The COVID-19 Pandemic and More: Colorado’s epidemic curve bends, the Supreme Court threatens public health, and FDA takes strong action on tobacco at lastJun 27, 2022
Note the subtle title shift from “The COVID-19 Pandemic” to “The COVID-19 Pandemic and More” as the pandemic fades for the moment in Colorado, but momentous events for public health continue. Starting with the good news, the epidemic curve in Colorado may be bending yet again. The latest modeling report and Colorado’s surveillance data show that the curve is not rising and may have started to fall, as the Colorado COVID-19 modeling group predicted last month and again last week. The prevalence of infection remains high, but fortunately this wave has had less impact on hospitalizations and deaths than the past surges.
There were two very discouraging decisions from the Supreme Court last week, both with profound implications for public health. One was the reversal of the previously-ruled, constitutionally-guaranteed right to abortion coming from the Roe v. Wade decision of 1973 and the second, the striking down of New York’s long-standing law on owning or carrying a handgun without a permit. The first ruling was anticipated after the draft decision was “leaked” several months ago. I don’t understand the Court’s thinking, and many experts have commented—see Jane Schachter’s comments, for example. But, I do understand the public health implications of the decision, and clearly the Justices reversing the 1973 decision do not. The decision overturning New York’s proscription against owning or carrying a handgun is also chilling and, if extended nationally, portends a future with ubiquitous availability of handguns.
Shortly after the decision on Roe v. Wade was announced, a communication was released by campus leadership stating the obvious from a public health perspective:
“The immediate impacts of this decision are completely predictable: a public health crisis – worse health outcomes for women of reproductive age and the widening of health disparities due in part to the costs of traveling out of state for care. The potential longer-range consequences are also extremely concerning: establishing the precedent of allowing legislatures and courts to further restrict personal autonomy and curtailing hard-won personal rights.”My training in internal medicine antedated the Roe v. Wade decision. I still recall the tragedy of young women with septic abortion whose lives were threatened along with the possibility of having children in the future. In the New England Journal of Medicine, Rosenbaum describes the tragic consequences of illegal and unsafe abortions before Roe v. Wade and Harris and Grossman provide a perspective on what may come. Inevitably and unnecessarily, history will repeat itself and the Supreme Court’s decision will increase inequities in reproductive health.
There was some positive news on several public health fronts. President Biden has signed a gun control bill that offers a few common-sense measures, although it left major issues untouched, e.g., the availability of assault rifles. The Food and Drug Administration seems to have recently awakened from “tobacco turpitude” with its proposal for a ban on menthol as a characterizing flavor, its resurrection of the plan for a reduction of nicotine content in cigarettes, and a ban on sales of JUUL e-cigarettes, albeit quickly blocked by a federal court. These measures would reshape the tobacco products marketplace, hopefully shifting towards products with less public health impact than combustible cigarettes.
And, we can add the unfolding story of the events of January 6 to this disturbing moment in our lives. In talking with my same-aged friends who lived through the 1960s and the Vietnam War and its consequences, we are in agreement that these times are among the most disturbing and dystopian that we have experienced. Quoting Buffalo Springfield’s “For What It’s Worth” (once again):
There's something happening here
But what it is ain't exactly clear
There's a man with a gun over there
Telling me I got to beware
I began writing these comments while flying to Frankfurt. There were two announcements concerning smoking and vaping of marijuana in the airplane's bathrooms—the second coming with a threat that we would land in Newfoundland or Iceland to inspect everyone’s personal items to find (and arrest) the culprit. This was a first for me, although I remember similar announcements about cigarette smoking in airplane bathrooms more than two decades ago.
Enjoy the upcoming holiday weekend. July 4 is an appropriate day for reflection on what is going on.
Jonathan Samet, MD, MS
Dean, Colorado School of Public Health