The COVID-19 Pandemic: What is endemic? Fauci vacillates; and menthol may be banned in tobacco productsMay 2, 2022
Our Colorado COVID-19 model estimates a relatively modest rise in the weeks to come. The COVID-19 modeling ensemble’s forecasts offer a wide range of projections, ranging from no increase to fairly sharp increases in hospitalization. Wait and see! This is a moment when a savvy modeler pleads uncertainty and waits for the pandemic to declare its course.
I have previously written about the transition from pandemic to endemic. Last week on National Public Radio, Dr. Fauci commented that the United States had “moved out of the pandemic phase.” He soon walked back this comment, stating, "What I'm referring to is that we are no longer in the acute fulminant accelerated phase of the outbreak." There is no sharp “bright line” for reaching a point of endemicity, which will depend greatly on the variant(s) of the moment. Dr. Ashish Jha, the new White House COVID-19 coordinator, held his first news briefing and offered the following: “The goal of our policy should be: obviously minimize infections whenever possible, but to make sure people don’t get seriously ill.” How do we achieve this goal?
The current, comparative lull reflects vaccination and the high level of immunity achieved because of the highly infectious (but fortunately, not highly virulent) Omicron variant. Last week, in “Morbidity and Mortality Weekly Reports,” the CDC reported findings of a seroprevalence survey for infection-induced SARS-CoV-2 antibodies from September 2021 to February 2022. Although based in a convenience sample, the findings are informative in showing an increase in anti-nucleocapsid antibodies, which result from infection. Overall, the rate of positivity increased from 33.5% to 57.7%, and in those aged 0-17 years, the seroprevalence reached about 75%. This high level of immunity will fade. Restoration of protection through vaccination will be critical.
Changing the topic, the Food and Drug Administration (FDA) made a historic announcement last week, proposing rules to prohibit menthol cigarettes and flavored cigars. My interest in this decision dates to 2010 when I became the first chair of the Tobacco Products Scientific Advisory Committee (TPSAC) formed under the 2009 Family Smoking Prevention and Tobacco Control Act. The act allowed continued use of menthol as a characterizing flavor but called on TPSAC to release a report on menthol within a year after its formation. We completed that report on schedule, reaching an overall conclusion that “removal of menthol cigarettes from the marketplace would benefit public health in the United States.”
At the time, the FDA went on to conduct an additional review and did not act on menthol after release of the TPSAC report. Lorillard Tobacco filed suit concerning the composition of TPSAC and the processes used to produce the report. Among the claims, upheld by tobacco-friendly Judge Leon, was conflict-of-interest on the part of three TPSAC members, including myself. My alleged conflict was past receipt of unrestricted support from the pharmaceutical industry for initiatives of the Institute for Global Tobacco Control at the Johns Hopkins Bloomberg School of Public Health. My favorite point made in Judge Leon’s decision concerned my consulting activity; I had none, but, per the judge, I “had the prospect of future fees from them.” This opinion was later set aside, but it tarnished the incredible effort made by TPSAC in producing the menthol report. Sorry for whining.
The proposed menthol ban will benefit public health. Menthol cigarettes are a preferred starter product and are used by the majority of African American smokers. Follow this story carefully as racialized arguments will be made. The tobacco industry has long targeted Black communities as a market for menthol cigarettes, a story told by Princeton’s Keith Waloo in Pushing Cool. The targeting was also highlighted in a recent story from our own school during Black History Month, featuring Cerise Hunt and this year’s Convocation speaker, Dr. Terri Richardson. Yesterday’s lead story in the Los Angeles Times provides an in-depth picture of the tobacco industry’s current strategies against menthol bans, including those used in Denver. Reynolds America has long relied on prominent Black figures, such as the Reverend Al Sharpton, to convey its message along with lobbyists. Economic arguments are also made.
I stand by the TPSAC findings. There will be an overall public health gain if the FDA moves forward.
Jonathan Samet, MD, MS
Dean, Colorado School of Public Health