The COVID-19 pandemic is the biggest, most harmful public health event since the great influenza pandemic more than 100 years ago. The pandemic was devastating for our state – more than 1.7 million cases, 71,000 hospitalizations, and 14,000 deaths.
These numbers are just one part of the broad range of COVID-19 impacts on virtually every aspect of our state: periods of economic lockdown, long gaps in in-person education, jobs lost, health and well-being reduced, and lives changed. And the full burden of long COVID remains to be realized.
Both of us were intensely involved in the public health pandemic response in Denver and the state. For those aspects of the pandemic that we were involved in, we recognize that some efforts went well and some did not, but our state has not systematically explored successes and failures. It is critical that we have rigorous, independent evaluations of key parts of the pandemic response. Additional public health crises will surely affect our state, and we need to learn as much as possible from the COVID-19 pandemic to enhance our preparedness.
Is this the right time for an evaluation?
Is the pandemic over? Perhaps, as it appears that the most recent variant (BA.5) is waning and the level of immunity in the population is high, but a new and highly transmissible variant could quickly send the epidemic curve upwards. COVID-19 is becoming established as an endemic infection — one of a number of infections transmitted primarily by cough and droplet or aerosol generation (such as influenza and pertussis) that affect our community every year. COVID-19 isn’t gone, but the pandemic is in a lull and perhaps moving to an endemic phase.
Do we need to review Colorado and Denver’s pandemic responses?
Reports have been released on lessons learned at the national level. These reviews proposed specific next steps for the Executive branch, Congress, and federal agencies. However, much of the COVID-19 response in our area was carried out by entities that are not the subject of national evaluations: the state government, counties, local health departments, hospitals and healthcare systems, local public schools, and many others. Colorado’s unique characteristics, such as its large rural and frontier areas, need specific consideration.
What parts of the COVID-19 response should be evaluated?
We need broad input from many groups in designing a rigorous evaluation of the pandemic; however, without careful consideration, an evaluation could become so large as to be unfeasible, and hence, unhelpful. Our initial thoughts are below, and we look forward to hearing from others.
Data and monitoring: Local, timely, accurate data drives effective emergency response. Public health departments in Colorado struggled to provide actionable data to their communities, particularly early in the pandemic. Public health data systems remain fragmented and isolated, for the most part, from regional health information exchanges, which allow healthcare providers to exchange data. Recommendations have been made at the national level, but we have local problems to fix.
Health disparities: Racial minorities in Colorado have experienced severe disparities in COVID-19 infection rates, hospitalizations, deaths, testing, treatment, and vaccination. However, once identified, health departments and other agencies struggled to effectively address disparities. We need data systems to identify disparities in real time and then models of care and funding that will alleviate disparities in future public emergencies.
Impact on K-12 education: There is increasing evidence of the problems stemming from prolonged periods of remote schooling during the pandemic – decreased academic achievement and increased depression and anxiety. We need a careful evaluation of policies, guidelines, and practices that led to school closures and a strategy to reduce transmission of airborne infections in schools.
Contact support (investigation) and contact tracing: A tremendous amount of public health effort went into reaching out to those diagnosed with COVID-19 and the persons they had been around . However, it is not clear whether these activities were beneficial to those affected and to the overall COVID-19 response.
Congregate living settings, particularly skilled nursing facilities: A large part of the mortality of COVID-19 was among the elderly and those with multiple chronic medical conditions. Outbreaks in congregate living settings were common, deadly, and hard to control.
Coordination of COVID-19 responses across systems: Responding to the pandemic required collaboration between many large systems: hospitals and healthcare systems, emergency medical systems and first responders, human services departments, schools, public health departments, and others. However, the ability to quickly and effectively collaborate was hindered by lack of pre-existing relationships, inability to share data, and siloed funding and data systems. We need structures and funding mechanisms that promote cross-sector collaborations to be able to respond to the public health emergencies of the future.
Conclusion: It is time for an integrated and coordinated review of the Colorado COVID-19 response, one that brings the key players to the same table.
William Burman M.D., of Denver, is former executive director of the Public Health Institute at Denver Health.
Jon Samet M.D., of Denver, is dean of the Colorado School of Public Health.
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