A Very Bad WeekJun 1, 2020
During my early years in the 1950s and 1960s, racism was open. I grew up in Newport News, Virginia as the child of liberal “Yankee” parents from Boston, in a segregated society: schools, bathrooms, swimming pools and more were “white” or “colored”; and my school-teachers frequently and unashamedly made racist comments in class as integrated schools loomed following the 1954 Supreme Court decision in Brown v Board of Education of Topeka. As a medical student in the late 1960s, I spent a summer doing clinical work at the local hospital and there I heard patient presentations on rounds that were openly racist. Over the ensuing decades, much has changed outwardly but racism persists, sometimes visibly surfacing as with this week’s episode in Central Park and most tragically and despicably, the murder of George Floyd by a police officer in Minneapolis. Outrage has been expressed appropriately in many ways, but unfortunately, uncontrolled demonstrations have taken place across the country, including in Denver.
As the Colorado School of Public Health, we ask again what we can do as a community and as individuals to change these root causes of poor health. Research on the topic is abundant and confirmatory that racism harms health through many pathways; the path to change is not more research, but using what we already know to affect change. Evidence-based advocacy is needed, but many of the pathways to action have long been blocked. This is also a time for conversation within our school’s community about what we can do to dismantle systemic racism. To that end as a tri-campus community we need to engage in honest conversations and action to be part of long-needed solutions (e.g., policy changes and practice). There are no easy answers to solve the issues of injustice and racism in our society. However, we owe it to our community to demand change and accountability. To be silent is to be complicit. We stand in agreement with the American Public Health Association that racism is an ongoing public health crisis that needs our attention now!
Previously I used John Meacham’s term—the “partisan pandemic”—in referring to the devastating COVID-19 epidemic. The deleterious consequences of this politicization in the United States continue to worsen. Remarkably, wearing of masks, which protects others from infected droplets, has been tarred with political symbolism. And, there is the Pennsylvania State House story—allegedly that Democratic members were not informed that a Republican member had tested virus-positive.
Of greatest concern in politicization’s fallout is the announcement by the President of his intent for the United States to leave and not fund the World Health Organization (WHO), originally chartered in 1948. Per its Constitution, WHO has as its objective “…the attainment by all peoples of the highest possible level of health.” All in public health know WHO’s holistic definition of health as: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Over more than seven decades, the WHO has had triumphs, including the eradication of smallpox, and failures. The organization has long been hobbled by its bureaucracy. In his 2018 book about his time at the CDC, Fears of the Rich, The Needs of the Poor, former CDC Director William Foege said, “Perhaps we will not get the strong WHO the world needs…a WHO that has an adequate budget, a way to reduce the political barriers to employment of the best people possible, and a mandate to follow the science rather than the politics.” Tedros Ghebreyesus, the WHO’s current Director General, has had a reform agenda, but now geopolitics seem to have overtaken the organization. The enormity of a U.S. withdrawal from the WHO as an uncontrolled pandemic is in progress is evident, but the consequences for global health are sweeping. The United States would lose its role as a leader in global health. It would no longer be partnered in the global effort to control disease and advance health, its monetary support would be withdrawn, and it would no longer be teamed with other nations to combat global health problems. My view, undoubtedly shared across the Colorado School of Public Health, is that withdrawal from the WHO is a mistake and wrong.
Turning back to the COVID-19 pandemic and modeling, our team released another report today that provides insights into the course of the epidemic following the reduction of some restrictions. With a 13-day lag from infection to hospitalization, the index of the epidemic that we track, the modeling now provides a look at the consequences of “Safer at Home” through mid-month. The findings are what we anticipated: a reduction in social distancing and a rise in the effective reproductive number. These changes are an unavoidable consequence of moving away from Safer at Home. Some of the most critical implications of the current findings: the need to maintain a substantial level of distancing and other measures for the long-term; older people and others who are vulnerable need to protect themselves with sustained distancing comparable to the Safer at Home phase; and masks provide benefit and should be used. We are looking at the effectiveness of contact tracing as it is implemented at the state and local levels. There will be a follow-up next week.
Until next week,
Jonathan Samet, MD, MS
Dean, Colorado School of Public Health