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COVID-19 Colorado: Risks of Second Wave After Stay-at-Home Order Ends

At an April 20 press conference addressing Colorado's response to the ongoing COVID-19 pandemic, Governor Jared Polis previewed the next steps after the April 26 end of the state's stay-at-home order based on model protections about the ongoing fight against the virus.

The document outlining those steps, released in the hours after Polis's address, makes it clear that if Coloradans immediately return to the way things were prior to the infection's rise, the state is likely to experience a second wave of infections that could prove more deadly than the one that's already taken at least 449 lives in Colorado.

The report, titled "Findings on the COVID-19 Epidemic in Colorado to Date and Projections for Future Scenarios of Social Distancing," was assembled by representatives from the Colorado School of Public Health, the University of Colorado School of Medicine, the University of Colorado Boulder Department of Applied Mathematics, the University of Colorado Denver and Colorado State University.

Its key conclusions:

• Relaxing social distancing carries the risk of a second peak of infections that could potentially exceed current hospital capacity. The more social distancing is relaxed, the sooner we can expect a second peak to occur and hospital capacity approached and possibly exceeded. In addition, the more social distancing is relaxed, the greater the hospital demand at the peak.

• Mask wearing, improved case detection along with timely, effective case containment to prevent further spread of infections, and recommendations that high-risk populations maintain high levels of social distancing will further delay the next peak and reduce the hospital demand at the peak.

• In order to avoid exceeding hospital capacity, relatively high levels of social distancing of around 60 percent and a combination of complementary interventions will be needed.

• Relaxing social distancing to low levels (such that the contact rate approaches normal levels) now or in early June has the potential to lead us to a severe second wave of infections that exceeds hospital capacity, even if complementary interventions are implemented.

• Protecting vulnerable populations is critical, particularly those above age sixty, who represent most of the deaths in Colorado. The need for critical care in this age group is a key driver of health care utilization but needed data on what is occurring in Colorado are lacking. 

The report posits six variations on Colorado life after April 26, with each adding new limitations. Scenario A calls for partial relaxation of social distancing. Scenario B adds the maintenance of social distancing at current high levels for older adults. Scenario C supplements these actions with mask-wearing by the public. Scenario D includes improved case detection and isolation. Scenario E combines mask-wearing, improved case detection and isolation to the other measures. Scenario F is essentially all of the above.

The outcome for the state will be different depending on what standards are adopted, the document suggests. For example, Colorado's current supply of intensive-care-unit beds is estimated at 1,800 (although Polis put the total at 2,000 during his most recent comments); under Scenario A, current ICU bed capacity will be reached on May 29 with 35 percent social distancing, June 6 with 45 percent social distancing, June 21 with 55 percent social distancing, July 9 with 60 percent social distancing and August 26 with 65 percent social distancing. Under Scenario B, each of those dates would be pushed back by weeks, or even longer: June 17 with 35 percent social distancing, June 29 with 45 percent social distancing, July 25 with 55 percent social distancing, and August 26 with 60 percent social distancing. And under Scenario B, the report suggests, the capacity will not be reached at all if the public manages to hit the 65 percent social distancing mark.

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Under Scenario A, the number of peak infections could differ by more than 100,000, depending on how much social distancing continues upon the order's expiration. Should the state successfully hit 65 percent social distancing, the infection peak is estimated at 19,800 on October 30. In contrast, 35 percent social distancing could result in a staggering 151,000 infections as soon as July 10.

These distinctions are even more striking when assorted scenarios are juxtaposed. Under Scenario A, even 45 percent social distancing will result in a peak ICU need of 15,600 by August 7, according to the report. Yet 65 percent social distancing under Scenario F, which combines mask wearing, improved case detection and containment, and asks older adults to maintain the social-distancing levels set during the stay-at-home order, would reduce that peak to 355 as of today, April 21 — and it wouldn't go any higher.

Would Coloradans go for the latter standard? On April 19, a demonstration at the Colorado State Capitol attracted a slew of folks who eschewed masks and ignored social distancing — and both mask wearing and social distancing were rare sights in Castle Pines and Daniels Park over the weekend. Unless improvements are made, Colorado health experts fear the end of the stay-at-home order could be a new beginning for the virus's spread.

Click to read "Findings on the COVID-19 Epidemic in Colorado to Date and Projections for Future Scenarios of Social Distancing."

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