Dean's COVID-19 Commentary

The Colorado COVID-19 pandemic in a few words: perhaps ebbing downwards with declining cases, test positivity, and wastewater concentrations. But Coloradans are still getting sick with 182 hospitalized last week.

While the pandemic slowly fades in Colorado, the story of its origins remains heated. In my last commentary, I wrote about the analysis of briefly available genetic sequence data from samples taken in the Wuhan Seafood Market. That analysis supported the hypothesis that raccoon dogs might have been an intermediary in the transmission of SARS-CoV-2. Now, Nature has just released a publication from Chinese researchers, including the Chinese Center for Disease Control and Prevention, that describes analyses of 923 environmental samples, collected from January 1, 2020, and 457 from animals, collected from January 18, 2020. The environmental samples confirm the presence of SARS-CoV-2, as with the prior analysis, while none of the 457 animal samples tested positive. The conclusions are vague and waffling on the potential path of the virus: from animal to man or from man to susceptible animals, including raccoon dogs.  

From the pandemic’s beginning, China has been accused of withholding data relevant to the pandemic’s origins. In a commentary in Science, “Share all SARS-CoV-2 data immediately,” WHO’s Maria D. Van Kerkhove calls on China and all countries to provide data relevant to identifying the origins of SARS-CoV-2. She proposes that China still has unshared data. China has countered vigorously. My take on this long controversy: insufficient transparency and incomplete data sharing have eroded trust and international collaboration in understanding the origins of one of the most devastating pandemics.

Decisions by federal courts continue as another threat to public health. Setting aside Judge Kacsmaryck’s decision on mefipristone, I turn to Judge O’Connor’s decision in Braidwood Management Inc., et al., Plaintiffs, vs. Xavier Becerra, et al., Defendants, which sets aside provisions of the Affordable Care Act around prevention. On religious and non-religious grounds, the plaintiffs ask for relief from mandates concerning coverage of contraception and PrEP, and also from requirements for coverage of prevention services for which the evidence is rated at the A and B levels of confidence by the U.S. Preventive Services Task Force (USPSTF).  The U.S. Preventive Services Task Force is a voluntary committee (chaired in the past by Ned Calonge, the school's Associate Dean for Public Health Practice) that reviews evidence related to prevention modalities. The Affordable Care Act requires coverage for those prevention modalities graded at the level of A or B without a deductible charge. Recommendations at the A and B levels come from systematic review evidence and a rigorous assessment that providing these services will improve health and longevity.  

The religious plaintiffs claim that they want health insurance that excludes coverage for certain preventive measures that they find objectionable: for example, the HPV vaccine and screenings and behavioral counseling for sexually-transmitted diseases and drug use. The non-religious plaintiffs “…claim injury based on their inability to purchase insurance that excludes or imposes copays or deductibles for preventive care services they do not want or need, resulting in higher monthly premiums.” The opinion includes extensive legal discussion of the appointment of the USPSTF and the authority conveyed to it as a voluntary task force that is not part of a federal agency. My bottom-line interpretation is that the compulsory nature of A and B recommendations under the Affordable Care Act can be portrayed as violating the Appointment Clause of the Constitution according to Judge O’Connor. While I cannot assess the correctness of his opinion, I understand its adverse implications for public health. The plaintiffs’ personal motivations—both religious and non-religious—undermine broader public health goals. Public health is for all and should not be diminished by the desires of some.

I was at the University of Miami last week, which reminded me that I have been neglecting Florida’s Surgeon General, Dr. Joseph Ladapo. In a recent news tidbit, it turns out that the report supporting Ladapo's recommendation that young males should not receive COVID-19 vaccines had been altered, removing analyses pointing to the risks of cardiovascular disease for those with COVID-19. Trust your Surgeon General? 

We can all learn from the lives of those who have made a difference in public health. Colin (Coke) McCord died in March at age 94. Coke was trained as a surgeon but began his career with international health work in Mozambique, India, and Bangladesh. Later at Harlem Hospital, he collaborated with Harold Freeman—fellow surgeon, cancer control pioneer, and “father” of patient navigation—on a landmark paper on mortality in Harlem. Published in The New England Journal of Medicine in 1990, McCord and Freeman showed that life expectancy for Black men in Harlem was less than that for men in Bangladesh, a country with very poor mortality statistics at the time. Later, as Assistant Health Commissioner under Mayor Bloomberg, he championed New York City’s pioneering indoor smoking ban (Note: I testified before the City Council on October 10, 2002, concerning the risks of secondhand smoke). McCord’s story shows how one person can make a difference in public health.  

One more obituary—not public health related—but another remarkable life. Emahoy Tsegué-Maryam Guèbrou—an Ethiopian nun, composer, and pianist—died in March at age 99. Even before I began collaborative work with colleagues at the Addis Ababa University School of Public Health in 2010, I had been drawn to Ethiopian music through the French series of collections of recordings: Éthiopiques. Number 21 in the collection features her music, haunting blues-like compositions reminiscent of some of Erik Satie’s work. For more, listen to BBC’s “The Honky Tonk Nun” broadcast.  

Last, Dr. Michelle Bell from the Yale University School of Enviroment will deliver the annual Richard Hamman Lecture, “Air Pollution, Weather, and Human Health,” on the CU Anschutz campus next Monday, April 17. The annual lecture is given by a leader in public health on a topic of interest to the school and the CU Anschutz Campus, and climate health is certainly of interest currently. Michelle will also join discussions on climate and health in a series of meetings on Monday and Tuesday. Don’t miss her.   

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