The Pandemic & More: The COVID-19 emergency ends, but the tobacco epidemic chameleon continuesMay 8, 2023
The quick Colorado update: all key indicators continue to trend downwards, and the COVID-19 hospitalization count last week in Colorado was at 127. Is the COVID-19 pandemic over? Perhaps that is officially the case, at least for the pandemic-caused emergency. Last week, the World Health Organization announced that COVID-19 would no longer be considered a “public health emergency of international concern” (PHEIC). The decision was based on “…the decreasing trend in COVID-19 deaths, the decline in COVID-19 related hospitalizations and intensive care unit admissions, and the high levels of population immunity to SARS-CoV-2.” President Biden previously announced that he would end the national emergency and public health emergency declarations on May 11. Denver has already ended its state-of-emergency and Governor Polis will likely follow the White House for the state.
While the public health emergency has “officially” ended, SARS-CoV-2 persists as does the legacy of long COVID. Per the New York Times, Colorado still has about five deaths daily from COVID-19; if that rate held annually, about 1,800 Coloradans would die each year from COVID-19. To now, the total number of deaths among COVID-19 cases in Colorado is 14,434. The just released provisional 2022 mortality data for the United States document the continued, albeit lessening, impact of COVID-19. Overall, the age-adjusted mortality rate dropped by 5.3% and COVID-19 as an underlying or contributing cause of death declined by 47%, dropping in all racial and ethnic groups. Nonetheless, COVID-19 was the fourth leading cause of death in 2022, following (in order) heart disease, cancer, and unintentional injury.
CDC Director Rochelle Walensky may have been an indirect casualty of the COVID-19 pandemic, as she announced her intent to resign last week. She took on the role of director in January 2021 as vaccines became available, but the COVID-19 pandemic was still surging. She also contended with the mpox epidemic. She followed Robert Redfield whose tenure was marked by the insertion of Trump administration politics and chaos into the CDC. She tried hard under trying circumstances. Hopefully, a COVID-19 outbreak at the annual Epidemic Intelligence Service (EIS) Conference did not figure into her decision-making. Certainly, political polarization has continued around the CDC and its actions. Perhaps as a result, directors appointed in January 2025 will require Senate confirmation, potentially problematic in a divided Senate. Walensky, like some other directors, proposed reorganization of the CDC to make it more responsive and nimble, but I have yet to see any details of that effort. Per the New York Times, other key public health positions related to the COVID-19 pandemic are unfilled or may soon be vacant.
Last week, I was in Madrid for the 9th European Conference on Tobacco or Health. My topic was an orphaned aspect of the tobacco problem—disposal of cigarettes and the myriad electronic devices delivering nicotine that are now in the marketplace, broadly classifiable as electronic vaping products, like JUUL, and heat-not-burn products, like IQOS. Most cigarettes have filters, and most filters are made from cellulose acetate, a non-biodegradable plastic material. With approximately 5.2 trillion cigarettes smoked each year and with smokers tossing them everywhere, the problem of cigarette waste is enormous and a neglected source of environmental pollution. The filters are contaminated by toxic tar and are a contributor to the disturbing problem of microplastics—small plastic particles that are now a ubiquitous environmental contaminant.
The electronic tobacco products are an emerging environmental problem as their use burgeons throughout the world. The make-up of these products includes lithium batteries, electronics, metals, and plastics. In the United States, about half of the sales of electronic vaping products are disposables and survey data suggest that they are not disposed of as e-waste. Done properly, disposal involves a cumbersome process of removing the battery for separate recycling and placing the device into a sealed container for delivery to an appropriate facility. As one example, Boulder County has a program to encourage safe disposal. For IQOS, Philip Morris International appears to have a “take-back” program, at least in some countries.
These new electronic products are proposed for harm reduction, substituting for more toxic combustible cigarettes. The topic is contentious as I have commented elsewhere. Risks to the environment posed by rising use of electronic products have not been mentioned in the harm reduction discussion. Here is another risk trade-off: the potential for harm reduction for smokers at the cost of environmental degradation by uncontrolled disposal of electronic products. The tobacco industry is not held accountable for these environmental externalities, and costs posed to society that are generated by the industry’s products. There needs to be accountability for the safe disposal of these electronic products.
On Thursday, many will come together to celebrate the contributions and legacy of Steve Berman, who passed away in January. Come to the event to learn about Steve’s broad footprint on our campus, in the state, and nationally and globally.
Jonathan Samet, MD, MS
Dean, Colorado School of Public Health