COVID-19 Pandemic: As hospitalizations surge, a federal effort to protect US workers is challengedNov 15, 2021
Last week, Colorado’s epidemic curve continued its upward spiral with the number of hospitalized Coloradans reaching 1,476 on Friday, November 12—up from 1,296 on November 5. Unfortunately, other states also have rising epidemic curves as does much of Europe. While cold weather with more time spent indoors may be a key driver of the current timing of these surges, inadequate rates of vaccination and waning immunity leave sufficiently large populations susceptible to infection, allowing them to occur.
As I noted last week, the November 3 modeling report projects a continued rise of the epidemic’s curve this month. Updated modeling, as the surge continues, shows that the rise could be sustained into December and potentially exceed last year’s high mark of 1,847 hospitalized with COVID-19. For the short-term, the surge is best brought under control through the all-too-familiar list of transmission control measures; we all know the list.
Governor Polis is also emphasizing use of monoclonal antibody therapy, which is effective in preventing hospitalization and death if administered early in the course of infection. About 15% of those eligible are currently receiving monoclonal antibody therapy so that there is an opportunity to reduce hospitalization through enhancing access to timely therapy. Governor Polis recently announced this objective. The state has also called for boosters for those who are eligible, 18 years and older, arguing that the surging epidemic is a sufficient justification to provide boosters to all adults.
Remarkably, in the face of an uncontrolled pandemic, challenges to fundamental public health measures continue. The U.S. Occupational Safety and Health Administration (OSHA) was created by Congress under the 1970 Occupational Safety and Health Act “to ensure safe and healthful working conditions for workers by setting and enforcing standards and by providing training, outreach, education and assistance.”
For respiratory protection, OSHA partners with the National Personal Protective Technology Laboratory (NPPTL) of the National Institute for Occupational Safety and Health (NIOSH) in the design, assessment, certification, and use of personal protective equipment (PPE). Selected groups of workers are covered in OSHA respiratory programs to protect against specific inhalation hazards.
Faced with the COVID-19 pandemic, OSHA promulgated an Emergency Temporary Standard, effective June 21, 2021, for healthcare settings. It includes a “Mini Respiratory Protection Program” for healthcare workers. This sensible step by OSHA has not been challenged.
However, OSHA's November 5 Emergency Temporary Standard, “COVID-19 Testing and Vaccination Testing ETS,” has been challenged and its implementation is now stayed by a decision of the U.S. Court of Appeals for the Fifth Circuit. That Emergency Temporary Standard calls for employees in workplaces with 100 or more employees to undergo COVID-19 vaccination, or take weekly COVID-19 tests and wear a mask. The reach of this Emergency Temporary Standard would greatly expand mandatory vaccine coverage, protecting workers and advancing pandemic control for the population.
The parties challenging the November 5 Emergency Temporary Standard include Republican Attorneys General and other entities. The Fifth Circuit’s decision is an informative read on the complexities of the interpretation of public health measures by the courts. In this instance, for example, the panel even questions the severity of the pandemic and gravity of the risks faced by workers. Concluding that the challenges to the OSHA action will be upheld, the three judge panel continued the stay on implementation.
Challenges continue against mask mandates as well, although Texas Governor Abbott’s ban on school mask mandates was recently overturned by a federal judge on the grounds that it violates the rights of students with disabilities. Here in Colorado, the newly formed Douglas County Board of Health plans to revise its public health order allowing exemptions to using a mask. The reason—a federal judge blocked the order after a lawsuit was filed by the Douglas County School District and parents of nine children with disabilities. The difficulty of following these lawsuits highlights the folly of subverting public health measures. Paraphrasing the Talking Heads, it has stopped making sense.
And a few other updates. For more on Florida’s Surgeon General, read this story. And Aaron Rogers did play football yesterday.
Also, a final note of congratulations to Dana Dabelea, who was named a University of Colorado Distinguished Professor last week. Only 129 Distinguished Professors have been named by the university since inception of the faculty honor in 1977. Dana was among 11 CU faculty awarded this year, and is the fourth Distinguished Professor for ColoradoSPH—others are Dick Hamman, Spero Manson, and Lee Newman. Congratulations on this much deserved honor, Dana.
Jonathan Samet, MD, MS
Dean, Colorado School of Public Health