Colorado’s pandemic picture remains mixed, with no clear trend for the epidemic curve. Hospitalizations have increased over the past two weeks, reaching 185 for the week of October 4. Test positivity has plateaued at around 5.5% while the aggregate sewage virus concentration for the state declines. We have published a new modeling report showing projections with and without the arrival of a new variant. Unsurprisingly, a hypothetical new variant with greater immune evasion than the current Omicron subvariants and with high virulence, could push the epidemic curve up sharply. New subvariants of Omicron continue to emerge. It is unclear whether any or all of them have the characteristics necessary to revive the pandemic. The report provides an analysis of the sub-variants currently lurking.

Maybe we are living a transition from epidemic to endemic, defined in CDC course material as:

“The amount of a particular disease that is generally present in a community is called the baseline or endemic level of disease. This level is not necessarily the desired level, which may in fact be zero, but rather the observed level If left unchecked and assuming the level is not high enough to deplete the pool of susceptible people, disease can continue to occur at that level indefinitely, so the baseline is often taken as the expected level of disease.

This definition and others do not offer quantitative criteria for identifying the transition from epidemic to endemic. In my opinion, it is too early to declare that the pandemic has become endemic. Modeling shows that an aggressive and virulent variant could rapidly change the COVID-19 situation. There are recent reports in Science and Nature which are full of (interesting) speculation about variants and the coming winter.

With the midterm elections a month away, there is a continuous barrage of political messaging on the airwaves. There’s also a new, equally ubiquitous tsunami of ads from attorneys recruiting people who may be eligible for compensatory damages related to having lived at Camp Lejeune in North Carolina, a training base. of the Marine Corps. To find examples, search “Camp Lejeune camps” in Google. These advertisements reflect a new chapter in the long history of drinking water at Camp Lejeune being contaminated with trichlorethylene (TCE) and perchlorethylene (PCE, also known as tetrachlorethylene) from the 1950s through the mid-1980s. Both chemicals are known to have harmful effects: TCE is carcinogenic and may cause adverse pregnancy outcomes and PCE is likely to be carcinogenic as well.

Because of these exposures, Navy veterans and their families became concerned about the risks of adverse reproductive effects, cancer, and other health effects; many had requested some form of compensation in the past. A National Academies Committee – chaired by David Savitz, a visitor to the school this year – has been tasked with addressing TCE and PCE risks for former base residents to put an end to the troubling and controversial issue. The committee understood the difficult context of their report and its implications for the exposed former residents of Camp Lejeune. The National Academies 2009 report concludes:

“It cannot be reliably determined whether the illnesses and disorders experienced by former Camp Lejeune residents and workers are associated with their exposure to contaminants in the water supply due to lack of data and methodological limitations. and these limitations cannot be overcome by additional studies.Thus, the committee concludes that there is no scientific justification for the Navy and Marine Corps to await the results of additional health studies before making decisions on how to follow up on obvious solvent exposures on base and their potential health consequences Services should undertake such assessments as they deem appropriate to determine how to respond in the light of available information.

In assessing the evidence and the likelihood of adverse effects, the committee offered a perfectly balanced assessment under the “on the one hand” and “on the other hand” model. The fact of exposure to TCE and PCE was well established, but epidemiological information on those who had served or worked at Camp Lejeune was insufficient to guide risk estimation for compensation purposes, as is the case with ionizing radiation. The last sentence of the quoted text shifts the burden of decision-making onto the military services, making it clear that there is insufficient scientific evidence to tip decisions in any particular direction. In the face of uncertainty and the report of national academies, the Department of Veterans Affairs has previously moved forward with benefits under The Camp Lejeune law of 2012. This act provides health care and health care funding assistance to eligible veterans and their family members who lived at Camp Lejeune for the specified length of time on station and who meet the service date requirements. Applicants must also have one of the covered conditions, defined based on toxicological and epidemiological evidence on the chemicals of concern.

This is an example of presumptive decision making, i.e. an exposure is presumed to have occurred if the affected person meets the baseline time requirements and the specified conditions are assumed to have occurred. been caused by the exposure. The presumptions address the lack of evidence related to the causation of listed illnesses by chemicals in Camp Lejeune drinking water and assume that Camp Lejeune individuals were exposed. There is a similar exposure presumption for Agent Orange in the Agent Orange Act. I chaired a National Academies committee that addressed these assumptions in a 2006 report. The bottom line: We could do a much better job of tracking the health consequences of military service if adequate data systems were in place to support studies of exposed military personnel and veterans. There should be no presumptions to fill the gaps, a recurring finding in public health!

The recent action causing the solicitations of lawyers is the Camp Lejeune Justice law of 2022 is part of Act of Congress S.3373, which also targets veterans exposed to combustion fireplace emissions and certain other toxins. The Camp Lejeune Act allows veterans to sue the government civilly for damage caused by water exposure at Camp Lejeune from August 1, 1953, to December 31, 1987. Packs of lawyers are seeking from them of any reward. received. Now you know why Camp Lejeune has become so familiar.

Last week the The Association of Schools and Programs of Public Health (ASPPH) released the report of its Task Force on Climate Change and Health, co-chaired by Lynn Goldman, Dean of the George Washington University Milken Institute School of Public Health, and myself. The report represents a year-long effort by the task force. His recommendations are timely and will receive the attention of the leadership of the Colorado School of Public Health.

Signature of Jon Samet

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





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