The Colorado COVID-19 update: Hospitalizations remain on a plateau with the October 18 hospital count at 179 versus 165 on October 11. Test positivity, however, has risen to 7% at the end of last week, an unambiguous increase. The picture of wastewater concentrations of SARS-CoV-2 across the state is mixed with some water systems experiencing a rising concentration while others are not. Looking to Europe, the epidemic curves of Germany, France, and Italy, which rose sharply in recent weeks, have turned and are declining and the United Kingdom’s epidemic curve remains flat. The list of Variants of Concern is unchanged. Summarizing the picture—uncertainty still prevails.  

Academia has returned to its 2019 guise with in-person meetings, including the upcoming American Public Health Association meeting in Boston, and a reactivated lecture circuit. Many meetings had been postponed by the pandemic. Now, the fall schedule is filled with make-up events. On October 14, I spoke at Johns Hopkins on the occasion of the 100th anniversary of the American Journal of Epidemiology, which began as The American Journal of Hygiene. Looking back over the 100-year span of topics was informative. The first issue included five articles: four describing experimental research and the fifth was a survey of hookworm infection in military recruits. The September 2022 issue included 16 articles covering a wide range of topics: structural racism, health inequities, curriculum design for incorporating antiracist principles, sleep, and more; one addressed a methodological problem in sampling from Google trends data; and the sole article related to infectious diseases was titled, “Heterogeneity in Spatial Inequities in COVID-19 Vaccination Across 16 Large US Cities.”  

Of course, neither the topics nor the methods could have been anticipated 100 years ago. For the presentation, we documented the slow shift in the journal’s content as the diseases threatening human health changed over the journal’s first century from 1921 through 2020. It was not until the mid-1960s that the American Journal of Epidemiology published significant numbers of articles on cancer, heart disease, and lung disease. These and other chronic disease topics were not dominant until the 1980s. The images below provide word clouds for the titles in the journal’s first year and its most recent year:

 

Epidemiology remains a fundamental method of public health, providing insights into the occurrence and causes of disease. A typical definition of epidemiology is: “The study of how disease is distributed in populations and the factors that influence or determine this distribution.” Such definitions do not convey that epidemiology is a science that has the purpose of making a difference. Wade Hampton Frost, the first chair of epidemiology at Johns Hopkins, insightfully wrote, “However, epidemiology is never, in fact, developed as a purely descriptive science. In collecting facts about the distribution of disease, the purpose in view is always to arrive at a better understanding of its nature, sources, means of spread, and eventually its control.” A comment that aptly captures why we do epidemiological investigations. 

My comments at the event ended with a look to the future—to the 200th anniversary, in fact. Disease in populations, whether human or animal, will remain the target of epidemiology, but the methods and the data will change. Is the 2022 article on Google trends foretelling a future of mining massive data sets from sources that we can’t imagine at present? How do we prepare 2022 graduates for what they might encounter at the end of 40-year careers in 2062? We need to help our graduates to gain skills and form an approach to lifelong learning—a competency lacking from the 22 competencies required by the Council on Education for Public Health.  

As another of my recent itinerant academic wanderings, I was at the Medical University of South Carolina (MUSC) to deliver the inaugural Susan Rosenblatt lecture, developed in her honor by Michael Cummings, a long-term colleague in tobacco control. Husband-and-wife duo, Stanley and Susan Rosenblatt, courageously took on the tobacco industry in Broin v. Philip Morris Companies, Inc., a class action brought by flight attendants against the tobacco industry. That case led to a $300 million settlement that established the Flight Attendant Medical Research Institute (FAMRI), a critical funder for research and care related to secondhand smoke. The Rosenblatt’s also launched the Engle class action case, which initially resulted in a $145 billion judgment against the tobacco industry. The class, originally certified by the Florida Supreme Court, was later dissolved, launching a series of individual post-Engle cases in Florida.  

I testified in the first phase of the Engle case, largely on the causation of disease by smoking, using the approaches to establishing causation that I addressed in last week’s commentary. I admire the Rosenblatts, two attorneys with the courage and fortitude to take on the tobacco industry. From the Rosenblatts and others, I have learned that litigation can benefit public health. One key outcome of the tobacco litigation was access to the tobacco industry’s internal documents. The documents revealed the industry’s long campaign to mislead the public and supported the Department of Justice’s case against the industry under the Racketeer Influenced and Corrupt Organizations (RICO) Act. Documents are now being compiled that relate to other industries, for example, the opioid documents jointly curated by the University of California, San Francisco and Johns Hopkins University. There are other mechanisms by which litigation may benefit public health: the use of settlement funds as with FAMRI, enforcement of public health measures, and holding manufacturers responsible for defective, disease- and injury-causing products.  

More trips and talks to come in 2022. 

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