with the coronavirus heading our way, we knew immediately we’d need to take swift and drastic action in every corner of the University. While all aspects of UCSF have felt the impact, our education enterprise has needed a special kind of heroic effort to enable our students to continue with their curriculum and graduate on time while staying as safe as possible.
Hands-on learning is a key component of the UCSF academic regimen, but how do we certify that a student is ready to work in the field when we have lost opportunities to interact with them directly? Without in-person observation or oral exams, how can UCSF maintain its rigor, ensuring that our graduates represent the top in the field?
Among the biggest challenges was the loss of clinical opportunities. Our School of Dentistry clinics were limited to emergency care. Many of our students are placed with community partners – and those clinics and hospitals could not risk having a trainee around with an anticipated coronavirus surge. One example of the types of significant decisions being made is that radiology, a clinical rotation for medical students, agreed it could move online. The School of Pharmacy had to get creative with scheduling its students because their clinical sites were shut down due to shelter in place.
In the research arena, the Graduate Division had to recall students from around the world, as well as halt student and postdoc work in research labs and social science research, preventing some PhD students from conducting that classic “one last experiment” to prepare for their oral examination.
Academic deans from all four schools and the Graduate Division spent many a long day sharing best practices and ensuring all remained in agreement on the big picture. They reached consensus around core guiding principles that are based on all students graduating on time, along with a commitment from UCSF to keep students as safe as possible.
As we prepare for a new academic year, the schools agreed to bring all students to the Bay Area, even while most of their classes will be online for the foreseeable future. Having them here means they can participate in clinical practice, and it also helps build community and supports their focus on their studies. I’m grateful to our IT and library teams who are helping make sure that students have the necessary computer bandwidth.
Students are being surveyed in some schools to assess their needs and see where they might need support. And Student Health Services is filling an important role, most notably by testing students for the virus and providing valuable mental health counseling. These efforts are ongoing, as the crisis keeps evolving.
Schools are dealing with everything from the extraordinary – like SON going through its national accreditation process at the height of the pandemic in March – to the small but important milestones that can define student life at UCSF like white coat ceremonies and commencement.
Likewise, many students have responded in extraordinary ways, channeling their energy and commitment to helping others as part of UCSF’s response to COVID-19 – by participating in patient screening, research, and community tracing – and to the fight against racial injustice by providing masks and first aid to protesters.
One thing that simply can’t be canceled is the spirit of our educators and students.
My thanks to Liz Silva, associate dean of graduate programs; Sara Hughes, School of Dentistry associate dean of education and student affairs; DoQuyen Tran-Taylor, School of Medicine director of student experience; Maureen Shannon, School of Nursing associate dean for academic programs; Lee Jones, School of Medicine associate dean for students; and Sharon Youmans, School of Pharmacy vice dean, who not only made this story possible – but whose contributions are all for the benefit of our learners.
Tightening the Belts Another Notch: Precarity of UCSF’s financial future
I wrote in June about the challenging financial situation UCSF confronts as a result of the pandemic, and now I bring an update.
We still face most of the constraints that I outlined previously, although we have started serving patients with non-urgent health appointments, some in-person and many through an expansion of our telehealth offerings. UCSF Health is climbing out of its deep hole from the spring, but that may be due in part to a backlog of patients now returning to the hospital and clinics for care. We still don’t know what the long-term picture will be given the unpredictability of the COVID-19 pandemic.
UCSF Health President and CEO Mark Laret wrote to colleagues recently that UCSF Health net revenue declined by more than $300 million in fiscal year 2020. He expects the decline to exceed $700 million in fiscal year 2021 if the impact of COVID-19 continues. To help reduce expenses, Mark and other members of the UCSF Health leadership team are taking the equivalent of 10 percent pay cuts and have frozen hiring on 80 percent of open positions, including those at the executive level.
We hope for more federal funding from the CARES and HEROES act to make up for our revenue losses and increased expenses.
And then there’s the state budget that calls for a $300 million budget cut for the UC system, translating into a $24 million cut for UCSF. Mike Clune, senior associate vice chancellor and chief financial officer, says, “That’s a relatively small share of our overall operations, but it's particularly important for the educational enterprise and also for administrative and academic support.”
That’s why Chancellor Sam Hawgood has asked the schools and administrative divisions to propose multiple scenarios representing a range of budget cuts, most of which can be accomplished through the hiring freeze, which is in effect through June 30, 2021.
Campus Life Services (CLS) faces a particularly difficult financial situation since it depends on revenue from those who use their on-site services, such as Fitness & Recreation, Conference Services, Retail Services, and Parking & Transportation. With only roughly one third of the UCSF community currently working or studying on campus, CLS is projecting an income loss for fiscal year 2020-2021 of $42 million (22 percent). Several CLS units are particularly hard-hit and forecasting revenue losses of more than 75 percent. All of this is in addition to the revenue losses already experienced in the previous fiscal year, from mid-March to June 30, 2020.
Our goal is to do everything we can to reduce expenses so that we can minimize the impact of COVID-19 layoffs and reductions in work on our workforce. The freeze on hiring and salary increases has helped. “We are turning over every stone to see where we can realize savings that don’t affect people’s livelihoods,” Mike says.
To address the near- and long-term impact on our finances, the Chancellor established an Integrated Recovery Committee (IRC), led by Sheila Antrum, senior vice president and chief operating officer for UCSF Health, and Paul Jenny, senior vice chancellor. The IRC is looking at the financial picture and coordinating the work of the various task forces, some of which I wrote about last month. The committee’s charge includes guiding principles that we are all well-advised to keep in mind as we navigate these uncharted waters:
- Focus on the health and well-being of the entire UCSF community and those we serve.
- Provide timely and transparent communication about planning, decisions, and what to expect.
- Manage our financial resources wisely and dynamically, staying focused on our long-term public mission while addressing our short-term challenges.
- Maximize new opportunities and efficiencies, adopting new practices that strengthen our research, education, and care delivery priorities.
- Work together and find strength as one, coordinating decisions, sharing the burdens of our challenges, looking for opportunities that raise all boats.
- Lead with our PRIDE Values, ensuring that we do not inadvertently create inequities.
Not to overwhelm you with lists, but those working on that third item – managing our financial resources – have their own guiding principles that dovetail nicely with these six. They include a commitment to shared responsibility, an eye toward the future, transparency, flexibility, and maintaining the balancing act between what we need and what we can do. All of us have to be prepared to make short-term decisions, with the adaptability in our processes to pivot as conditions change.
We need these guiding principles because we are facing the reality that COVID-19 has fundamentally changed the way UCSF operates. Dealing with multiple challenges is a balancing act as we confront the uncertainty created by this pandemic. “We need to preserve our core,” Mike says, referring to keeping our high standards and maintaining our ability to attract and retain high-caliber faculty, staff, and trainees. And at the same time, we must make sure that the campus stays safe; we stay in compliance with federal and state laws and regulations as well as UC policies; and we don’t let the cuts fall disproportionately.
If you missed the campus and UCSF Health town hall on July 24 that focused on our financial situation, I encourage you to check out the recording. Paul Jenny, Mark Laret, Mike Clune, and Raju Iyer offered a lot of useful insights – including the goal to avoid layoffs if at all possible. One positive note: UCSF has already received $96 million in COVID-related research grants. For more detailed information, the slide deck is available online (MyAccess is required).
Paul reiterated that the biggest challenge is uncertainty. Will the curve flatten? Will we face another shelter-in-place order? The impacts could be huge. We have to prepare for the worst. By doing so during the last economic crisis, the Great Recession of 2008, UCSF emerged stronger than ever.
Brazilian author Paulo Coehlo said, “Life has many ways of testing a person’s will, either by having nothing happen at all or by having everything happen all at once.” Sacrificing to the degree necessary is a tall order, but we can do it.
Yours, Mine, and Ours: Cybersecurity – we can really get burned!
Now that so much of our work has moved online, keeping up with BigFix and security upgrades is tantamount to wearing a face mask – both are intended to prevent unwanted intrusions. This was driven home by a ransomware attack in June that has cost the University more than $1 million and remains under investigation. In addition to the ransom, there are other substantial costs, including legal fees, remediation activities, lost productivity of researchers, and diversion of IT resources.
“Since the shelter in place began, we’ve had a lot of concerns in IT security,” says Patrick Phelan, UCSF’s chief information security officer. “Number one, the global threat landscape has dramatically changed. The volume of attacks is off the charts.”
One of the key attacks involves phishing – using a fake email or website to lure someone, possibly to put malware on their computer. “Users are getting phished more than ever,” Pat says. “A huge percentage of phishing messages are COVID-themed, and given the nature of our work at UCSF, that’s pretty good bait.”
He gives one chilling example: A phisher took Johns Hopkins University’s fantastic COVID map, which so many of us have used, and sent it out from another site loaded with malware. It looked perfect. “It made the rounds at UCSF,” he says. “We were aware of it pretty early and were able to neutralize the threat for the bulk of our users.”
“Five years ago, you could spot phishing a mile away because of the awkward wording, but now, even very IT-literate people are enticed,” he says.
And that’s the point: Don’t feel ashamed if you fall for a scam. It may feel embarrassing, but to minimize and correct the damage, you need to let IT know as early as possible.
We all have a “report phish” button on our Outlook email toolbar; don’t be afraid to use it. It’ll go to an automated system for forensic analysis, and the machines will let the pros know which ones need attention.
Simply put, IT wants to know everything that seems like a threat.
When you see something, say something – to the IT Service Desk. Call them at 415-514-4100. The biggest vulnerability is email. It’s the easiest gateway into the system. UCSF has many safeguards, but hackers are persistent. One new trick has people creating a fake email using the real name of someone at the institution. You might get a note from a Gmail account with, say, my name on it, saying I need a response right away. Be careful of those. At the least, write back to my UCSF email to verify that I did send it. And, for goodness sake, do not open any attachments unless you are certain they’re legitimate!
Having a workforce that is hyper-aware of IT security issues is an ideal situation. Christian Sisenstein, the supervisor for the IT security incident response team, tells us, “Our automated security systems are not a silver bullet. They will not catch 100 percent of attacks. Supplement those systems with users who understand what to look out for and when to report things – that’s a key component of our defense strategy.”
The other challenge these days is that, with people working from home, many folks are using personal devices that may not be as secure as a UCSF-issued desktop. That’s one of IT’s biggest concerns in this pandemic. I implore you – please make sure the computers you’re using follow the IT minimum security standards. If you need assistance, call or email the IT Help Desk. They’ve got software you can download to bring your system into compliance.
So when I remind you to “stay safe,” even though I generally mean from the real-world virus, I’m also asking you to be cyber-safe too.
Dan’s Tip of the Month
How can those of us who are not Black sympathize with what it’s like to be Black in the wake of George Floyd’s death? After hearing from friends and colleagues, Assistant Professor Ashley McMullen (who was featured in the July 9 SF Business Times) decided to use storytelling to break down barriers and highlight recent experiences of her Black colleagues to create understanding. She collaborated with the medical storytelling podcast The Nocturnists, founded by fellow Assistant Professor Emily Silverman, and launched Black Voices in Healthcare. With compelling illustrations by Ashley Floréal and original music by Janaé E., Ashley has thus far hosted five riveting episodes elevating and exploring the unique challenges and personal insights woven into being Black in healthcare. Each runs about thirty minutes and all are worth the listening time.