Dean's COVID-19 Commentary

Memorial Day, occurring on the last Monday in May, is a federal holiday for mourning those who have died while serving in the U.S. military forces. The total exceeds 1.3 million since the founding of the United States. For this year’s Memorial Day weekend, mourning for and anger over yet another tragic school shooting are the focus of conversation, displacing its intended purpose. President Biden did lay a wreath at the Tomb of the Unknown Soldier on Monday; but on Sunday, he and his wife were in Uvalde, Texas after an 18-year-old with a just-purchased automatic weapon killed 19 schoolchildren and two teachers. As with the Buffalo shootings, only a few weeks ago, the president’s empathy for the victims and their families was powerful and his frustration with yet another mass killing was evident. Once again, the now ritualized calls for action followed the school shooting, juxtaposed by the maddening Kabuki theater of opponents of measures to curb gun violence.
 
In a full-page announcement in Sunday’s New York Times, Kaiser Permanente proclaimed that “Gun violence is a public health crisis. A preventable one.” It is establishing a new Center for Gun Violence Research and Education. The Colorado School of Public Health and the University of Colorado School of Medicine recently established the collaborative Injury & Violence Prevention Center, led by Ashley Brooks-Russell and Emmy Betz, which builds on the prior Program for Injury Prevention, Education & Research (PIPER). Such centers carry out research and develop educational initiatives and policy approaches. Sadly, politics block the needed evidence-based and reasonable actions suggested by research and have long done so.
 
The magnitude of the public health crisis is enormous and deeply troubling. Between 1990 and 2015, there were 851,000 firearm deaths in the United States. Not surprisingly, mortality rates are high among young men, particularly Black men with lower educational attainment. Firearm deaths rose by 28 percent during the first year of the COVID-19 pandemic. The Uvalde tragedy highlights the reach of gun violence into our schools. The Hill lists 27 school-related shootings that have already occurred in 2022. In the public health problem-solving paradigm, a problem has been identified and its root causes characterized. Once again, opinion columnists propose next steps, as they have done in the past. Will the body count of children and teachers sway the nation’s leaders?
 
Although displaced from the front pages, the COVID-19 pandemic continues to evolve. Test positivity and the number of people hospitalized in Colorado continue to increase and the BA.4 and BA.5 variants have reached the state. While the state of the pandemic in Colorado is not so threatening as before, the future, cumulative burden from long COVID is concerning. A report last week in the CDC's Morbidity and Mortality Weekly Report provides a national look at post-COVID conditions among adult COVID-19 survivors. The investigators used a national electronic health record database to carry out a cohort study of people with a diagnosis of COVID-19 or a positive SARS-CoV-2 test and a matched control group. Of 26 pre-specified conditions, one in five 18-64 year-old adults experienced at least one. The cumulative incidence was even higher among those 65+ at one in four. Patients who had COVID-19 were twice as likely to experience a pulmonary embolism and respiratory symptoms compared to the control group. Risks for cardiovascular outcomes and general symptoms were also higher, with some differences by age group. One of the upcoming projects for the Colorado COVID-19 Modeling Group is to estimate the burden of long COVID on the state.
 
While there was a great deal of difficult news last week, we were able to find moments of hope and connection. Last week’s Convocation was a wonderful event, held outdoors in front of the Fitzsimons Building on a beautiful Colorado morning. Being together felt right and was refreshing. Our speaker, Dr. Terri Richardson, was powerful in reminding students of the problems needing attention and the engrained health inequities that need to be erased. Her exhortation to the graduates will be remembered.
 
A past graduate—Jen Myers—wrote to me with her charge to the new alumni:

 
To our graduates—congratulations. You have much to do. I know you will rise to the occasion.



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