The COVID-19 pandemic: The epidemic smolders and Colorado burnsAug 18, 2020
Epidemics set their course. Our public health interventions purposefully alter that course with varying success, depending on the virulence of the infectious agent, the force of the measures taken and the public’s adherence to them. As K-12 schools, colleges and universities reopen, Colorado’s epidemic is smoldering. An uptick in mid-July was highly concerning, but in recent weeks the epidemic curve has declined and the effective reproductive number (RE) has remained below one. The uptick may have been caused by insufficient social distancing as bars were reopened in June and travel and gatherings took place over the July 4th holiday. The decline since may have been driven by the closure of bars at the end of June, rising use of masks, and more careful social distancing by Coloradans who saw the surges in nearby states.
Yesterday’s COVID-19 discussion in our collaborative series with the Denver Museum of Nature and Science focused on Latin America, featuring two friends and colleagues: Dr. Maurico Hernandez-Avila, Director of Economic and Social Benefits at the Mexican Institute of Social Security (IMSS) and Colorado’s Dr. Edwin Asturias, Professor of Pediatrics-Infectious Disease and Epidemiology. Edwin is currently in Guatemala, his native country, advising the Guatemalan President and government on COVID-19. The contrast with Colorado and the United States was informative: severe resource constraints, lack of access to reagents for testing, inadequate personal protective equipment (PPE) initially, and sparse primary medical care in Guatemala. In Mexico, the response is complicated by a very high percentage of vulnerable adults, combining obesity, diabetes and hypertension. There, IMSS has instituted training for employers. Edwin covered the heterogeneity of the epidemic across Central America, noting that Panama had been particularly hard hit because of its role as a transport and shipping hub.
I have commented previously on school reopening. Since then, there is little additional relevant evidence. Anecdotes show that outbreaks will occur if social distancing is not maintained. In Colorado, K-12 is opening in differing ways and at differing times; perhaps through careful evaluation, we can learn what works best. Not surprisingly, our modeling shows that school reopening could drive the epidemic curve upward if contacts that transmit infection are increased. The state’s major residential campuses are also opening now, bringing the challenge of limiting interactions in spaces designed to promote mingling among students and faculty. The football season has become controversial and politicized, as with other consequences of the pandemic. A contact sport brings risk of transmission. For a particularly graphic example, read this paper, written by a former student, on transmission of Norovirus infection during a game. My prediction (but not taking bets): too many outbreaks with an end to the season.
Colorado has been smoke-covered for a week as some of the state’s largest wildfires cannot be extinguished. The photos are the Flatirons, taken from Davidson Mesa coming into Boulder. The notably clear picture was taken when we were staying home and vehicular emissions were greatly reduced. The smoky picture was taken yesterday with the Flatirons enshrouded with wildfire smoke.
Beyond the risks to firefighters, air quality has been poor because of the fires and at a level that may harm the general population. A severe drought continues in Colorado, leading to a persistent potential for dangerous fires, and a reminder of what Colorado’s future could look like as climate change continues. Per the EPA’s Fourth Climate Assessment, drought and increasing wildfires are among the most serious consequences of climate change for the state. We cannot continue to pause action on climate change, whether for politics or pandemics. Climate change is a public health issue.
Wear your mask and watch the air quality warnings,