Dean's COVID-19 Commentary

The BA.2.12.1 subvariant has arrived in Colorado and is likely the predominant cause of SARS-CoV-2 infections in the state at present. It is perhaps 25% more transmissible than BA.2, which is more transmissible than BA.1. Once again, the more transmissible variant becomes dominant, a lesson that we have learned repeatedly over the pandemic’s almost 30-month course. The consequences of BA.2.12.1’s rise in Colorado are evident. Over the last month, the number of Coloradans hospitalized with COVID-19 has risen from the recent low of 77 to 116 last week. In parallel, test positivity has risen from a low of 2.5% to over 7%.  

We are still uncertain about critical characteristics of BA.2.12.1, particularly the degree of escape from immunity acquired from prior infection and from vaccination. Last month’s modeling report projected that Colorado would experience a rise in hospitalization that might peak in the range of 300 to 500. Last week’s modeling report provides a similar picture with the peak projected for later June, reaching as high as 500 or more. In other states, e.g., Pennsylvania and New York, where BA.2.12.1 became predominant earlier than in Colorado, the epidemic curves have been rising progressively for a month or more. This course will likely be repeated in Colorado, although the curve is not rising as rapidly as it did in those two states.

As I have commented repeatedly, the future course of the pandemic remains highly uncertain. New variants continue to emerge, a form of mutation roulette; we never know what the outcome may be, but it is the critical determinant of what is to come. BA.4 and BA.5 have emerged in South Africa, but have not yet spread widely. Dr. Ashish Jha, the new White House coordinator for COVID-19, stirred controversy last week with the suggestion that there could be 100 million cases in the United States across the fall and winter. He tied this possibility to Congress not moving forward with further funding to combat the pandemic, but did not provide specific modeling in support of this large estimate. I am concerned that interest in controlling the pandemic and preparedness will wane as the pandemic possibly enters into an endemic phase, less frequently punctuated with dramatic surges.  

There was some public health bad news as Colorado’s legislative session ended. The proposed ban on flavored tobacco products, which had passed the House, was voted down (5-2) by the Senate Appropriations Committee. I was impressed by the misinformation in the crowing on the bill’s failure by Amanda Wheeler, President of the American Vapors Association: “Colorado rejecting the flavor ban is a signal for other jurisdictions to refocus public health efforts on what works — vaping,” she said. “Nicotine vaping is the single most effective smoking cessation method ever devised.” There is a single nicotine inhaler that is an FDA approved replacement therapy; the myriad products sold in vape shops and online are not FDA approved. Wheeler’s statement concerning nicotine vaping is wrong and tantamount to a cessation claim that is not allowed for these devices. There is always next year and the FDA has initiated the process to move forward with banning menthol as a characterizing flavor in tobacco products.  

I write from Croatia, where we are spending five days cycling in this beautiful country. By observation, few were wearing masks in the Denver International Airport, but they are still required on international flights. And we’ve seen few people wearing masks in Croatia where 55% of the population is fully vaccinated. Per Yogi Berra, “it ain’t over till it’s over,” and wishful thinking is proven to fail.    



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