Dean's Notes

The Omicron variant took over in Colorado the week before the winter break holiday and Christmas, and then drove up the epidemic curve until last week. Since then, we have seen declining case numbers and dropping test positivity, although the percentage of test positivity remains very high at about 26% as of Friday. With regard to hospitalizations, after reaching a plateau of around 1,650 Coloradans hospitalized for confirmed COVID-19, there was a slight drop at week’s end. What can we expect over the next month? The wave of the highly infectious Omicron variant has undoubtedly raised the level of Colorado’s population immunity adding to that from vaccination. If Colorado’s experience mirrors that of the United Kingdom or of New York City, we can expect a rapid decline in cases and a slower decay in hospitalizations. Finally, good news after the six-month onslaught of the Delta and Omicron variants.

With a high rate of naturally acquired immunity at the moment along with that from vaccination, some have offered optimistic predictions about the course of the COVID-19 pandemic. In a commentary last week in The Lancet, Chris Murray, who heads up the Institute for Health Metrics and Evaluation (IHME) gives away his prediction with the title, “COVID-19 will continue but the end of the pandemic is near.” He optimistically concludes, “The era of extraordinary measures by government and societies to control SARS-CoV-2 transmission will be over. After the omicron wave, COVID-19 will return but the pandemic will not.” Harvard experts delivered a similar message. Epidemiologist William Hanage correctly notes, however, that “endemic” does not mean “harmless” and that continued mutations can bring surprises—a lesson already learned repeatedly. My view is optimistic for the short-term and more guarded for the long-term because of the specter of further mutations.  

I am watching two initiatives of the Biden Administration with interest: the provision of 500 million rapid tests; and 400 million N95 respirators to U.S. households. Both require the implementation of nationwide systems that will lead to success for the programs and the wanted public health impact. Hopefully the goals of these initiatives will be met, as universal access to rapid tests and the most protective respiratory protective devices can make a difference. But until now, we have seen failures at the national level in surveillance, testing, and communications, for example.  

I have just finished two “insider” accounts that tell the stories of these well-known breakdowns: testing at the pandemic’s start; a lethargic initial response; imprecise communications and conflicting messaging; and more. The two books: Uncontrolled Spread: Why COVID-19 crushed us and how we can defeat the next pandemic by Scott Gottlieb, former FDA Commissioner; and Preventable: The inside story of how leadership failures, politics, and selfishness doomed the U.S. coronavirus response by Andy Slavitt, former head of the Centers for Medicare and Medicaid Services. The titles give away the punchlines. Have lessons been learned so that we can move from bumbling to competence in order to implement the sequence of protocols that will put tests and respirators in every household? So far, our household has been successful in placing our order with the U.S. Postal Service website. Test kits are slated to ship in late January—we will soon learn if that is the case. In Colorado, there were hiccups in following through in making KN95 respirators available through libraries and other public venues. 

These books offer snapshots of events that involved their authors. Their views are engaging, and the insights offered have value in assessing strategies at the moment. In contrast, John Barry’s The Great Influenza was published in 2004, nearly nine decades after the 1918 pandemic. With the skills of a historian and the opportunity to examine the story retrospectively, he wrote a masterfully insightful book that offers wisdom for the COVID-19 pandemic. For the future “John Barry” who writes the story of the 2019-20XX(?) COVID-19 pandemic, these two books and others will be in the footnotes documenting what happened decades in the past. For now, still applicable “lessons learned” can be found along with these insider authors’ opinions that their guidance could have helped if heeded.  

Stay well, 

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