by Catherine Colquitt, MD
Tarrant County Public Health Medical Director
This article was originally published in the September/October issue of the Tarrant County Physician. You can read find the full magazine here.
With healthcare systems, policy makers, and community partners preoccupied with the ongoing COVID-19 pandemic, other infectious diseases are percolating in the United States and across the globe, reminding us that Hamlet was right: “There are more things in heaven and on earth, Horatio, than are dreamt of in your philosophy.”1
Recently, the National Vital Statistics System (NVSS) issued a rapid release describing the effects of COVID-19 on U.S. life expectancy, which declined overall by 1.5 years between 2019 and 2020, from 78.8 years to 77.3 years.2 It is the sharpest decline in U.S. life expectancy since 1943, when World War II casualties were to blame for the decline from 1942 to 1943. Life expectancy decreased by 3.0 years for persons of Hispanic origin, and by 2.9 years for the non-Hispanic Black population over the same time period. The magnitude of the drop in life expectancy and the disparate effects of COVID-19 based on race and ethnicity are sobering.
In addition, many epidemiologists and public health experts are anticipating a busy influenza and other respiratory virus season after very low incidences of flu and other non-COVID respiratory infections in 2020 (attributed to COVID-19 shutdowns of schools, workplaces and businesses, masking requirements, and social distancing guidance). The CDC says to plan for “resumption of seasonal flu virus circulation” in the population with decreased “immunity due to lack of flu activity since March 2020” along with “co-circulation of flu, SARS-CoV-2, and other viruses like RSV” which may “place a renewed burden on the health care system.”3
The Texas Department of State Health Services attributes drops in vaccination rates to “stay-at-home measures, school and school-based clinic closures, and business closures” during the COVID-19 shutdown along with healthcare providers “suspending or postponing wellness visits including vaccinations in some cases.”4 From April 2019 to April 2020, vaccination rates through TVFC program decreased by 43 percent and remain well below 2019 rates even now. ImmTrac2, the Texas Immunization Registry, reported on July 1, 2021, that age-specific benchmarks for most VFC-supported immunizations (including pertussis, Hepatitis B, Hemophilus influenzae, rubella, measles, mumps, and varicella) remain well below benchmarks with schools soon to reopen for in-person classes.
Dallas County Department of Health and Human Services reported 100 cases of Hepatitis A in 2020 (an increase from an annual average of 19 cases for the prior 10 years) and has already recorded 52 Hepatitis A cases in the first three months of 2021.5 The outbreak in Dallas County is associated with drug use (both injection and non-injection) and homelessness. Tarrant County is working with the Tarrant County Homeless Coalition and John Peter Smith Hospital among other partners to offer homeless Tarrant County residents Hepatitis A vaccines (highly efficacious at preventing future Hep A infections).
And in July, the CDC issued a statement on Monkeypox in Texas.6 The infected U.S. resident had recently returned from Nigeria and traveled by air from Lagos to Atlanta and then to DFW International Airport. A contact investigation is underway; Monkeypox is rare in the U.S. The last large outbreak occurred in 2003 and was associated with transmission from pet prairie dogs to humans. Monkeypox can cause serious morbidity and is usually contracted through contact with infected animals (bites, scratches, or dressing wild game) but can be transmitted via respiratory droplets, body fluid contact, or fomite spread (via contaminated clothing or bedding). More information about monkeypox is available at https://www.cdc.gov/pox virus/monkeypox,index/html.
1. Shakespeare, William. Hamlet, Act 1, Scene 5.
2. “The 2020 Decline in Life Expectancy.” Centers for Disease Control and Prevention, July 21, 2021. https://www.cdc.gov/nchs/pressroom/podcasts/2021/20210721/20210721.htm.
3. “Frequently Asked Influenza (Flu) Questions: 2021-2022 Season.” Centers for Disease Control and Prevention, August 6, 2021. https://www.cdc.gov/flu/season/faq-flu-season-2021-2022.htm.
4. “Preliminary Report on the Texas Vaccines for Children Program: Impacts of COVID-19 on TVFC Vaccine administration.” Texas Department of State Health Services, September 16, 2020. https://www.dshs.texas.gov/immunize/docs/COVID19impactTVFC.pdf
5. Dallas County Health and Human Services Health Alert, April 5,2021. https://www.dallascounty.org/Assets/uploads/docs/hhs/health-advisories/2021/DCHHS-HealthAlert-HepatitisA-04.05.2021.pdf
6. “CDC and TEXAS Confirm MONKEYPOX in U.S. Traveler.” Centers for Disease Control and Prevention, July 16, 2021. https://www.cdc.gov/media/releases/2021/s0716-confirm-monkeypox.html.