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Sunday, November 27, 2022

The doctor. Colorado’s Fauci’ reflects on COVID and the state of public health

Nearly half of Jon Samet’s tenure as dean of the Colorado School of Public Health has been spent fighting COVID-19, from modeling the spread of the virus to advising state and local leaders; he even found time to keep a regular blog with his thoughts on the situation.

Now, at the end of his time as the school’s longest-serving administrator, Samet is literally battling COVID-19, which he contracted after a wedding in Scotland. It’s okay, he said he: he’s fully vaccinated and twice boosted. In his “Dean’s Notes” blog, he described the circumstances that led to his infection as only an epidemiologist could, with an assessment of a meeting’s (poor) ventilation; of the prevalence of the virus in Scotland (one in 18 residents currently infectious); and the cause of this high rate of spread (two highly transmissive subvariants).

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When Samet became dean of the school in 2017, he committed to a minimum term of five years. The school, a joint effort of the state’s three big public universities, was a decade old then. Five years have come and gone, half of them swallowed by COVID-19, and Samet has announced that he will step down as dean once he hires his replacement later this year.

When he started, he had a strategic plan, much of it focused on building the reputation, weight, and pedigree of a nascent show. COVID-19 was “a distraction” from that plan, one that came right in the middle of their five-year commitment. Fun or not, it was important, she said, because it helped the school further establish itself while cementing relationships with state and local public health officials.

Young faculty have been recruited, and while Samet recommends that “nobody should pay attention” to US News & World Report rankings, he still notes that his school now ranks as the 19th-best graduate health program in the country, out of nearly 200 .

“We have achieved a lot in five years,” he said.

He won’t retire: His long list of upcoming projects includes writing a book on research to finish a project on radon and uranium mining that has been in limbo for years, and instead he will join the school’s faculty. His background is in respiratory health: he’s a pulmonologist by training and has focused on tobacco and secondhand smoke, and there’s plenty there to keep him busy for a while.

Still, his impending step back and the turnaround in the COVID-19 pandemic allow for some reflection.

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He is optimistic about the future of public health, even two years after his field has become a piñata for anyone looking to vent frustration over COVID-19. He has become more professionalized since he began his career several decades ago: training has improved, new tools and research methods are available. The reach of public health has grown, from health inspections and sexually transmitted infection cartels to tackling the tobacco industry and now becoming the front line of the response to COVID-19.

That’s a silver way of life for the pandemic, he said: “It has given a new importance to public health and its persistence in the public eye.” The degree to which it has been politicized and its findings and recommendations derailed by misinformation: those are the biggest surprises of the last two years.

He was also struck by how “extraordinarily cynical” some politicians were in “politicizing a critical tool of public health, whether it be vaccines or respiratory protection.”

“It was really unfortunate,” he continued. “It cost lives.”

Pandemics have always been political — go back and look at 1918, he said — but this pandemic still stands out.

He pointed to the dissolution of the Tri-County Health Department, the largest county-level health agency in the state, as evidence. The department has been beset by political disagreements within its three constituent counties, and after they withdrew from the agency one by one, it will cease to exist at the end of this year.

Tri-County, he said, “is a great example of what has happened with politics and public health.”

He’s not alone: ​​Public health leadership across the state, and country, “has taken a hit,” Samet said. Medical and public health groups “are burned out” and have lost critical staff.

But he is hopeful that the next generation of professionals, motivated by what they have experienced in the last two and a half years, will step up to the plate.

“The need for public health and (ensuring that we have) a public health infrastructure has become more clear,” he said, “which should lead to strengthening… This should be a moment where we step back, reflect and thinking about what we have to do next.

Is that happening? Even now, the United States is struggling to deal with an outbreak of monkeypox that is much milder than COVID-19, at a time when the nation should be well versed in slowing the spread of the disease.

The strengthening of public health, Samet said, will occur “irregularly” throughout the country. He said Colorado is well positioned, praising the state’s health leaders and collaboration among local public health agencies. The state’s data systems need to be improved, as they are across the country, and the workforce needs to be strengthened as well. Always an administrator, Samet said the School of Public Health can help with both problems. It is committed, he said, to serving this region specifically.

“I think we have learned, on the one hand, that (public health) is an anchor, and we are needed to protect the health of the population,” he said. Vaccines and other responses pushed by health officials were “important contributions” that saved lives, regardless of what the public and politics have said about them.

That’s the other thing: “We’ve learned (that) the public certainly didn’t understand public health at the start of the pandemic, or not much of the public,” Samet said. “I think there has been progress in perception. It has progressed favorably for the majority and unfavorably for the minority. I think one lesson we have is that we have to advance our understanding of public health and why it matters.”

It is a concept, in part, of public good for the public good. Wearing a mask protects you, but it also protects everyone around you. The idea that collective action is necessary and important, Samet said, “somewhere, we need to explain that better.”

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