COVID-19 & More: COVID, the "mask wars," and East Palestine redux – Colorado School of Public Health

Starting with the (fortunately) ever-briefer COVID-19 update. In a word: “unchanged” in Colorado. There was yet another kerfuffle about the value of masks this week, provoked by a Cochrane systematic review. Reviewing findings of randomized clinical trials only, the authors concluded that wearing masks in the community makes “little or no difference” to the outcomes of influenza and SARS-CoV-2. Bret Stephens, a New York Times editorialist, highlighted this paper with a wrongly named commentary: “The Mask Mandates Did Nothing. Will Any Lessons Be Learned?” The Cochrane review did not address mask mandates and included only two studies during the COVID-19 pandemic. Masks do work to reduce concentrations of exhaled respiratory viruses and there is observational evidence on the effectiveness of mask mandates. The “mask wars” go on, as does the East Palestine train derailment story.  
The saga of East Palestine continues as yet another public health problem is politicized and “lawyerized.” My distant read of the minds of people in East Palestine is that they are worried about health risks that they face now and in the future. What is the legacy of the formidable black cloud and the spill of chemicals? These real questions are tough to answer, and the answers are inevitably couched in the language of uncertainty: “possibly,” “we can’t be sure,” and “research is needed.” Clinical investigations are being offered, but physical examinations, symptom reviews, and routine bloodwork are too insensitive in this setting and falsely reassuring. Collecting biosamples, e.g., blood and urine, may be helpful if sensitive analytical methods are used. The emerging method of metabolomics, scanning for chemicals and metabolites, might be informative. The “research is needed” might take the form of a health survey focusing on relevant endpoints and an initial cross-sectional survey might become the basis for a cohort (follow-up) study.  
Some initial insights concerning pollutant concentrations in East Palestine were released last week by the Texas A&M Superfund Research Center, a program funded by the National Institute for Environmental Health Sciences. The Texas A&M team used measurement data from the Environmental Protection Agency for February to calculate hazard quotients for a number of chemicals, making comparisons for these estimates against national and Ohio data. A hazard quotient (HQ) is the ratio of the measured concentration to the level at which there is no adverse effect expected (the so-called NOAEL). For nine chemicals, the HQ values for East Palestine were higher than the comparators, particularly for acrolein. This highly irritating toxin was not present in the derailed cars but is formed by combustion of organic materials. These HQ estimates do not translate into potential health risks for the residents of East Palestine. The values can be interpreted as showing that concentrations for some pollutants moved out of the “safe zone” following the derailment. The Texas A&M group has teamed with Carnegie Mellon University to make measurements, not yet reported, on the streets of East Palestine.
Leaving science and public health behind, let’s turn to politics and public health again. A rhetorical question: Is the presence of a political figure at the scene of an environmental disaster helpful? Here are the names of some who have traipsed to East Palestine: Donald Trump, Rudy Giuliani, and JD Vance; along with Michael Regan (twice), the Administrator of the Environmental Protection Agency; and Pete Buttigieg, the U.S. Secretary of Transportation. As I mentioned last week, train derailments are common, but not with such an extreme outcome as that in East Palestine. Given Ohio’s political context, a disaster has been symbolized. Becoming a symbol is not helpful to the people of East Palestine. 
Not surprisingly, lawyers have swarmed East Palestine as well. Class action litigation is being filed and the lawyers are trolling for clients. Erin Brockovich, famed for her role in California litigation about groundwater contamination, and for the namesake movie with Julia Roberts, has already teamed with lawyers to form East Palestine Justice. Such litigation has potential benefits: the possibility of litigation is a driver to risk management, and a brokered settlement or a judgement in court brings compensation to victims (and a substantial proportion of that proffered typically goes to the lawyers). Such litigation also has potential harms: clouding understanding of the risks, adding to situational complexities, and raising expectations around future settlements. 
I am writing from Hiroshima where I am attending a meeting of the Board of Councilors for the Radiation Effects Research Foundation, the binational organization that carries out the studies of the survivors of the Hiroshima and Nagasaki bombings.
Hiroshima (1945) Hiroshima (2023)
The Hiroshima Atomic Bomb Dome and Peace Memorial in 1945 (left), and the structure today (right), preserved in the same state as it was immediately after the bombing. The Genbaku Dome was the only structure left standing in the area after the first atomic bomb exploded on Aug. 6, 1945.
As always, I visited the Peace Park and Peace Museum, and, as always, I was reminded of the inhumanity of atomic weapons. The two pictures included tell the story, one showing the Atomic Bomb Dome—the remnant of a building near the hypocenter—shortly after the blast, and the other taken yesterday. “No more Hiroshimas.” 
Jon Samet's Signature
Jonathan Samet, MD, MS
Dean, Colorado School of Public Health
CU Anschutz
Fitzsimons Building
13001 East 17th Place
3rd Floor
Mail Stop B119
Aurora, CO 80045
© 2022 The Regents of the University of Colorado, a body corporate. All rights reserved.
Accredited by the Higher Learning Commission. All trademarks are registered property of the University. Used by permission only.