Respiratory viruses are on the rise (again), mask work, and more

Brigadier General John Summit

The Colorado COVID-19 Update is no longer quick and reassuring. The number of hospitalizations rose to 379 in the week of November 15, up from 218 in the week of November 1. And for context, recall that April’s low was 77 and previous highs reached above 1,800. Other indicators have also moved in an unfavorable direction: test positivity is at 11.8% and sewage concentrations of the virus are trending across the state. The mix of variables changes as BA.5 decreases and BQ.1 rises. The diverse alphabet soup will inevitably change as SARS-CoV-2 continues to cause infection, multiply and mutate.

Respiratory syncytial virus (RSV) remains a major concern, especially for infants and children as the unprecedented RSV epidemic continues. Hospital admissions for RSV have risen at an astounding pace, far more acute than in previous years. And hospitalizations for influenza are rising at a trajectory matching those of recent years with high peaks, but we’re still early in the trajectory of an influenza pandemic. While there is significant uncertainty at present, the simultaneous peaking of the curves for influenza, RSV and COVID-19 would underline hospital capacity, especially for the pediatric age group. As always, more time will bring greater certainty about the potential threat of a “triple pandemic”.

The use of mandatory respiratory protection in schools — “mask mandates” — has been a politicized flashpoint in public health efforts to control the COVID-19 pandemic. Masks are one of the key tools in the toolbox for controlling transmission of airborne infectious agents in schools, along with improving ventilation, air filtration, and UVC. I previously described discussions at a National Academies of Sciences, Engineering, and Medicine workshop related to managing indoor environments in schools. Workshop participants considered masking an effective option and commented on barriers to successful implementation of the full toolkit.

just published paper in New England Journal of Medicine Provides real-world evidence of the effectiveness of school mask mandates. Taking advantage of the incomplete halt to mask mandates in Massachusetts after the statewide expiration in February 2022, investigators compared infection rates across 72 school districts to assess the impact of the mandate. Of these school districts, two (Boston and Chelsea) have maintained mask mandates while the rest dropped their states over a three-week period. The researchers used the difference-by-differences approach to document the effectiveness of mask mandates at the school level. Using this approach, infection rates in the two “treatment” school districts (Boston and Chelsea) are compared with those in the remaining 70 districts, before and after the three weeks during which mandates were eased. Infection rates were comparable in the two groups before the statewide relaxation but diverged afterward — remaining lower in the two school districts that maintained mandates. With this design, variable factors over time that may influence infection rate are controlled for, providing an estimate of the causal impact of mask mandates on infections in children and staff in school districts.

The results were amazing in demonstrating the effectiveness of the mask mandate. During the 15 weeks since the statewide mask mandate was dropped (before the end of the school year), the incidence of COVID-19 infection was 44.9 additional cases per week among students and staff. For context, this avoidable increase amounted to 29.4% of total cases over the post-term period. This authoritative guide provides guidance for the future if the toolbox of air transport control in schools needs to be reopened.

Sadly, we once again find ourselves grieving the victims of yet another horrific shooting. This took place in Colorado Springs over the weekend and was targeted at the LGBTQ+ community. Five people were killed at Club Q and at least 25 were wounded when a gunman with a semi-automatic weapon entered and opened fire. The Colorado School of Public Health stands in solidarity with the LGBTQ+ community in all of our campuses and programs. I urge anyone who needs support to use the campus resources at CU, CSU, and UNC; Please see resources and messages from CU Chancellor Anschutz Elliman, CSU Interim President Rick Miranda, and UNC President Andy Feinstein. The Center for Injury and Violence Prevention addresses firearms, but science-driven policies to protect public health from gun violence have long failed to advance. However, we need to continue our work.

Every year on the Monday before Thanksgiving, the American Public Health and Research Association honors! America’s public health professionals who work tirelessly to protect the health of all people and all communities as part of Public Health Thanksgiving Day. The resilience and dedication of the public health workforce is something to be grateful for every day, but it deserves a special day—especially in this stressful moment for public health workers. Reach out to colleagues and say thanks “just because”—we could all use some support amidst all that is currently going on around the world.

Jonathan Summit, MD, MA
Dean, Colorado School of Public Health





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University of Colorado Dean’s Notes


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