The COVID-19 Pandemic: COVID-19 is in retreat in Colorado, but stay tuned!Feb 22, 2022
This commentary comes two years after my first to mention COVID-19 on February 19, 2020. Since then, I have written 99 commentaries on the COVID-19 pandemic, making this number 100. I began to write these columns on a weekly basis in March 2020, replacing a monthly column that covered both the Colorado School of Public Health and general public health happenings, and I did not anticipate that there would be 100 of them (or more). But each week since March 13, 2020, when I wrote my first weekly COVID-19 commentary, has come with notable happenings that offer lessons learned for control of the pandemic and for public health more broadly. Writing leads me to synthesize what has happened and to coalesce the most critical events. In general, I try not to read what I have written, fearful of what inanities I will find. But I did skim through the 2020 commentaries, and some highlights are at the end of this week’s note. Of course, I only include quotes that seem prescient now and not my many erroneous speculations.
The good news for Colorado does continue. The number of Coloradans hospitalized for COVID-19 dropped to 536 on February 18, down to less than one-third of the Omicron peak. Our modeling team released a report on Thursday that offers encouraging projections. The epidemic curve is descending on a trajectory that drops the number hospitalized to below 250 by month’s end. The drop reflects the high rate of immunity in Colorado’s population consequent to vaccination and the high transmissibility of the Omicron variant. The modeling report finds almost all Coloradans are now protected against more severe COVID-19 that would result in hospitalization or even death. The report cautions that this COVID-19 vacation can be interrupted by another SARS-CoV-2 variant, particularly as immunity wanes.
We should take advantage of this lull. Mask mandates have been dropped throughout Colorado’s counties; Boulder’s ended on Friday, February 18. The picture for schools is mixed. On the University of Colorado Anschutz Medical Campus, mask requirements end on February 28. The New York Times offers a compilation of expert opinion that lines up with my own view: in most settings a mask is no longer needed to protect others because of the drop in the rate of infection, but consider wearing a “well-fitting mask”, e.g., an N95 respirator, if you want to protect yourself. The CDC is lagging with its recommendations, while claiming it will “follow the science.” On Sunday, the CDC website advised residents of Boulder and Denver to wear masks indoors, out of line with county policies.
The notion of “following the science” sounds on-target until it’s dissected for what it means in practice. For me, these three words mean systematically tracking the relevant evidence as it cumulates and basing guidance on its overall “weight” on the critical question for decision-making. Done correctly, the evidence has been collected and evaluated in a transparent and unbiased fashion and key uncertainties are highlighted. Some form of systematic review, done in an ongoing fashion, should be central in “following the science.” We don’t know what the CDC does, but we should. There are numerous “living” systematic reviews in progress related to COVID-19 that exemplify the transparent accumulation of evidence, for example, on COVID-19 trials and preventive interventions. A living systematic review is in progress on smoking and COVID-19, a topic that has been controversial throughout the pandemic. I have consulted the review periodically as background for presentations. The CDC should have the resources needed to carry out such reviews.
And continuing to pile on the CDC, an article in yesterday’s New York Times, “The C.D.C. isn’t publishing large portions of the Covid data it collects,” lays out disturbing practices around data handling and release. According to the article, the CDC has not provided potentially useful data on hospitalization stratified by age, race, and vaccination status, even though available internally. A dashboard on wastewater data was just put into place; see the latest modeling report for how useful the wastewater data might have been. I found this string of quotations in the article from the CDC to be tone deaf to the pandemic’s urgency: “Kristen Nordlund, a spokeswoman for the C.D.C., said the agency has been slow to release the different streams of data ‘because basically, at the end of the day, it’s not yet ready for prime time.’ She said the agency’s ‘priority when gathering any data is to ensure that it’s accurate and actionable.’”
I am looking forward to seeing colleagues and students on campus face-to-face and not mask-to-mask. Have you had the experience of seeing someone whom you know well and being uncertain as to who they are because of a mask?
Quotations from 2020December 21, 2020—a year’s end summary.
“The year 2020 started quietly. The New York Times headlines on January 1, 2020, were anodyne and hardly portended what was to come. Of course, the run-up to the 2020 election was well underway. The Dow Jones average was set to soar to a new record on January 2, but below its current new record-setting levels. There were not yet news stories about an emerging virus. China had reported the outbreak on December 31, 2019, as told in the first New York Times story about the emerging epidemic on January 6. Our vocabularies were yet to include SARS-CoV-2, COVID-19, lockdown, masks, and social distancing.”
February 19, 2020—a comment on vaccine hesitancy at the pandemic’s start.
“As the new coronavirus (now named Coronavirus Disease 19 or COVID-19) epidemic surges, vaccine development and the timing for a new vaccine are under hopeful discussion. In the setting of a pandemic of a disease with a high case-fatality rate, would there be vaccine hesitancy?”
April 13, 2020—the epidemiology versus the economy story starts.
“Now, a delicate and impossible balancing begins. How soon can the policies that have increased social distancing be relaxed and by how much? The balancing is between resurgence of the COVID-19 epidemic and its human costs, and the ever-shrinking economy and its consequences.”
April 27, 2020—the impact of the COVID-19 pandemic on public health emerges.
“Pivoting, we should begin to anticipate the consequences of the COVID-19 pandemic for public health generally. We were moving into the era of Public Health 3.0, defined by a broad framework that addressed the societal determinants of health in a multi-sectoral approach. That broader vision is now likely to be replaced by an evolving set of constructs, let’s call them Public Health X.X, as we move from the necessary immediate focus on containment of the SARS-CoV-2 virus to addressing its sweeping legacy of harms to public health.”
June 1, 2020—the inequities of the pandemic become apparent.
“The COVID-19 epidemic continues to lay bare the deep structural problems that are root causes of so much disease and of shortened lives: worsening economic inequality and persistent racism. Perceptions that these problems have faded are mistaken, too optimistic, and wrong.”
July 6, 2020—masks are politicized.
“I am both frustrated and angry that a basic tool of public health has been rendered a political symbol. Why should we wear masks? and is there a scientific controversy about doing so?”
November 18, 2020—administrative chaos affects pandemic control.
“No one is running the circus as every metric for the COVID-19 pandemic soars in most states and in Europe…I summarize as follows: the virus has a plan, but we do not (with apologies to humankind for anthropomorphizing the virus).”
Hoping for a healthy spring,
Jonathan Samet, MD, MS
Dean, Colorado School of Public Health