Dean's Notes

Another unprecedented week! Colorado's epidemic curve continues to rise steeply and the Presidential election is finally decided.

Since mid-September, week over week, Colorado's epidemic curve has risen ever more steeply (see figure). The most recent estimate of the effective reproductive number (R_E) is 1.66, well above the range around 1.0 where it should be. I am concerned that the synergistic combination of a rising epidemic curve, plus holiday travel and gatherings, will accelerate the epidemic and increase cases, hospitalizations, and deaths. The most recent modeling report from the Colorado COVID-19 modeling team explores scenarios that describe how unfortunate this combination might be. The models projected that the April peak of hospitalizations would be reached; we are now at that point. Inevitably, COVID-19 cases and deaths will continue to rise. 

I continue to be asked the "why" question. My answer is unchanged and covers our collective failure to reduce transmission. Quoting from an article by New York Times reporter Jack Healy, with whom I spoke last week: "Dr. Samet said pandemic fatigue and people's yearning for normalcy after months of lockdown and mask wearing may be playing a part in the recent surge. 'Everybody's impatient,' he (Samet) said. 'People want to have their lives back. But it's too early to do that.'" Coloradans need a return to strict adherence to the behaviors that helped suppress SARS-CoV-2 transmission previously. Policy levers will help, but are not sufficient by themselves, unless there is a dreaded return to a full lockdown. 

Turning to the election results, the implications of the Biden-Harris victory for public health are profound. The disorganized and conflicting approach of the Trump Administration has failed to slow the pandemic in the United States, now causing record numbers of cases and threatening to overwhelm healthcare resources. As I have commented previously, the Centers for Disease Control and Prevention have been marginalized, noted experts like Dr. Anthony Fauci have been undermined, and misinformation has been propagated repeatedly. Already, the incoming administration is forming a Coronavirus task force that will begin its work this week. As the states continue to struggle with controlling the pandemic, cohesive coordination among the Administration and the national public health agencies will be beneficial. 

Other aspects of public health will benefit from the change in administration, particularly those related to the environment. As the Trump Administration began, I joined with colleagues Bernie Goldstein and Tom Burke, both former heads of the EPA's Office of Research and Development, in writing a commentary entitled: "The Trump Administration and the Environment — Heed the Science." Looking back, science-based approaches have been displaced by a broad and systematic strategy of deregulation. Tom Burke and I summarized the scope of deregulation related to the environment in a 2020 article in the Annual Reviews of Public Health: "Deregulation and the Assault on Science and the Environment." After putting the full picture of deregulation at the EPA together, we were dismayed by the systematic destruction of bedrock measures to assure that science and policy are linked. There is much to rebuild to reestablish that linkage. Initiatives to mitigate climate change will return to the national agenda.

Once again, the course of the pandemic over the next few weeks is critical — in Colorado, the United States, and the world. Do all that you can to "bend the curve."