The COVID-19 Pandemic: Reopening and Public HealthJun 29, 2020
Looking across the United States and the world, the COVID-19 pandemic is rising, falling, or has fallen. In the United States, there are troubling surges in some states (Florida, Texas, Arizona, Utah, and more) that come four months after cases first soared. In Colorado, deaths have fallen, hospital counts are stable, and case counts are increasing slightly. Explanations abound as to the differences among the states, but the most critical factor is how locales moved from being shut down to opening up. In some states, young people are being blamed as responsible for increases in cases and deaths by behaving as though pre-COVID-19 life could be resumed, and some states overshot in their relaxation of social distancing measures.
In Colorado, measured changes continue with the announcement of the next phase for controlling the pandemic: Protect Our Neighbors. This phase gives counties, working with local public health agencies, the opportunity to assume control over their reopening if metrics for transmission, treatment, and control can be met. It also acknowledges the heterogeneity of the pandemic across Colorado. We are at the right point to enter this next phase, but close monitoring is critical—a point of collaboration between the Colorado COVID-19 Modeling Group (led by the Colorado School of Public Health) and the Colorado Department of Public Health and Environment.
The delicate balancing continues of the positive economic consequences of reopening with the risk of causing a resurgence of the pandemic. There is no scale for this balancing and, in practice, we see that there are different scales that vary by region and the politics of those doing the balancing. Regardless, a point at which case numbers exceed medical care capacity must be unacceptable to all. Harris County Judge Lina Hidalgo, who oversees the Texas county that includes Houston, spoke eloquently and with frustration as intensive care beds filled to capacity. "Since when did we decide as a society that instead of saving a life and preventing the spread of the virus, we would treat human lives, the lives of our neighbors as collateral damage to be dealt with?"
For the first 20 years of my career, I practiced as an academic pulmonologist, often putting patients on ventilators to support their breathing. The dilemma of putting one person but not another on a ventilator is to be avoided, even when protocols have been developed for doing so. I remember this dilemma in the context of renal failure as an intern (long ago) at the University of Kentucky in 1970-1971. Coverage of dialysis and transplant by Medicare began in 1972. Prior to that date, committees reviewed candidates for acceptance into dialysis and transplant programs. I have not forgotten one of my patients, a 22-year-old construction worker, admitted for peritoneal dialysis to control his renal failure before his interview with the committee. He was rejected for treatment for renal failure by the committee and I was left to tell him the decision—his death sentence. The Medicare coverage beginning in 1972 reflected a societal judgment and political action rendered when cost was the barrier to a treatment necessary for survival.
The epidemic’s course over the summer months will be defining for our lives or for the rest of 2020 at the least. We need to find that right balance point; Colorado continues to do so. And, a surging epidemic could distract from broader public health needs and deflect attention from conversation and action on structural racism and health and economic inequity. We need to ensure that this work continues in tandem.
Wear your mask,
Jonathan Samet, MD, MS
Dean, Colorado School of Public Health