The COVID-19 Pandemic: Deja vu all over again!Oct 6, 2020
Last week's title was That was the week that was, equally applicable to this week and leading me to this Yogi Berra quotation. The pandemic piled on with a White House super-spreading event and the President hospitalized with COVID-19.
Before going there, a particularly valuable All-Faculty Retreat took place on Friday. Attendance was record-setting at a peak approaching 120, possibly because no one faced a long drive and more likely because of the topic: Addressing Structural Racism and Diversity, Equity, and Inclusion in Public Health. The retreat was carefully planned and useful background materials were assembled: a compilation of resources on anti-racism and a summary of current and planned initiatives by each of the ColoradoSPH organizational units. On reviewing the latter and hearing the presentations at the retreat, the scope of the activities in progress and planned is broad. Across the units, many discussions have been held and are ongoing, curriculum is being reviewed, and admissions and hiring approaches are being examined.
And note that the October speaker in the Dean's Seminar Series is Cheryl Anderson, founding dean of the University of California San Diego Herbert Wertheim School of Public Health and Human Longevity. Cheryl's topic is: Racism is a Public Health Crisis — Opportunities and Challenges for Schools of Public Health.
Back to the pandemic's remarkable week. Epidemiological roulette caught up with the White House last week, possibly because of a super-spreading incident at the announcement of the nomination of Judge Amy Coney Barrett for the Supreme Court. The New York Times provides annotated photos of the event, documenting close physical proximity of attendees who were not wearing masks. With the first attendee (Hope Hicks) testing positive four days after the event, there may be more cases as those infected become symptomatic. Surprisingly, per media reports, a systematic contact tracing process has not been implemented.
There are "lessons learned". First, the testing strategy in place, as apparently the sole measure, did not protect the President and First Lady from becoming infected. Second, aerosol transmission likely dominated the transmission of SARS-CoV-2 at the event, perhaps particularly during the indoor part of the event. And, third and speculatively, would the outbreak have taken place if face coverings had been used and recommended distancing had been in place? Fortunately, although ill, the President appears to be recovering as I write this commentary.
The White House outbreak further emphasizes the public health significance of super-spreader events and the necessity for ongoing measures to guard against them. A favorite recent example of prevention: the evacuation of the student section at the Southern Methodist University football game on Saturday for failure to wear masks and maintain distancing. A readable article in The Atlantic argues that super-spreader events cause the majority of cases and that strategies should be directed at deterring them. The author proposes backward tracing to find the source clusters rather than prospectively identifying the contacts of incident cases as is the usual approach. A large contact tracing study in India showed a distribution of secondary cases compatible with super-spreading individuals. The lead author, Ramanan Laxminarayan commented: "Here in this study, we found that 8% of the people who were infected were responsible for 60% of the infections that grew out of these primary cases." For a general description of super-spreading, I recommend this article by Lee and Frieden.
The pandemic remains unconquered and threatening. In the United States and globally, some locales are experiencing a rise in cases. In Colorado, case numbers and hospitalizations are increasing and the modeling team's estimates of the effective reproductive number (Rt) have been above one for several weeks. This shift from below one has multiple potential explanations: gatherings over the Labor Day weekend, the opening of some K-12 school districts and colleges and universities, and more time indoors as temperatures drop. The next few weeks will be critical as we approach the holidays.
Wear your masks and pick your events carefully,