Dean's COVID-19 Commentary

This is an unprecedented Thanksgiving holiday. But for me, as always, I turned to a year’s accumulated journals, piled-up issues of the The New Yorker and The Economist, and saved scraps of The New York Times containing stories for later reading. Stories from January and February did not anticipate today’s surging pandemic in the United States but were already anticipating non-pharmaceutical interventions and their consequences. Some themes still resonate, like the cover story for the April 4-10 issue of The Economist: “A grim calculus. The stark choices between life, death, and the economy.” The numbers of cases and deaths that were then drawing attention seem tiny when stacked up against current totals: 13 million cases and 263,000 deaths in the United States.

Already, books have been published on the pandemic, even as its course continues to shift and its clinical picture evolves. These books offer snapshots, like that published in June by Richard Horton, editor of The Lancet: “The COVID-19 Catastrophe. What’s Gone Wrong and How to Stop It Happening Again,” while “Apollo’s Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live,” by Yale physician and social scientist Nicholas A. Christakis, offers a deeper picture of pandemics and of the COVID-19 pandemic through the summer of 2020. Christakis provides thoughtful coverage of how the structures of our societies can promote the spread of pandemics, while also bringing them to a close. Most critical is how people interact and their willingness to take steps as individuals to protect everyone, a characteristic eroded with this pandemic. Much of the book will stay relevant as the pandemic proceeds. For those looking for a deep plunge into the science of epidemics, you may be disappointed after reading “Apollo’s Arrow,” as this is a book for a general audience. Christakis will be speaking on December 16 in the school’s collaborative series with the Denver Museum of Nature and Science. 

I am midway through “The Rules of Contagion” by UK epidemiologist Adam Kucharski. Published in July, the book does not specifically cover the SARS-CoV-2 pandemic, but its coverage of spread is relevant to today—whether around the spread of the virus or of misinformation. The book moves from Nobel-Prize winner Ronald Ross and his landmark work on malaria transmission to today’s social media and “big data.”  

Last week’s 5-4 Supreme Court decision striking down NY Governor Cuomo’s restrictions on the size of religious gatherings has potentially significant implications for control of the pandemic. Cuomo had issued an order restricting the size of gatherings in houses of worship; the Court moved forward with its opinion, even though the challenged measures had been withdrawn. The majority opinion cited the First Amendment. Quoting from this opinion: 

“Members of this Court are not public health experts, and we should respect the judgment of those with special expertise and responsibility in this area. But even in a pandemic, the Constitution cannot be put away and forgotten. The restrictions at issue here, by effectively barring many from attending religious services, strike at the very heart of the First Amendment’s guarantee of religious liberty. Before allowing this to occur, we have a duty to conduct a serious examination of the need for such a drastic measure.”

And earlier in the opinion: 

“Not only is there no evidence that the applicants have contributed to the spread of COVID–19 but there are many other less restrictive rules that could be adopted to minimize the risk to those attending religious services.”

In offering its First Amendment concerns, the Court makes comparison between the seemingly differential handling of bicycle repair shops, liquor stores, and other commercial venues compared with places of worship. Bicycle repair shops have not been linked to superspreading events, while religious services have. 

The five Justices offering the majority opinion describe themselves correctly: “Members of the Court are not public health experts…”. The role of superspreading events in propagating the epidemic is clear, both from principles of epidemic spread and from well documented events, many involving houses of worship. There is powerful synergism between crowded spaces during worship services and the generation of aerosols by singing and chanting. What are those “many other less restrictive rules” that could be adopted and what is the evidence to support them? From me to the Supreme Court—“stay in your lane.”

Also of concern is the precedent set by the Supreme Court as it projects the federal government into aspects of public health that have historically been the jurisdiction of state and local governments. This long history is reviewed by John Witt, a Yale law professor, in his recent (and very short) book, “American Contagions. Epidemics and the Law from Smallpox to COVID-19.” Covering the history of the United States, Witt describes how the states and municipalities have been left in charge of public health. Per Witt, “the basic police power to look after the health of the people” is left to the states. This power is essential to control outbreaks, which have been critical in propagating Colorado’s epidemic (see the CDPHE website).  

Some time was left for the growing piles of books and reading fiction. “Winter Counts” by Denver author and Lakota citizen David Heska Wanbli Weiden has been well reviewed. Set on the Rosebud Indian Reservation and in Denver, this crime story weaves the social problems of reservation life with the identity struggles of its protagonist. Colson Whitehead is an extraordinary writer: “Underground Railroad” uses surrealism and allegory to tell the story of slavery and those who fled via the network of the underground railway. And for a remarkable photographic reimagining of the underground railway, learn about the recent work of the African-American photographer Dawoud Bey; “The Nickel Boys,” winner of the 2020 Pulitzer Prize, is direct and chilling in addressing racism, played out in a juvenile reformatory—the Nickel Academy. The story grips, and racism and its consequences horrify.  

Now, on November 30, we need to wait at least a week to learn if the holidays have unfavorably altered the course of the pandemic in the United States. The weekend’s news that Governor Polis and First Gentleman Reis are SARS-CoV-2 positive is a reminder that we are all at risk.  

I hope that your holiday was safe,