Dean's COVID-19 Commentary

Colorado’s epidemic curve continues to decline. On February 7, the number of Coloradans hospitalized with COVID-19 had fallen to 467, approximately one-half of the April peak and one-quarter of the early December peak. When should policy measures be relaxed to allow further opening and expansion of economic activities? There is an inherent tension between assuring that the epidemic curve continues its descent, and that economic activity ascends. Finding that balance has been challenging across the pandemic in Colorado and elsewhere, and we lack consensus on where the balance point lies. Here in Colorado, Governor Polis is the final decision maker, trying to optimize the balance: assuring public health while maximizing economic health.  

On Saturday, February 6, Colorado implemented its COVID-19 Dial 2.0. The indicators change: percent positivity and case numbers per 100,000 both shift to different cutoffs and to 7-day averages from 14-day averages, making the indicators more sensitive to short-term changes in Colorado’s epidemic. In comparison to the prior COVID-19 dial, the new version shifts, allowing more economic activity on the same color scale. I was interviewed by the Denver Post about the COVID-19 Dial 2.0. My response: it is not the “wrong time” to make the switch. Colorado’s epidemic curve is on a sustained decline and vaccination is increasing. We will learn about the net consequence of the changes in policy measures, schools reopening, and increasing vaccination over the next month. Some good news: our latest modeling results show that even dire scenarios of rapid penetration of the B.1.1.7 strain and lapses in transmission control will not lead to peaks above our state’s capacity to provide clinical care.  

On Friday, I spoke with about 100 participants in the Osher Lifelong Learning Institute at the University of Denver on the pandemic. The questions were informed, and many were poignant: When can we visit and hug our grandchildren? Can we book the trip to Hawaii? Are we safe once vaccinated? We are all asking similar questions about the pandemic and our lives. With a high likelihood that Emergency Use Authorizations will soon be granted for additional vaccines, and with ever stronger planning and action at the national level, I am increasingly optimistic that the pandemic will soon (by fall?) be controlled.  

Politics and misinformation continue to interfere with common-sense public health measures: using masks and being vaccinated. In a just released report, the Centers for Disease Control and Prevention provide empirical evidence for the effectiveness of masks in reducing hospitalization for COVID-19. In this 10-state study, implementation of mask orders was followed by a decline in the rate of growth of hospitalizations among those less than 65. Contrast the evidence-based approach of mask mandates, now at the federal level and in many states, with the chaos in Wisconsin. In that state, the Republican majority state legislature repealed Governor Evers’ statewide mask order, followed by its reinstitution by the governor, a Democrat. Beyond some misguided political “litmus test,” why would an elected body take steps that endanger the state’s citizens? The anti-vaccination movement is also a mounting concern. In California, there is an emerging alliance between the far right and those opposing vaccination. And there is widespread vaccine hesitancy among some groups within the population that are grounded in past injustice. For African Americans, the legacy of the Tuskegee Study persists. Bad Blood: The Tuskegee Syphilis Experiment by James Jones is an essential read for all in public health.  

One last reading recommendation: the recent Supreme Court decision in South Bay United Pentecostal Church, ET AL, v. Gavin Newsom, Governor of California, ET AL. By a majority, the Court found against one of the prohibitions that California imposed on houses of worship: singing and chanting during indoor services. California was allowed to maintain the 25% occupancy restriction for indoor worship. The opinion is complicated with four differing viewpoints across the Justices. I found this article in Vox to be helpful in its explanation. Justices Kagan, Breyer and Sotomayor dissented. Quoting from Kagan’s opinion: “Justices of this Court are not scientists,” and “In the worst public health crisis in a century, this foray into armchair epidemiology cannot end well.” For a refresher on some of the relevant science, turn to the proceedings of the National Academies workshop on airborne transmission of SARS-CoV-2 that I chaired in late August.  

The policy challenges of the pandemic continue. 

Related to policy, join us for the first virtual Public Health Day at the Capitol this Thursday with the Colorado Public Health Association. Associate Dean for Diversity, Equity and Inclusion Cerise Hunt and I will make opening remarks. 

Stay well,  

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