Dean's COVID-19 Commentary

Mathematical modeling of epidemics dates to pioneering work at the start of the 20th century. Ronald Ross, a Nobel Prize winner for his malaria research, related disease transmission to the size of the mosquito population, and Kermack and McKendrick described compartmental models that are the predecessors of those the ColoradoSPH modeling team is using. Epidemics lend themselves to modeling. Several parameters describe the course of the epidemic curve: the transmissibility or infectiousness, captured at the start by the R₀, and the temporal course of the infection from the initial infection, through the incubation period, and on to the clinical course. In the models, differential equations describe how the epidemic evolves as people move from susceptible (S) to exposed (E), to infected (I), to recovered (R): hence, SEIR models.  

These models do not project abrupt changes in the course of the epidemic curve. The epidemic curve is anticipated to follow a gradual course, as control measures change (changes in policy and behavior, and the countervailing force of vaccination at the moment). Colorado’s curve has had several sharp drops that deviate from model projections—at the start of September 2020 and during the second week of May 2021, as COVID-19 hospitalization counts quickly dropped by 100 persons. Perhaps we reached a “tipping point” not anticipated from the orderly processes incorporated into the models. Regardless, that drop has ended as the curve shows yet another plateau with just under 1% of Coloradans currently infected with SARS-CoV-2—too high a percentage and indicative that the epidemic continues.  

Across the United States, governmental authorities and people are behaving as though 2019 had returned. It has not. More than 500 Coloradans are hospitalized with COVID-19 and some will not survive. While policy measures have largely been removed, those who are not yet vaccinated can protect themselves as before by wearing a mask, maintaining distancing, and avoiding crowded indoor spaces.  

In the fall, I recommended two pre-pandemic works of fiction based around a pandemic (The End of October by Lawrence Wright and Fever by Deon Meyer). Phase Six by Jim Shepard is the first post-COVID-19 pandemic book to appear (I think). Described as written pre-pandemic, the story line appears to have been updated to bring in COVID-19 as a reference point. Some of the plot unfolds as a case study in an introductory epidemiology class and the protagonists are two disease detectives in CDC’s Epidemic Intelligence Service (EIS). Read it if you intend to be a completionist on pandemic fiction. For me, the realities of COVID-19 are far more interesting than a hypothetical sequel. Phase Six lost cohesion as the story unfolded. Bottom line—skip this one, there will be more—books (and pandemics).

COVID Chronicles, a cartoon collection, is far more poignant. The book includes more than 60 short comics describing the pandemic’s reality, sadness, and hope. One panel displays Dr. Fauci as MVP—Most Valuable Physician. I also learned that there is a Dr. Fauci MLB Topps Now baseball card that is selling for thousands. Perhaps there is a market for further pandemic public health cards?

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