The most recent COVID-19 data for Colorado are puzzling. After a steep rise in hospitalizations for COVID-19 in early November, the count has stabilized with 387 hospitalized last week and 379 the week before. Through mid-month, test positivity appears to have peaked, but remains high at more than 12%. From the health care perspective, the pause in the growth of COVID-19 cases is welcome, as the state contends with the trio of respiratory viruses: SARS-CoV-2, influenza, and respiratory syncytial virus (RSV). Together, the three viruses have stressed hospital capacity across the state, particularly for pediatric beds. Fortunately, the rate of RSV-associated hospitalizations is dropping, but remains very high. Influenza hospitalizations are rising but are well below historical highs.  

The tripledemic calls for common-sense actions by Coloradans to protect themselves against the three viruses. Respiratory protection should be an effective tool; influenza and SARS-CoV-2 are transmitted by droplets and aerosols, and RSV by droplets and fomites. Of course, vaccines are available for SARS-CoV-2 and influenza; however, only 21% of Coloradans have had a complete series for COVID-19 and one of the new Omicron boosters. A recent CDC Morbidity and Mortality Weekly Report provides findings of a case-control study on the effectiveness of the bivalent mRNA vaccines beyond prior monovalent booster doses. The study showed that receipt of a bivalent booster provided protection above that achieved with two or more monovalent doses. The protection afforded beyond the last monovalent dose was about 30% at 2-3 months and rose to about 50% at eight months or more. The greater effectiveness at eight months implies that additional protection was gained as immunity waned. What Coloradans should do is obvious. Why aren’t they doing it?

I write this commentary over the Thanksgiving break, always a time to catch up on reading and pondering. This year, climate change captured my attention as the 27th Conference of the Parties (COP27) to the United Nations Framework Convention on Climate Change (UNFCCC) ended. The annual Conferences of the Parties involve the parties to the UNFCCC and are a venue for assessing progress and negotiating next steps. One breakthrough was the creation of a “loss and damage” fund to assist developing countries’ responses to climate change consequences.  

Well described consequences of climate change are warmer temperatures and greater temperature variability with increased likelihood of intolerable heat waves. A New York Times article describes the future, hotter world and the inequities of contending with it. The writers monitored the heart rate of a welder working outdoors in Iraq, charting its rise to 138 beats per minute over the morning as he worked in conditions with the heat index reaching 125 degrees Fahrenheit. Daily life for those who can afford the adaptation of air conditioning is contrasted with that for those who cannot. The article includes discouraging graphics showing how hot and uninhabitable many locations will be in 2050—not so distant. 

Future heat waves are of particular concern, bringing temperatures that can kill, particularly in locations without sufficient adaptive measures. One such heat wave took place in June 2021 in the Pacific Northwest. As a reminder, temperatures of 108 Fahrenheit were recorded in Seattle and 116 in Portland. The death toll is estimated at 1,400 or more. A just-published article in Nature Climate Change details analyses linking the occurrence of this previously impossible event to climate change. The article is complex, but the title tells the story: “2021 North American heatwave amplified by climate change-driven nonlinear interactions.” In other words, we have poked nature too much.  

Continuing with climate change, the November 28 New Yorker includes three stories related to climate change under the theme “Annals of a Warming Planet,” presumably COP27 inspired. Elizabeth Kolbert’s piece, “A Vast Experiment: The climate crisis from A to Z,” takes an alphabet-inspired approach to detailing where we stand with climate change. The tour works with a broad look at approaches, people, successes, and failures. For Coloradans, “Z” stands out – “The Colorado River Basin has been called ‘ground zero for climate change in the United States.’”  

I also read Kolbert’s Under a White Sky: The Nature of the Future, a collection of essays about attempts to contend with the unintended consequences of the manipulation of nature. The vignettes are fascinating, for example, the intensive effort to save the pupfish, which have adapted to the constant 93-degree temperature of the water at Devil’s Hole in Death Valley. The census reached as low as 38 in 2006, but it has since risen and the species has a back-up in a simulated Devil’s Hole. Chapters address the complications raised by the reversal of the Chicago River and the efforts to protect New Orleans and environs. Of course, climate change is a topic of some chapters; the descriptions of geoengineering solutions are a reminder of what a mess we have made. The book ends:

“One last point: neither optimism nor pessimism alters the fact that we live in an extraordinary moment. The choices that we’ll make—that we are making right now, without necessarily being aware of them—will determine the future of life for our children and their children and all the other species on earth for generations to come. This is the situation we’re in, and there’s no avoiding it, because, in the end, this marvelous, fragile planet is all we’ve got.”

Well said, and are we up to the “extraordinary moment”? 

Last week’s commentary mourned the shootings at Club Q in Colorado Springs. A thoughtful vigil at the CU Anschutz campus offered comments from our LGBTQ+ community, some describing fear because of targeting. Last week brought another mass shooting, this one at a Walmart in Chesapeake, Virginia. Inevitably, after these shootings there is speculation about motivation, but weapons, particularly automatic weapons, are the killing tool. The tragedy of a mass shooting is repeated at least weekly, constantly reminding us that we are all at risk everywhere: schools, stores, work, and at play—even in places that we thought were safe. Enough. 

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