Dean's COVID-19 Commentary

After less than a week in office, the Biden-Harris Administration is moving forward with a national plan to address the COVID-19 pandemic. The title—National Strategy for the COVID-19 Response and Pandemic Preparedness—signals a shift from the prior decentralized state-based approach to a coordinated effort at the national level. The shift is needed and its rationale is clear. Across the country, the pandemic rises and falls in ever-shifting patterns as control measures are tightened and loosened without coordination. States and municipalities do set their own policies, but national, evidence-based guidance should be a starting point. The initial problems implementing vaccination across the country also call for a national approach.

The plan has seven “goals” with numerous steps to take under each:

1. Restore trust with the American people.
2. Mount a safe, effective, and comprehensive vaccination campaign.
3. Mitigate spread through expanding masking, testing, data, treatments, healthcare workforce, and clear public health standards.
4. Immediately expand emergency relief and exercise the Defense Production Act.
5. Safely reopen schools, businesses, and travel while protecting workers.
6. Protect those most at risk and advance equity, including across racial, ethnic, and rural/urban lines.
7. Restore U.S. leadership globally and build better preparedness for future threats.  

By itself, the release of the plan on January 21 is reassuring, as is the emphasis on science (the word appears 46 times) and evidence (the word appears 18 times). The scope of the plan matches the enormity of the pandemic.

Now comes implementation of the plan and the setting of priorities. Actions are already in motion through paths that can be taken by the Executive Branch: Executive Orders, Directives, and Memoranda. Some sensible steps are being taken using these paths—requiring masking on airplanes and directing the Occupational Safety and Health Administration to update guidance for workers, for example. The plan will harness resources across the federal government and build coordination and communication with the states. My worries come from the need for rapid and concerted actions by many players.  

The plan has a needed vaccination goal. There are myriad accounts of the challenges and failures so far in “getting shots into arms.” The problems extend across the many steps from manufacturing to injection. Even though we lack sufficient vaccine, we are not using the supply already in hand. We all have personal stories about vaccination: our own and those of friends and families. My favorite Los Angeles Times columnist, Steve Lopez, recently described how he could readily schedule a vaccination in Alaska, while failing repeatedly in California. 

Last week, I received my first dose of the Pfizer vaccine, qualifying by age, at UCHealth. The process was smooth from email invitation to the needle in my arm. I am fortunate to be in a health system with vaccine available and functioning protocols to deliver it. Unfortunately and not surprisingly, inequities have quickly surfaced around vaccine delivery; those suffering the greatest disease burden are less likely than the non-Hispanic white majority to be vaccinated. Colorado is experiencing these inequities. Goal 6 of the national plan seeks equity.  

As to my personal experience, this first dose was without consequences—minimal soreness at the injection site and nothing more. I will report back after the second, described by some as more likely to have adverse effects. I will also keep track of the implementation of the national plan. Its success is critical and, looking ahead, we need to “…build better preparedness for future threats.”

And, put Wednesday’s conversation in the collaborative series with the Denver Museum of Nature and Science on your calendar. Last week, Governor Polis was the guest. This week, the former CDC Director, Tom Frieden, will join this Wednesday, January 27, at 8:30 AM. Recall that Dr. Frieden was a highly effective director across the eight years of the Obama Administration.  

Stay well and be patient while waiting for vaccination, 

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