Dean's COVID-19 Commentary

Like many, I have been watching the news from Ukraine with sorrow, anger, despair, and worry. As a child growing up during the Cold War era, the threat of nuclear confrontation was a reality as these impossible-to-use weapons proliferated and became ever more powerful. In elementary school, “duck and cover” in the event of a nuclear strike involved getting under your desk (as did earthquake drills for the few years that I lived in California). Nuclear saber rattling by Russia’s Putin reminds me of that era and it is frightening. 

The reality of the invasion of Ukraine is horrifying. We watch the invasion of a democratic nation of 40 million people in real-time. People are being killed and many Ukrainians are fleeing to neighboring countries. A public health crisis is inevitable with the need to shelter and feed those remaining and those who have fled. I was in Ukraine about 10 years ago for a visit to Chernobyl with a team from Green Cross Switzerland, part of Green Cross International—founded by Mikhail Gorbachev in 1993. At the time, Ukraine’s President was the notably corrupt Viktor Yanukovych. Nonetheless, Kyiv was a thriving European city and its possible take over and ruination by Russia are unimaginable. War is the most evil of public health threats.  

Putting this pall aside, the pandemic news in Colorado remains encouraging. Hospitalizations of Coloradans with confirmed COVID-19 dipped to 369 on Friday, less than one-fourth of the Omicron peak, and the 7-day test positivity was below 5%. Responding to the pandemic’s status, Governor Polis released “Colorado’s Next Chapter: Our Roadmap to Moving Forward” on Friday. Quoting the document: “Now, Colorado is ready to move into a new chapter: one where if vaccinated, Coloradans can live life normally.” For now, I concur and delivered the same message at a town hall meeting for the Colorado School of Public Health at the CU Anschutz Medical Campus on Thursday. I also concur with the attention given by Governor Polis to using the COVID-19 lull in-progress to prepare for what will come next. For public health, the “next chapter” calls for “ensuring public health readiness and surge capacity.” It also calls for “investing in health care workforce stabilization and expansion.” I would have welcomed a parallel call for the public health workforce.  

It happened: the Centers for Disease Control and Prevention (CDC) posted new guidance on masks. In doing so, it relied on new indicators of the status of the pandemic, moving from calling for use of masks in most of the U.S. to about 28% of the country. The new mask guidance is tied to these indicators. The guidance is sensible, but if CDC is “following the science” with these new recommendations, where is the “science”? Search the CDC website and you will not find the back-up review of evidence supporting this major shift in approach.  

The phrase “follow the science,” oft uttered by the CDC Director and others, has received some recent editorial attention from, for example, The New York Times and Bloomberg News. I also point to an article in the British Medical Journal on the experience of scientists involved in expert panels that “follow the science.” I am still puzzled by the phrase, but let’s parse the three words. I know what “science” is along with the scientific method. Let’s transpose “the science” into the relevant scientific evidence. As to “follow,” I will expand the word to mean evidence-based decision-making. So, my final translation: keep track of the emerging scientific evidence and use it to make decisions—definitely the right way to proceed. Perhaps CDC “followed the science” in offering its new guidance, but it was silent as to how it did so. It shouldn’t be. 

COVID-19 follies redux: Last week, George Washington School of Public Health faculty member Leana Wen, a frequent media commentor, tweeted: “Glad to see that CDC has heeded repeated calls from Governors and local officials to revise mask guidance.” From Lynn Goldman, her Dean: “No Leana. CDC decides on the basis of public health science and protecting of all of us and not political pressure.” Lynn said what needed to be said and Wen’s comment illustrates that CDC should have reported its scientific foundation for decision-making. And, Florida’s Surgeon General was confirmed last week. 

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