Dean's COVID-19 Commentary

Heading into the Thanksgiving holiday, Colorado’s epidemic curve has continued to rise with the COVID-19 hospitalization count at 1,518 on Friday, November 19. Model projections continue to indicate a further rise into mid-December or beyond. The State of Colorado is seeking to reduce hospitalization demand through increasing use of monoclonal antibody therapy while Metro Denver public health directors are considering a regional mask mandate (Douglas County excepted). Previously, the Metro Denver Partnership for Health requested a statewide mask mandate and a vaccine passport approach for high-risk indoor settings. With the state not preceding as requested for now, a Metro Denver-wide mask order may be forthcoming. A driving consideration is the mixing that will inevitably occur across the Thanksgiving holiday as people travel and gather in groups.  

A smorgasbord is a Scandinavian buffet serving up a variety of foods. The semblance to the COVID-19 pandemic should be obvious with its ongoing tsunami of new twists and turns. Here are some of the items in the buffet:

The origins of the COVID-19 pandemic remain obscure and controversial and quickly became a politicized topic. Last week, a paper in Science offered a forensic epidemiological analysis. Author Michael Worobey dug through the details of published reports to reconstruct the unfolding of the initial cases. His bottom line—SARS-CoV-2 made the jump to humans in the Huanan market in Wuhan. This hypothesis may never be definitively confirmed, given the lack of critical samples from the market. A New York Times story provides further background and opinions from the inevitable dueling experts. Controversy will persist since definitive evidence will likely never be forthcoming. Despite the lessons of SARS, the initial data gathering in China appears to have been incomplete and possibly erroneous. 

For those in public health, if you reach into the budgetary smorgasbord of the House-passed Build Back Better Act, you will be disappointed. I found the text of the Act to be impenetrable, but the American Hospital Association offers a useful summary. Keeping in mind that the total 10-year expenditure will exceed $2 trillion dollars, $26 billion is designated for public health. Some of the funding is for pandemic preparedness and public health infrastructure. Not surprisingly, and in keeping with the miserly funding of public health, far greater amounts are directed at medical care. And to benchmark the $26 billion, there is $4 billion in electric bicycle credits through 2025, a useful tool for reducing emissions but the comparison is revealing. The bill still needs to make its way through the Senate and will likely shrink in its scope. Keep your eyes on public health.   

Need a novel for the Thanksgiving holiday? I am halfway through Gary Shteyngart’s Our Country Friends, set during the COVID-19 pandemic and the unfolding impact of the murder of George Floyd. A cheap shot review would describe it as a redo of The Big Chill set in the COVID-19 pandemic. In case you missed it (or were not born), The Big Chill is about a weekend reunion of college classmates after the suicide of one of the group’s stalwarts. In Our Country Friends, an odd group has come together to weather the pandemic in a sheltered country setting that is nevertheless reached by all that is happening outside, including SARS-CoV-2. Relationships form and events happen among the eight protagonists—all aptly penned by Shteyngart. For example, Senderovsky, a lead character, reminds an arriving guest: “Can’t hug,” he said.  “And, just to warn you, Masha’s gone all epidemiological.” 

Sandro Galea, Dean of the Boston University School of Public Health, is arguably the most prolific author among the deans of schools of public health. His latest book, The Contagion Next Time, takes on the COVID-19 pandemic, probing its origins, lessons learned, and looking to the future. The book goes beyond recounting of details to search for underlying causes and the deeply rooted societal structures that have sustained and focused the pandemic’s harms.  

A few more reads. Anticipating that you may be turned to as a public health expert with questions about risks over the holidays, turn to this New York Times feature: “Can Covid winter be merry and bright?” Linsey Marr, Juliet Morrison, and Jennifer Nuzzo provide practical answers to frequently asked questions. DrPH students in the Department of Community and Behavioral Health teamed with faculty members in a recent article in the HPHR Journal (formerly Harvard Public Health Review) on “the decolonization of public health.” They set an ambitious and needed agenda for change.  

Enjoy the Thanksgiving holiday and stay safe. Remember, it is 2021, not 2019.  

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