Dean's COVID-19 Commentary

The scary rise in COVID-19 cases, hospitalizations, and deaths has led to widespread vaccination mandates by employers, municipalities, states, and colleges and universities. In Colorado, more and more healthcare systems are requiring vaccination for staff and the City of Denver has mandated vaccination for its employees and those in high-risk settings. Across the three campuses of the Colorado School of Public Health, vaccination is now required for faculty, staff, and students at the University of Colorado and Colorado State University, and will be needed at the University of Northern Colorado once one of the available vaccines receives full approval from the Food and Drug Administration.  

There was good news this week from the Supreme Court on the topic of vaccine mandates. Justice Amy Coney Barrett turned down a request from eight students for emergency relief in their case against Indiana University’s vaccine mandate. The original opinion by Judge Leichty from the United States District Court is informative and readable on the issues raised by the students and the legal precedents. The opinion led me to Henning Jacobson, Plff. in Err., v. Commonwealth of Massachusetts, a pivotal 1905 Supreme Court decision involving Jacobson’s refusal of smallpox vaccination. The issues covered in the decision resonate today. Quoting the penultimate sentence: “It is the cause of an adult who, for aught that appears, was himself in perfect health and a fit subject of vaccination, and yet, while remaining in the community, refused to obey the statute and the regulation adopted in execution of its provisions for the protection of the public health and the public safety, confessedly endangered by the presence of a dangerous disease.” The Court found against Jacobson.  

This decision explicitly recognizes that vaccination of people — one by one — protects “public health and the public safety.” From the start of the COVID-19 pandemic, non-pharmaceutical interventions were the key to avoid exceeding the medical care system’s capacity to provide care for acutely ill COVID-19 patients, while continuing to manage ongoing care needs. Now, we have vaccination as an effective tool, but vaccination rates have not reached levels needed to slow the pandemic sufficiently, particularly since the Delta variant is now prevalent and causing most cases.  

Healthcare providers and hospitals are again seeing a surge and anticipating with dread full intensive care units and COVID-19 wards. Last week, Marc Moss, Head of the Division of Pulmonary Sciences and Critical Care Medicine at the CU School of Medicine, wrote to me expressing concern about the impact of another surge on the providers taking care of the COVID-19 patients. His message needs to be heard and I asked him to join me this week.  His contribution follows.

Notes from the front lines of patient care
Marc Moss, MD 

As the COVID pandemic enters its 20th month in the United States, the number of COVID patients is increasing, again. For frontline providers, this next surge could leave permanent psychological scars and negatively impact the healthcare delivery system for many years. 

Caring for the critically ill COVID patients has been emotionally challenging. Prior to the availability of the vaccines, front line providers were working in a difficult and scary environment; and literally putting their lives on the line for their patients. According to the World Health Organization (WHO), over 3,600 U.S. and 114,000 healthcare professionals worldwide have died from COVID during the first 14 months of the pandemic. However, among frontline providers, there was a sense of heroism driven by a common mission that COVID patients needed our help. Healthcare professionals worked long hours, putting on and taking off protective equipment as we entered and exited each patient’s room, while trying not to get sick ourselves. Because of the inability of family members to visit the hospital, healthcare professionals stayed within patient rooms to try and diminish the sense of isolation on the part of the patients. They often held a patient’s hand and tried to provide reassurance. They developed extensive safety routines to not bring the virus home, such as changing clothes multiple times between the hospital and their homes. They slept in basements or other isolated rooms of their homes, all in an attempt to not infect their family members. It was an honor to witness their extraordinary and relentless efforts to care for our sickest patients. 

As the struggle to care for COVID patients continued through the fall, the availability of an extremely effective vaccine created a sense of hope that the pandemic might end. On the frontlines, we began to believe that we might not die in the line of service. Many of us cried with joy when we received our vaccines in December. There was hope. However, that sense of hope seems short lived at the current time. 

Currently, the pandemic rages on due to lower than expected vaccination rates, and as a result there are many deleterious consequences. First, the care of non-COVID patients is being hampered due to the necessity to shift resources and personnel to care for COVID patients. Across the country, elective surgeries are being postponed again, and healthcare providers are being shifted to inpatient responsibilities at the expense of not being available to care for their patients in outpatient settings. Second, as the virus continues to mutate and surge, vaccinated immunocompromised patients are contracting COVID because they cannot mount a sufficient immune response to the vaccine. Third, the number of pediatric cases of COVID continues to rise and pediatric hospitals are starting to be overwhelmed. Finally, patients are suffering from post-COVID symptoms, and seeking outpatient medical care at exponentially increasing numbers. As a result, the need for these outpatient services is beginning to outstrip the supply of healthcare providers capable of caring for these patients. 

Before the pandemic, the wellness of healthcare professionals had become one of the more important issues in healthcare. COVID accelerated the triggers and stressors, and further heightened the parallel pandemic of psychological distress in healthcare professionals. The new wave of COVID patients in predominantly unvaccinated people may ultimately “break the souls” of healthcare professionals. With all the sacrifices that healthcare professionals have endured and all the tragedy that they have encountered, there is clearly a questioning of “how can people not get vaccinated”? There seems to be a general sense of dismay among healthcare professionals, even outrage and anger.  

According to recent studies, between 20% and 30% of frontline U.S. healthcare workers say they are now considering leaving the profession. Notably, one April 2021 marketplace study of 1,273 nurses across all 50 states found that four in 10 (43%) nurses are considering leaving their role in 2021 — a figure that is even higher among ICU personnel (48%). When even a few healthcare professionals leave, the amount of work is increased for the remaining employees, further stressing everyone, and spiraling the exodus of healthcare workers from their profession. 

The next few weeks and months could be a critical and determining moment for healthcare professionals as they contemplate whether to remain in healthcare.

The public can make a difference — get vaccinated!




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