COVID-19: Why So Many Colorado Sites Are Having Second Outbreaks

The COVID-19 pandemic has continued long enough that six Colorado sites where previous outbreaks were considered to have been resolved are currently going through the same nightmare again, including the Swire Coca-Cola warehouse in Denver, the processing center for Denver jail inmates, Boulder's iconic Pasta Jay's restaurant, and a trio of health-care or assisted-living facilities.

This new and frustrating development has moved the Colorado Department of Public Health and Environment to apply protocols designed to identify new infections in places where they've already wreaked havoc.

The CDPHE considers an entity an outbreak after two or more COVID-19 cases among residents, staffers or the like are confirmed within a fourteen-day period, or two or more cases of respiratory illness with an onset of symptoms within a fourteen-day period are paired with at least one additional COVID-19 diagnosis.

The August 5 CDPHE outbreaks report was the first to include repeat entries — specifically Pasta Jay's; the Denver Reception and Diagnostic Center, which serves as an intake and classification facility for the main city jail; and Centennial Health Care Center in Weld County. That skilled-nursing center was among the earliest outbreaks in Colorado (it began on March 27), and it proved extremely deadly: Up to 22 residents died before it was wrapped up on June 10; twenty of the victims tested positive for the virus, while two others were listed as probable for infections. Overall, the CDPHE recorded 41 positive resident cases, five probable resident cases, 25 positive staff cases and seventeen probable staff cases at Centennial Health the first time around.

In their second outbreaks, Pasta Jay's has registered two positive staff cases; Denver Reception and Diagnostic Center has three positive resident cases; and Centennial Health Care lists fifteen positive resident cases, eight positive staff cases and one probable staff case.

Three more return outbreaks appeared in the August 12 outbreaks report. The Swire Coca-Cola warehouse, which previously suffered ten positive staff cases, has four new ones. Northglenn Heights Assisted Living Community in Adams County has just one positive staff case, after earlier being linked to five positive resident cases, five positive staff cases and one probable staff case. And then there's North Shore Health & Rehab Facility in Larimer County, which was hit hard the first time around: 22 positive resident cases, seven probable resident cases, six positive resident deaths, five probable infection-related resident deaths, nine positive staff cases and four probable staff cases. In the latest outbreak, North Shore is connected to two positive resident cases and three positive staff cases.

We asked the CDPHE how it's dealing with these fresh challenges. Here's the email exchange:

Westword: Does the CDPHE carefully monitor sites of outbreaks after they're resolved to make sure they don't recur?

CDPHE: All positive cases must be reported to local public health agencies or CDPHE. Once we confirm an outbreak, local public health agencies or staff from our department work with the facility or business to help mitigate spread of the virus and to ensure disease prevention protocols are in place.

A COVID-19 outbreak is over when 28 days have passed with no new illness. For outbreaks at businesses, after 28 days and the outbreak is resolved, the business doesn't have to report cases directly to public health weekly, but would still be required to report any new potential outbreaks. That said, CDPHE keeps a close eye on cases in some settings that are high risk for outbreaks, like residential facilities. In addition, the CDPHE outbreak team continuously looks at information for interviewed cases to determine if there are potential outbreaks or clusters in any setting. This surveillance helps CDPHE identify outbreaks early, including a second outbreak at the same location.

Do these recurrences serve as a reminder that the virus is extremely communicable and safety protocols must be strict at all times to prevent it from taking root and spreading again?

This is a novel virus and we continue to learn more about it. It is highly contagious, and everyone’s continued daily actions (wearing masks, maintaining distance), including those of businesses and employees (cleaning, reducing in-person workforce size, enforcing gathering sizes and masking), are critical in helping to prevent the spread of the virus.

Do the recurrences tell us anything about the issue of antibodies and whether previously exposed individuals may build up resistance to infection?

Only people infected with the virus can develop antibodies. Simply being exposed to the virus will not cause a person to produce antibodies. We are still learning about how antibodies for COVID-19 work, how long they last, and if you can get reinfected with this virus. So far, these outbreaks seem to involve people who were not ill in the original outbreak. In Colorado, we do not currently have any confirmed cases where we suspect someone was reinfected.