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COVID-19 Isolation Guide: Is it too early for Colorado to re-open?

RISK ASSESSMENT

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Many Colorado businesses are reopening even as COVID case numbers rise. - JENLO8 / SHUTTERSTOCK.COM
  • jenlo8 / Shutterstock.com
  • Many Colorado businesses are reopening even as COVID case numbers rise.

Colorado has started reopening, but not because COVID-19 is no longer a threat. Far from it — according to data from Johns Hopkins University, the state had 230 new cases in the week that ended June 26, compared to 195 the week before and 172 the week before that. But according to Dr. Jonathan Samet, epidemiologist and dean of the Colorado School of Public Health (CSPH), the state is in a “good place with regard to our own piece of the pandemic.”

“We track hospitalizations very carefully,” says Samet. “They were up, they came down and were roughly trending down to reaching sort of a plateau. Deaths, of course, are way down.”

Gov. Jared Polis has even relaxed the state’s stay-at-home order into a safer-at-home order, with the most visible change being that restaurants can now serve dine-in customers, but at 50 percent of typical capacity. Counties that meet certain criteria can even move into the next phase of reopening, called “Protect Our Neighbors.” Don’t mistake this for what happened in Texas, where Gov. Greg Abbott’s June 3 reopening order was amended to close bars and restrict restaurant occupancy June 26, after the number of new cases per day spiked. Colorado’s phased reopening plan is designed to maintain a measured balance between risk of infection and economic realities.

“[Many Coloradans] simply can’t pay their rent or buy food if they’re not working,” Polis told Colorado Public Radio in May.

Samet says that now is a reasonable time for Colorado to start reopening.

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According to the Centers for Disease Control and Prevention (CDC), contact tracing is the process by which an organization identifies people that a known infected person has come into contact with. It includes tracking everyone the infected person might have exposed to COVID-19 (in this case) so they can be warned, quarantined, tested and, if they’ve been infected, isolated and treated, with further tracing work expanding from there. To do the job statewide, Colorado has hired 50 students from CSPH and begun training more than 800 members of AmeriCorps and Senior Corps.

Though contact tracing has expanded, reopening still has risks. Samet says that one of the biggest risks is reopening too fast. Texas rolling back its reopening has gotten a lot of press, as new cases jumped from 1,768 through the week ending June 12 to 4,968 through the week ending June 26, according to that same Johns Hopkins dataset. But the data from Texas also illustrate another of Samet’s points: It takes a while to know if a state is opening too quickly because of the pace of the pandemic. Right now, the CDC estimates that a person infected with COVID-19 will develop symptoms within two weeks of exposure. That means officials don’t get a clear picture of how a given reopening action affects transmission of the virus for at least two weeks.

“These pictures of crowds on beaches or at the Lake of the Ozarks that you’ve probably seen are what we don’t need to do,” says Samet.

This invites the question: Is it more responsible to stay shut down, the way other countries have done to prevent the spread of infection? On June 8, The Washington Post reported that shutdowns prevented an estimated 60 million COVID-19 infections in the U.S. alone, citing two pre-publication articles from the science journal Nature. Solomon Hsiang, director of the Global Policy Laboratory at the University of California at Berkeley, told the Post that, before shutdowns, the number of infections was doubling around every two days. Hsiang compared the response to “seeing cracks form in the ceiling and realizing the roof was about collapse,” then, despite the economic consequences of shutting down, “[catching] the roof and [holding] it up before it crashed in on everyone.”

There is another cause behind the push to reopen. The psychological consequences of shutting down workplaces and self-quarantining have been widespread, with even the CDC publishing guidance for dealing with COVID-19-related stress. 

“There are folks who want to get back to life as it was, and I think look for a step toward a return to the world as it was,” says Samet.

Before that can happen, Samet says that humans need to achieve what’s called herd immunity — that is, enough people must become immune to the virus that it can’t spread rapidly enough to cause major outbreaks. A group of people have herd immunity when between 70 and 80 percent are immune to a given virus, and there are two ways of getting there.

“One is that those [percentages of the population] actually get infected with [COVID-19] to become immune,” says Samet. “That’s hard to do without horrible threats to public health, to health care [infrastructure] and to everything else. You let the epidemic run rampant, we’ll all get infected, and a lot of people die and let’s get it over with? That’s not a choice you would want to make.”

The other way to achieve herd immunity, the option that doesn’t cull the elderly, infirm and economically disadvantaged — and, disproportionately, Black Americans, according to a May 30 NPR article — is to develop a vaccine. But that takes a long time, too. Samet says that, optimistically, it might take a year to develop and deliver it on a mass scale, such that life can return to normal. 

“Then comes the question of living… with as little risk as possible while the virus is around. That’s where we need to have in place the public health infrastructure, the testing capability [and] the contact tracing,” says Samet. “As people, [we need] to maintain the distancing needed, [and wear] masks or face coverings to protect others.”

Unfortunately, Springs residents haven’t adhered to these recommendations as well as might be hoped. A report from Denver’s Westword estimated less than 10 percent of people downtown were wearing masks on Memorial Day weekend, with little adherence to social distancing. On June 24, Westword reported that “four weeks ago, El Paso County registered 230 COVID-19 diagnoses per 100,000 residents [according to a data tool from The New York Times]. As of June 24, the Times puts El Paso County at 316 positives per 100,000 residents, a 37 percent increase.” 

No less alarming, President Donald Trump has announced plans to end funding and support for 13 federally supported COVID-19 testing sites across the country, including one in Colorado. Given that Gov. Polis and Sen. Cory Gardner had to covertly import more than 100,000 COVID-19 tests from South Korea amid fears they’d be confiscated by the federal government, the months between now and when a vaccine can be developed and propagated will be full of fresh challenges in the pursuit of public health.

Update: After Gov. Polis announced the closure of bars that do not function as restaurants on June 30, Samet said, "Closing bars is a reasonable precautionary step, given the increasing case numbers. For now, hospitalizations are stable and death counts are low. Closing bars should help to sustain this favorable situation."

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