Dean's COVID-19 Commentary

With the 4th of July intervening since my last commentary three weeks ago, much has happened, as always, with public health, in spite of the summer’s COVID-19 lull (Colorado hospitalizations were very low at 59 last week and the case count dropped). I found the Ruling on the Request for Preliminary Injunction from Judges Doughty and McClusky (U.S. District Court, Western District of Louisiana, Monroe Division) to be particularly concerning for public health. Central to Public Health (big P and big H) is communicating “good information” and countering “bad information,” whether unintentionally or intentionally provided. The judges’ granting of elements of the plaintiffs’ request represents a disturbing potential threat to public health and yet another judicial decision isolated from its implications for the nation’s health. 

Plaintiffs contend that the defendants, constituting a wide swath of the government, have restricted free speech by interacting with social media enterprises to remove or suppress misinformation on health (and some other) matters, many specifically related to COVID-19, and in doing so have violated the First Amendment clause assuring protected free speech. As a reminder, here is the First Amendment: 

“Congress shall make no law respecting an establishment of religion or prohibiting the free exercise thereof: or abridging the freedom of speech (italicized for emphasis), or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.” 

The Memorandum ruling on the request is lengthy at 155 pages, but skim through it to understand the nature of the alleged violations of the First Amendment’s guarantees. The plaintiffs include two authors of the Great Barrington Declaration who allege censorship in the government’s response to the document (recall that it pushed for herd immunity). The Memorandum takes a political tone, arguing that the restrictions focus particularly on “conservative” speech. Some topics covered in the memorandum include vaccine misinformation, ineffective therapies, and the lab-leak hypothesis.  

There is an appeal and a committee of the National Academies of Sciences, Engineering, and Medicine is addressing what constitutes misinformation. Reports of the National Academies, however, may not sway judges. I will be watching for the outcome of the appeal with concern. 

A summer reading recommendation follows for a book that addresses the complex networks linking species and the consequences of their perturbation by man’s destructive impact. The Narrow Edge: A Tiny Bird, An Ancient Crab & An Epic Journey by Deborah Cramer is about the red knot, a tiny shore bird that flies from wintering in Tierra del Fuego to summer nesting in the Arctic. As the birds make this 19,000-mile journey, they need to continually feed and replenish fat stores as they move from feeding stop to feeding stop. Cramer describes their journey, traveling herself from its springtime start in the Southern Hemisphere to its summer-time end in the Northern Hemisphere. At each of her many stops, she explores the dwindling number of red knots and the ecological threats from human activities. She tells stories about the people she meets, many concerned with the perils for the red knots and other birds along the shorelines. She gives historical reminders about the species of birds eliminated by our actions—the passenger pigeon, for example, extinct since 1914.  

Here comes the connection to health. The “ancient crab” of the book’s title is the horseshoe crab, a species that predates the dinosaurs and that has been abundant along the shores. I remember beaches covered with their shells. The crab’s eggs, laid at critical stopping points in the red knot’s journey, are one of the major foodstuffs for the migrating birds. However, horseshoe crab numbers are declining, threatened by their harvesting for commercial purposes and incursion into their habitats. As told by Cramer, they were once swept up by the truckload for making fertilizer, an industry that flourished a century ago in the South.  

The more recent threat comes from the use of their blood for the limulus amebocyte lysate (LAL) assay, used to detect endotoxin lipopolysaccharides in fluids and devices that contact blood or cerebrospinal fluid. The LAL assay, which tests for sterility and fever-causing contaminants (pyrogens), replaced more expensive testing with rabbits over 40 years ago. The LAL is obtained from captured horseshoe crabs by drawing blood from the pericardium and the crabs are then returned to the shore. However, some percentage does not survive this procedure and how the capture and blood draw affect longer-term vitality and survival is unknown. Populations of horseshoe crabs continue to decline at some of the red knots’ key stopovers.  

In an editorial earlier this year in the New York Times, “When the Horseshoe Crabs Are Gone, We’ll Be in Trouble,” Cramer wrote about the decline of the horseshoe crab worldwide, as it is threatened by blood draws and harvesting for use as bait. A substitute is available for the LAL assay that uses recombinant factor C (rFC). Although available since 2003, rFC does not yet have needed approval by the U.S. Pharmacopeia (USP). Some major pharmaceutical companies are making the transition to rFC, but the USP review process has been slow. Cramer’s bottom line: “The world has only so many horseshoe crabs. It’s time for us to let them be.”

Some good news on the red knots on Delaware Bay beaches: this year’s census showed the largest number migrating northward in four years. 

Enjoy the summer, 

Jonathan Samet, MD, MS
Dean, Colorado School of Public Health