Dean's COVID-19 Commentary

Let us start with Shakespeare’s “Song of the Witches” from Macbeth: “Double, double toil and trouble; Fire burn and caldron bubble.” One of my last verse memories from high school and it fits with the pandemic stories of January. This has been a month that began with optimism and ends with the realities of providing vaccines to the world, and the troubling emergence of SARS-CoV-2 strains that may be more transmissible and more lethal than the circulating strain. Both challenges were inevitable—RNA viruses mutate and the logistics of delivering shots into the arms of the United States (N=328 million) and of the world (N=7.7 billion) are formidable.  

Some good news about Colorado first. The epidemic curve continues down with the effective reproductive number staying below 1; hospitalizations, which peaked at 1,847 on December 1 declined to 558 two months later on January 31. This good news should be tempered by the still-high prevalence of infection; around one in 125 Coloradans is infected. We did not experience surges caused by the Thanksgiving and December holidays, and the combination of policy measures and the transmission-control behaviors of Coloradans are proving effective at the moment. A revision of the COVID-19 dial framework is planned; the proposed dial 2.0 will reflect the beneficial consequences of vaccination and the reduced threat of reaching hospital capacity. 

The return to “normalcy,” if 2019 is the standard, will be slow, but is it time to get started to move in that direction in Colorado? The threats to success are those of the bubbling cauldron: new viral strains and vaccinating enough Coloradans to achieve herd immunity, and, in the face of a declining epidemic, avoiding “COVID fatigue” and its consequences for transmission-reducing behavior.  Relaxations of policy measures are “N of 1” experiments and we will not have insights as to the consequences until weeks after a change is made.  

Certainly, the patchwork of vaccination policies with limited successes and too many failures fits with “Double, double toil and trouble.” News highlights include impossible challenges in getting on lists and scheduling vaccinations, widely varying priority designations across the states, and long lines at vaccination sites. I was distressed by a report in the Los Angeles Times that described the interruption of drive-up vaccinations at Dodger Stadium by anti-vaccination and far-right protestors. We don’t need the interference with the rights of others to be vaccinated.

On to the new strains of SARS-CoV-2—for an up-to-date description, this article in Scientific American provides a quick, readable overview. Concerns about the strains with these mutations include increased transmissibility, greater virulence, and reduced efficacy of vaccines and monoclonal antibody therapy. So far, 11 cases of the B.1.1.7 have been identified in Colorado and surveillance is ongoing. These emerging strains are worrisome, but we need a deeper understanding of the mutations and their impact on the viruses’ behavior to know how worried we should be. Colorado’s declining epidemic with the effective reproductive number below one provides a degree of protection against the new strains becoming dominant. More transmissible strains become more common when a rising epidemic curve provides an opportunity in a race against less transmissible strains. There is ongoing surveillance by the Colorado Department of Public Health and Environment and the Centers for Disease Control and Prevention.  

Once again, follow public health recommendations, beware COVID-19 fatigue, and hope for a cooling caldron. 

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

P.S. As we close out the first month of 2021, a year that should bring a close to the COVID-19 pandemic, we are at a good point to reflect on where public health has been and where we’re going. With these reflections in mind, our marketing and communications team has launched a new video that aims to capture who we are, what we do, and why we believe in the power of public health. I encourage you to watch it and share it with family, friends, and colleagues — people who may one day be our students, staff, faculty, and public health leaders.