The COVID-19 Pandemic: Breaking up is hard to doOct 25, 2021
If you were listening to the radio in 1962, you may remember that Neil Sedaka’s “Breaking Up Is Hard to Do” was omnipresent on the airways. Beginning with vocalese, the lyrics move on to the profundities of breaking up. Here is a sample:
They say that breaking up is hard to do
Now I know
I know that it's true
Don't say that this is the end
Instead of breaking up, I wish that we were making up again
This remembrance was prompted by the recent break-up of the Tri-County Health Department, which was opened in 1948 and originally served Adams, Arapahoe, and Jefferson Counties and later Adams, Arapahoe, and Douglas Counties. Until the break-up, its 400 employees served more than 1.5 million people. Now, by 2023, there will be three separate health departments with Douglas County already parting from Tri-County in September and Adams County doing so by 2023. The Douglas County School District and parents of at-risk children have already sued the fledging Douglas County Health Department over an opt-out option for schoolchildren in its first public health order.
The Douglas County schism reflects politics and mask mandates. Tri-County’s mask mandates sparked friction with the County Commissioners early on in the pandemic, eventually leading to the September vote that ended the relationship with Tri-County. The rationale for the departure of Adams County is less clear. County Commissioner Eva J. Henry said: “This new structure gives us an opportunity to focus on the specific needs of our residents and invest dollars in the areas that need it most.”
Breaking up is hard to do and there appears to no “making up again.” Much is lost with the break-up—a well-functioning agency that offers economies-of-scale has been splintered and county residents face the transition during a pandemic. Aurora, a city approaching 400,000 in the 2020 Census, has residents in each of the three counties. Which county will provide public health services for the City of Aurora? or will all three, depending on location?
Dr. John Douglas, a veteran public health official with lengthy CDC experience, has headed up the Tri-County Health Department for over 8 years. In Friday’s Denver Post, he thoughtfully reflected on the demise of Tri-County and the challenges of the transitions ahead. His last comment: I’m sorry to see it happen—I think we’re caught up in the maelstrom of national and even global politics.” The saga of the Tri-County Health Department speaks to the buffeting that public health agencies have sustained and the coming rebuilding challenge.
This paragraph reflects Dr. Douglas’ reflections on the origins of the break-up. Quoting his words:
“The break-up also appears to be part of the larger climate of mistrust in which we are living, whether mistrust of societal institutions (e.g., the government, election results, science, public health, or vaccines) or of one county in a longstanding regional collaboration for another. It appears that one element in common to the decisions of both Douglas and Adams Counties was concern about whether they could trust policy and political decisions of their neighbors (as determined by a common board of health) going forward, with a judgment that it was better to go it alone even if it meant trading off some expertise, efficiency, and continuity. Understanding how to recapture and build better trust seems like an important priority for the public health enterprise in the months and years to come.”
The annual meeting of the American Public Health Association is taking place this week in Denver. The event follows a mixed format this year with about 4,000 people attending in person (compared to around 12,000 in 2019). In-person attendees need to be fully vaccinated and wear a mask indoors. Months ago, we planned for ColoradoSPH activities in coordination with the meeting, anticipating that the pandemic would be in retreat and defeated by vaccination. Now, we have canceled an alumni reception and do not expect the usual traffic at the school’s table in the exhibit hall.
I have written regularly about the course of Colorado’s epidemic and tried to explain its ups and downs. Last week was another “up” week with hospitalizations rising to over 1,100 and continuing upwards today. With the effective reproductive number above one, projections show a curve that could continue to rise for several weeks, although not reaching the state’s December 2020 record. Even now, however, hospital capacity is strained. With Thanksgiving approaching, hopefully there will be a downturn in the epidemic curve soon, but a prediction cannot be made with any certainty.
Jonathan Samet, MD, MS
Dean, Colorado School of Public Health