During an April 1 press conference at Centennial's Emergency Operations Center, Governor Jared Polis extended school closures in the state until April 30 and underscored planning for the point at which the health-care system is likely to be overwhelmed by individuals suffering from COVID-19.
Unveiling details of that strategy was Scott Bookman, incident commander for Colorado's COVID-19 response. Bookman discussed a tiered-treatment system that includes the designation of arenas and other large facilities to hold patients who've survived a medical crisis but are not yet ready to return to the general population.
Polis began by talking about April Fools' Day, traditionally celebrated on April 1 with pranks and gags. In his view, the outbreak is "a very cruel April Fools' joke. ... Unfortunately, there are still some people who consider this somewhat of a joke. But this is not a joke. This is not an April Fools' Day event. This is a very serious pandemic."
He added: "Really, the only fool is us — and I mean 'us' in the broadest sense, humanity, for not having the necessary preparations in place" to best address the novel coronavirus. "We will, as a species, learn from this."
The most common question he's hearing, Polis said, is "When will this be over, and when can we resume some degree of normalcy?" He was unable to provide an answer, but he expressed empathy for those feeling anxious. He also revealed that he has two personal friends who've been diagnosed with COVID-19, including one who was hospitalized today.
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Polis then outlined "the three factors that weigh heaviest" on his decision-making process. First, "When will the viral spread be under control rather than expanding exponentially?" — and he maintained that the most effective way to arrest its progress (short of mass testing and then quarantining those who've tested positive even before symptoms develop, which isn't feasible right now) is to stay at home as much as possible and rigorously obey social-distancing recommendations. Second, "When will our medical surge capacity be built for those sickened by the virus, so they can go on and live healthy lives?" — a major theme to which he promised to return. And third, "How can we resolve supply-chain issues" around COVID-19 tests, personal protective equipment (PPEs) and more?
On this last topic, Polis discussed efforts to obtain masks, gowns and the like from suppliers around the country and the world after it became clear that the federal government would be unable to meet most of Colorado's needs. He lamented the necessity to compete for such gear even as he revealed that 10,000 new masks had been obtained from China; the items will be checked by personnel at Colorado State University to ensure that they're up to snuff, and Polis said the government won't pay for them if they fall short.
To underscore the impact that COVID-19 has already had on Colorado, Polis shared early data from the Colorado Department of Health and Environment: 3,338 positive cases in fifty Colorado counties, 18,645 tests given, 612 people hospitalized and 77 deaths. "Our hearts go out to the families and loved ones of the family," Polis said.
From there, Polis got wonky by digging into the "R naught" value of the virus — a term he introduced during a press conference last week. This metric reveals that the number of Colorado cases is doubling in around five days, as opposed to two days or fewer — an improvement, but not nearly enough, since continuing increases could well overwhelm the health-care system and result in what he characterized as "horrific economic devastation."
Right now, Colorado has placed orders for 2.5 million N95 masks, which protect wearers from the virus, plus 1.5 million pairs of gloves, 1 million surgical masks, 250,000 gowns and 25,000 face shields. These supplies equate to lives saved, he said, and he doesn't want to see Colorado doctors and nurses having to wear homemade masks and ponchos or trash bags in lieu of gowns, as has happened in other locations around the globe.
By way of "taking a deeper dive" into such issues, Polis introduced Bookman, who said the mission of those working in the health-and-medical-care areas is to "save lives by ensuring the stability of the Colorado health-care system and increase capacity within that system."
Some medical facilities have been hard at work since January to do just that, he stressed, and because of these efforts, "we assume our health-care systems will work within their systems until they're overwhelmed" by too many sick people and not enough equipment. Predictive modeling suggests this could happen between April and July, with a wave of "patients who are going to require intensive care, who are extremely ill and dependent on a ventilator for an average of eleven to twenty days — and they won't be done with health care at that point." Instead, they'll be transferred from hospitals to "lower-acuity settings."
With this in mind, Bookman verbally sketched a "four-tiered system by which we will classify patients and facilities in which they receive care."
Tier one represents critical-care patients who will be hospitalized. Tier two comprises "ambulatory surgical centers in critical-access hospitals, to create additional capacity for our hospitals." Tier three will focus on "sub-acute patients who will require daily monitoring by a doctor and twice-daily monitoring by a registered nurse. These will be large facilities: arenas, convention centers, even warehouses that can be converted." And tier four "is for non-acute-care patients, people who are asymptomatic but need to be quarantined. This could include people experiencing homelessness." Such folks would be placed in "hotels, dormitories and other lodging facilities that we can turn into medical-care facilities."
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These efforts require a great deal of ramping up, Bookman confirmed. Colorado needs to increase the number of tier one beds from 1,800 to 5,000 by April 18, the number of tier three "surge beds" from zero to 2,000 by the same date, and tier four beds from zero to 10,000 by May 15. And then there's the patient-transport unit that should be ready to roll by April 10.
Returning to the podium, Polis reiterated that patients who have relatively minor symptoms shouldn't go to medical facilities, where they could infect other people; the wiser course of action would be to self-isolate unless serious breathing difficulties or other critical matters come to the fore.
Only then did Polis announce that he'd extended closures of Colorado schools until April 30 and acknowledged that "I expect many districts will decide to stay closed for the remainder of the school year," even if COVID-19 conditions improve more quickly than many expect them to. He praised the ingenuity of teachers who are finding new ways of teaching students remotely and predicted that pupils "won't fall behind academically" because of their inability to attend in-person classes.
Following another scolding of people traveling long distances to visit mountain communities, many of which have extremely high rates of infection, Polis said, "The more we succeed at staying home, the sooner this crisis will end."