Dean's Notes

The COVID-19 pause continues in Colorado. Hospitalizations were at 182 statewide, a drop from last week but a return to the week before. Wastewater trends across the state are little changed, while test positivity tracked by the Colorado Department of Public Health and Environment is turning upwards. Vaccination data indicate a gap for those under age 11 and only 27% of Coloradans have had a bivalent booster.  

Worried about the next pandemic? After all, it is never too early to worry about the next one and we just dodged the “tripledemic,” albeit with two familiar viruses in the trio. Sociologist Zeynep Tufecki, the New York Times columnist now at the Columbia Journalism School, nominates avian influenza as the next pandemic-causing pathogen. Her nomination was made in a recent commentary titled: “An Even Deadlier Pandemic Could Soon Be Here.” She points to the bird flu strain H5N1, which is classified by the Centers for Disease Control and Prevention as highly pathogenic. This strain has caused outbreaks among poultry, but is now circulating more and more among migratory birds, bringing the possibility of global spread and introduction to humans through infected animal populations. In fact, last week Colorado State Parks and Wildlife officials confirmed the deaths of a bear, a mountain lion, and a skunk from H5N1.

Concern about this pathway for igniting a new pandemic has been heightened by a recent report of spread of H5N1 among mink at a large mink farm in Spain. The outbreak’s significance lies in its documentation of spread within a mammal population, previously thought to be infrequent. It also suggests that farmed minks could become a bridge for avian flu to move from wild birds to human populations. On the presumption that there could be an H5N1 pandemic, Tufecki points to preparatory measures that might be undertaken: vaccine development and stockpiling, vaccination of high-risk people, and appropriately targeted surveillance.  

How bad might an influenza pandemic with H5N1 be? I don’t know and neither does Tufecki. For a fictional account of the world post “Georgia Flu,” read Station Eleven by Emily St. John Mandel. This 2014 book was a National Book Award Finalist, and, per its cover, now a series on HBO Max. The post-apocalyptic landscape for the book’s engaging story is bleak and leads to another unanswerable question: could an infectious disease lead to the collapse of civilization? Certainly, historians would respond to the question by affirming that epidemics have imprinted history.   

I was in Ottawa last week to give the Janet Wendy and John Last Lecture at the University of Ottawa’s School of Epidemiology and Public Health. I mention the lecture to champion the legacy of John Last who died in 2019 at the age of 92. The leading reference source in public health is titled after John and two other public health pioneers: Maxcy-Rosenau-Last Public Health and Preventive Medicine. Last also edited A Dictionary of Epidemiology and A Dictionary of Public Health. I often turned to A Dictionary of Epidemiology to resolve seemingly endless debates among epidemiologist colleagues, who notably cannot even agree on a definition of “epidemiology.”  

Beyond his skills as an editor, Last made visionary contributions that remain relevant to today. In my presentation, I highlighted his senior authorship of a landmark 1985 paper on biomass fuel burning, joining with Kirk Smith who globally championed remediation of biomass fuel burning for decades: “Biomass Fuel Combustion and Health” published in the Bulletin of the World Health Organization. In books and articles, he addressed the links between ecological change and human health. The first edition of his book, Public Health and Human Ecology, was published in 1987. Other articles that I mentioned in the lecture addressed the health of immigrants and the ethical responsibilities of epidemiologists to research participants and investigated populations.  

I make an effort to read books, often mysteries, set in places that I am visiting. Louise Penny’s The Madness of Crowds made the Denver-Ottawa round trip, albeit set in Quebec and not Ottawa (note to Canadians, I do know the difference). The title and the story play off an 1841 book by Charles Mackay, Extraordinary Popular Delusions and the Madness of Crowds. In Penny’s book, the “madness” is about a suppressed statistical analysis done for the government that leads its author to conclude that euthanasia of susceptible, disabled, and elderly persons with COVID-19 is an efficient strategy. In the book, the idea reaches the public, spreads and polarizes, as too often happens in the current era of viral spread of bad ideas. As I wrote these comments, I was struck by the parallel to last weekend's story in the New York Times, which chronicles the spread of ideas in Japan from a Yale economist, Yusuke Narita. His solution to Japan’s demographic crisis of an aged population—mass suicide and perhaps euthanasia. He has back-pedaled, but his reprehensible ideas have spread. 

A remarkable medical and scientific villain has a place in the book’s twisting plot: Donald Ewen Cameron. If I once knew his story, I had forgotten it, but will not after reading the Wikipedia entry. His immoral life is outsized and beyond fiction: a role in the Nuremberg trials; misdirected theories; and the unconscionable experiments of the MKULTRA Subproject 68, which were secretly funded by the Central Intelligence Agency. The project’s findings were the foundation for an interrogation manual.  

My recommendation as to whether to read The Madness of Crowds is guarded, as the plot tediously unfolds. But it is another example of pandemic-influenced fiction. I have more stacked up.  

For those who read these commentaries regularly, you may have noticed that I am falling off a weekly cadence. This is good news since the fluctuations of the COVID-19 pandemic are no longer so significant nor the news so acute as to call for weekly reflections. But stuff continues to happen that is comment worthy. That will always be the case in public health and these commentaries will continue



Jonathan Samet, MD, MS
Dean, Colorado School of Public Health