Dean's COVID-19 Commentary

The Thanksgiving holidays were already worrisome for the possibility of increased transmission as people traveled and gathered. The news of a new SARS-CoV-2 variant—Omicron—is now an additional concern. Prior to the variant’s identification a few days ago, I did not know that the fifteenth letter of the Greek alphabet is omicron (uppercase Ο, lowercase ο). Labeled a “variant of concern,” by the World Health Organization, Omicron has a large number of mutations in comparison with the original strain with 30+ mutations affecting the spike protein. First detected in Botswana and South Africa, two cases have now been reported in the United Kingdom and also in Canada. 

The large number of mutations affecting the spike protein raises concern about reduced effectiveness of current vaccines. Ashish Jha, Dean of the Brown University School of Public Health, provides a useful perspective in the New York Times. He poses three key questions concerning the variant:

“The first question is whether the variant is more transmissible than the current, prevalent Delta strain? Second, does it cause more severe disease? And third, will it render our immune defenses — from vaccines and prior infections — less effective (a phenomenon known as immune escape)?”

These questions echo those that came with the identification of the Delta variant and that were subsequently answered.  

Still lacking answers to these questions for Omicron, there is global alarm. The identification of Omicron was immediately followed by events that are a reminder of our interconnectedness. Stock markets plunged with the Dow Jones Industrial Average experiencing its greatest drop of the year. Nations closed their borders to people from nine countries in southern Africa, bringing protests from their leaders, who noted the failure to assure that vaccines were brought to everyone in the world.  

In the United States, 59% of the population is fully vaccinated while the figures for South Africa and Botswana, where Omicron was first identified, are 24% and 20%, respectively. For Ethiopia, where I maintain an active collaborative research and training program, only 1% of the population is fully vaccinated. Whether in the United States or Africa, these large unvaccinated populations are sustaining the pandemic and allowing the unfettered viral replication that leads to mutations. Remember, the most transmissible strain will eventually dominate as strains compete.  

Omicron is a reminder of the necessity of universal vaccination for COVID-19. Frustratingly, in the high-income countries, resistance to vaccination is now a choke point in the face of an ample supply of vaccine. In many low- and middle-income countries, an insufficient supply of vaccines is the obstacle, one that must be addressed by the wealthier nations and the international organizations involved in global health.  

In Colorado, the epidemic curve of hospitalizations reached a plateau across the Thanksgiving week with a hint of decline at week’s end. The leading indicators of the case rate and test positivity are declining, perhaps signaling that “the curve has been bent,” but we will not see any adverse impact of the Thanksgiving holiday for at least a week.  

Colorado’s situation reached a sufficiently serious point to prompt the implementation of mask orders by Metro Denver counties (Douglas County excepted) last week. Decisions concerning public health orders are voted on by boards of health. In Jefferson County, the board of health hearing lasted for hours with 35 speaking against a mask order. The residents of Metro Denver’s counties mix, leading to the need for the coordinated action taken by the counties. Quoting former faculty member Dawn Comstock, now executive director of Jefferson County Public Health: "The virus doesn't care which side of a county border you're on."  

Boards of health are making critical decisions. Their meetings represent a venue for public health voices to be heard, for example, in support of a mask order when appropriate. Below, Lisa Miller, our Associate Dean for Public Health Practice, offers comments on the board of health meetings and the opportunities that they afford for learning and contributing:  

"What else can we as faculty, staff, and students do to help support our health departments? This has been an incredibly difficult time for our partners in public health, and they often hear from only the loudest voices, which may not be supportive voices. One thing we can all do is to attend our local or state board of health meetings and use our knowledge of public health to add to the discussion. Meetings are usually accessible remotely and may provide an opportunity for public comment. Observing is a great learning opportunity, and providing a public comment is an excellent way to show support. Comments can be provided as a verbal statement at a meeting or written as note to a board of health."

Please see below for the links to the meeting information for several of our local and state boards of health and consider attending a future meeting:

• Larimer County Board of Health meeting information
• Denver Board of Public Health & Environment
• Weld County Board of Public Health
• Tri-County Board of Health meeting information
• Colorado Board of Health

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