Dean's COVID-19 Commentary

Not surprisingly, Colorado has its first two cases of COVID-19 due to the Omicron variant, and both have a travel link to southern Africa. As of yesterday, the variant had been identified in at least 16 states. Most cases appear to have a connection to southern Africa, but some seem to have resulted from community spread. Undoubtedly, there will be many more cases and attention will shift from anecdote to tracking the epidemic’s spread, assuming that Omicron is more transmissible than the Delta variant. Last week, a paper from South Africa found an increased risk for reinfection in November when Omicron emerged. They found an estimated increase in risk of 2.39 for November compared with the time period of the country’s first SARS-CoV-2 wave. The authors interpret the increased risk as potential “immune escape” by Omicron, i.e., its ability to evade immunity from prior infection. Questions remain related to vaccine immunity. Yesterday’s New York Times has a fascinating description of an anime convention in the city and the efforts to determine whether or not it was a superspreading event for Omicron. We once again face a variant that will challenge our public health capacities.  

At last, I can provide encouraging numbers for Colorado. After charting the epidemic’s upward course since September in these commentaries, I can now report that the curve of the number of hospitalized Coloradans is in decline, from a peak of 1,576 on November 23 to 1,376 on December 3.  While the consequences of gatherings and travel for the Thanksgiving holiday might still slow the decline, the direction of the epidemic curve for the state is now clearly downward. The timing of the decline is optimal, if we are about to experience the arrival of a more transmissible variant in Omicron.

Even as concern rises about the possibility that Omicron poses a graver threat than Delta, efforts continue to thwart public health measures. In an amazingly near-sighted move, several Republicans threatened to force a government shutdown because of the Biden Administration’s mask mandate actions. I also note with bemusement that three National Football League players were suspended for having falsified vaccination records.

Three weeks ago, I wrote about the challenge to the Occupational Safety and Health Administration’s COVID-19 Vaccination and Testing Emergency Temporary Standard (ETS) and the decision of the U.S. Fifth Circuit Court of Appeals staying the ETS. Last week, both Distinguished Professor Lee Newman and I signed on to an amicus brief supporting the OSHA ETS. We were joined by many public health colleagues, all supporting a sensible measure in the face of a life-threatening pandemic that has placed disproportionate disease burden on workers. I am asked to sign on to such amicus briefs from time to time and do so when the issue is significant. At the least, by signing on, Lee and I increase the weight of the scientific consensus supporting the OSHA ETS. 

There is other action against sensible recommendations from the Biden Administration. On November 4, the Centers for Medicare and Medicaid Services (CMS) issued an Interim Final Rule requiring COVID-19 vaccination for many classes of providers receiving CMS funds. That regulation has now been stayed by two District Court Decisions. I perused the November 30 opinion from Judge Doughty of the Western District of Louisiana. While there is much legalese that I don’t understand, I find misrepresentations of features of the COVID-19 pandemic. For example, “natural immunity” is asserted as providing equivalent or greater protection than that from vaccination. Perhaps this statement is true for some previously infected individuals for a time following infection, but not for the long run. Here is an informative, summarizing quotation from Judge Doughty:

“During a pandemic such as this one, it is even more important to safeguard the separation of powers set forth in our Constitution to avoid erosion of our liberties. Because the Plaintiff States have satisfied all four elements required for a preliminary injunction to issue, this Court has determined that a preliminary injunction should issue against the Government Defendants.

"This matter will ultimately be decided by a higher court than this one. However, it is important to preserve the status quo in this case. The liberty interests of the unvaccinated requires nothing less.”  

The “liberty interests of the unvaccinated” need explanation, at least for me in the face of a pandemic that is reaching the two-year mark and is being driven by the unvaccinated in the United States. Stay tuned to this legal channel.  

Continue to stay well, 

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