Dean's COVID-19 Commentary

The COVID-19 pandemic has dropped from the news as its decline continues. In Colorado, hospitalizations declined last week, reaching 103, and trends of wastewater concentrations remain encouraging. Surveillance for COVID-19 has changed as the pandemic has abated. Johns Hopkins ended its invaluable agglomeration of the world’s data on March 10 of this year and surveillance by the Centers for Disease Control and Prevention (CDC) changed with the end of the public health emergency declaration on May 11.  

These improving statistics raise the inevitable question: are we there (endemic) yet? Per CDC, “Endemic refers to the constant presence and/or usual presence of a disease or infectious agent in a population within a geographic area.” Remember R₀ (R naught) from the early days of the pandemic—the number of cases caused by an infected individual at the start of an epidemic? And recall that as the epidemic evolves, its growth is described by the effective reproductive number R_eff. When the epidemic becomes endemic, the R_eff equals one so that the epidemic is sustained, but neither decreasing or increasing. Immune efficacy is key to controlling epidemics as it is driven by post-infection immunity and vaccination over an epidemic’s course. Immunity can reduce susceptibility to infection, reduce infectiousness, and reduce severity. The course of an epidemic and who is affected depends on these three components of immune efficacy—their strength and their persistence over time. Our understanding of immune efficacy for SARS-CoV-2 is still incomplete, but we will learn more as we follow the course of COVID-19. For a primer on endemicity, this article by Antia and Halloran is excellent. 

Try a simple Google search on the question: Is COVID-19 endemic? A smorgasbord of opinion surfaces. The emergency posed by COVID-19 has greatly lessened, but we still cannot be certain as to the pandemic’s evolution and what endemicity will look like, if achieved. 

Matthew Desmond’s Poverty, By America explores the societal structures in the United States that have maintained and deepened income inequality in the United States. Desmond also wrote the Pulitzer Prize winning book Evicted, that is now in my ever-larger pile of books to read. Poverty, By America lays out the structures that maintain poverty to the benefit of the more affluent. The culprits are numerous: persistent segregation, banks and other lenders, the tax codes, residential zoning, and the biases, hidden and overt, on the part of the affluent. Desmond piles on with passion for reform as he enumerates these the factors maintaining poverty. He calls for solutions that range from practicable to sweeping, too sweeping to be accomplished in today’s polarized United States. But quoting the book’s last page: 

“What are we doing to divest from poverty? Every person, every company, every institution that has a role in perpetuating poverty also has a role in ameliorating it.  The end of poverty is something to stand for, to march for, to sacrifice for. Because poverty is the dream killer, the capability destroyer, the great waster of human potential. It is a misery and a national disgrace, one that belies any claim to our greatness. The citizens of the richest nation in the world can and should finally put an end to it.” 

Read this book, which is brief (187 pages and with extensive documentation) and approachable. Poverty is an upstream contributor to perhaps almost all public health challenges and a challenge for finding and implementing solutions.  

If you are facing a long airplane trip, then you might read The Tobacco Wives by Adele Myers. Given my long-standing work on tobacco control, I could not resist a fictional account of “Big Tobacco” burying evidence on smoking and birth outcomes in the town of Bright Leaf, North Carolina, in 1946. Central to the story is a new cigarette for women—MOMints, a plot ploy that accurately reflects the targeted marketing of cigarettes to women. Recall that Marlboro was originally a “women’s brand,” marketed with the slogan “Mild as May.”

The academic year has a rhythm that starts with expectations and anxieties and ends with the celebration of graduates. Along the way, there are the peaks of work as terms end, and seeming lulls, and points when the academic year seems interminable to students and faculty alike. The culmination of the year is graduation, my favorite day of the academic year. By definition, all attendees are joyous, and the day truly marks a turning point in life trajectories. In the lead-up, we have had award ceremonies for students, faculty, staff, and alumni. These ceremonies reminded me of the extraordinary contributions of the Colorado School of Public Health, which really do range from local to global.  

As this was my last Colorado School of Public Health Convocation as Dean, I gave the Convocation address. My take-home message: there will always be much to do in public health, now and in the future; stay prepared to contribute and be ready for the unexpected. And, of course, I opined on the unfortunate staining of public health by politics and its consequences for public health and the public health workforce.  

This is the 15th Convocation for the Colorado School of Public Health. This year’s class brings the total of alumni to more than 3,000. The school is fulfilling its mission to the state, nation, and world.

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