COVID-19 Update: Colorado Named One of USA's Next Big Concerns

Dr. Deborah Birx, with President Donald Trump, has identified Colorado as one of the next big areas of national concern.
Dr. Deborah Birx, with President Donald Trump, has identified Colorado as one of the next big areas of national concern.
The White House via YouTube
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The challenges of fighting COVID-19 in Colorado continue to grow. Over the weekend, Dr. Deborah Birx, the White House's response coordinator for the novel coronavirus, identified this state as an emerging national hot spot (along with Pennsylvania and Washington, D.C.), even as the Colorado death toll took another disturbing leap, a staffer at the state's Emergency Operations Center in Centennial tested positive, health officials established new procedures to handle the expanding crisis, and more.

During his most recent press conference, on Friday, April 3, at which he recommended that residents wear face masks whenever they leave their home, Colorado Governor Jared Polis also offered a midday update on the impact of the virus in the state: 4,174 cases, 806 hospitalizations, more than 22,000 people tested and 105 deaths. This was the first time Colorado's fatality count exceeded 100, yet Polis made no mention of this tragic benchmark — and the rapidity with which the figures rose over the next two days offers a possible explanation why.

Here are the latest statistics from the Colorado Department of Public Health and Environment, released Sunday afternoon, April 5:

4,950 cases
924 hospitalized
54 counties
25,773 people tested
140 deaths
37 outbreaks at residential and non-hospital health care facilities

The number of Colorado deaths remains a small percentage of those globally (in excess of 69,000 at this time) and nationally (more than 9,600). But the upswing in Colorado cases and casualties inspired Birx to suggest that the state could be on the way to joining New York City, Louisiana and Detroit as the places of greatest concern in the United States.

Meanwhile, on April 4, the Colorado State Patrol announced that troopers would start wearing masks as part of their everyday duties, and the state communication office revealed that "a member of the Colorado Unified Command Group (UCG) working at the State Emergency Operations Center tested positive for COVID-19. The staff member went through daily medical screenings and was asymptomatic until April 4, when symptoms started. The staff member then contacted executive leadership and self-isolated."

The CDPHE immediately launched what was described as "a full epidemiological investigation to evaluate the level of exposure. ... Staff members at the facility were notified [on April 4]. All staff were asked to evaluate whether or not they worked in the same area of the facility in the last 48 hours following public health guidance for possible exposures" and "inform supervisors if they had contact or worked near the person before transitioning to remote work following CDPHE guidelines to self-quarantine and monitor for symptoms twice daily (including measuring your temperature) for fourteen days." Asymptomatic employees are being asked to monitor their health closely for the next two weeks while continuing with their previous assignments.

As for Polis's Expert Emergency Epidemic Response Committee, it "voted to update the crisis standards of care guidelines to take into consideration the challenges presented by COVID-19" on Sunday, April 5. They include contingency plans for a declaration of a public-health emergency should "patient needs exceed available resources," such as ventilators and beds in intensive-care units, and specifics about the composition of triage teams, which will consist of "an expert on ethics or palliative care; an attending physician familiar with critical care (e.g. hospitalist or critical care physician); a representative of nursing staff; and a representative of the hospital’s leadership."

The most recent COVID-19 numbers from the CDPHE.
The most recent COVID-19 numbers from the CDPHE.

The committee emphasizes that "the primary medical team caring for a patient SHOULD NOT be involved in crisis triage decision-making for their own patient. Each institution should create a crisis triage team that is objective and removed from the patient." Moreover, decisions should not be made based on race, ethnicity, ability to pay, disability status, national origin, primary language, immigration status, sexual orientation, HIV status, religion, veteran status, "VIP" status or criminal history. Instead, a so-called scoring system will be developed for the most critical patients "based on a combination of acuity or severity of acute illness (the likelihood of surviving weeks) and morbidity, or measures of chronic illness (the likelihood of surviving months to years)."

In addition, Colorado has released new COVID-19 modeling data developed by a team that includes experts from state agencies, as well as the University of Colorado School of Medicine at the CU Anschutz Medical Campus, and the University of Colorado in Denver and Boulder.

A key to the models is "the reproductive number (R0)" — that is, the average number of new cases generated per infected person at the beginning of the outbreak. (The Governor has referred to this number as the "R naught.") If that number exceeds 1, then the infection will spread. Various figures for R0 have been reported at the start of the COVID-19 pandemic from different parts of the world, ranging from about 2 to 5. The reproductive number depends, in part, on the frequency of contacts between infected and uninfected individuals. The goal of social distancing is to reduce these contacts and lower the reproductive number with a target value below 1, so that contagion ends. A critical question: How much social distancing is needed to control the epidemic, and how long does it need to be in place?"

(See tables showing modeling for R naughts of 3.0 to 4.0 and 3.5 to 4.0 respectively.)

Polis has joined other political leaders in calling for increased state and local aid from the federal government in a letter to Colorado's federal delegation that reads in part: "As you look toward the Phase 4 stimulus package, we stand united as state and local partners on the front lines of this crisis, urging you to include at least $500 billion in direct, robust and immediate State and local aid. Absent this assistance, the State of Colorado and local governments who are directly helping Colorado’s communities respond and recover from the impacts of this public health crisis will face an unmitigated economic crisis."

The next press conference by Polis on the subject of COVID-19 is currently scheduled for 6:30 p.m. today, April 6. The timing of the address has led to speculation that he will extend Colorado's stay-at-home order, which is currently set to expire on April 11.

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