On Monday, Gov. Jared Polis plans to begin lifting social distancing restrictions, including his stay-at-home order, perhaps his most restrictive public health order aimed at slowing the spread of COVID-19.
The timeline makes Colorado the second state with a Democratic governor to lift such restrictions at a time when it’s still unclear whether the disease has peaked in the state.
In fewer than seven weeks, diagnosed COVID-19 cases in Colorado have climbed from 0 to 10,000. The disease has killed more than 486 people, with the highest single-day death total increase reported on Tuesday. So far, 2,003 people have been hospitalized due to the disease.
Meanwhile, due to supply shortages, the state has had trouble increasing testing capacity, which health experts say allows governments to manage the disease with fewer social distancing restrictions. Health officials wanted 3,500 tests per day by this time and 5,000 tests per day come May 1. The state is doing about 1,000 to 2,000 tests per day, health officials said Monday.
The state is also yet to ramp up contact tracing, a process by which the state isolates people who come into contact with someone infected with the disease. While other states are hiring and training new staff and volunteers, Colorado health officials said Monday they plan to use existing epidemiologists and hope to deploy mobile apps to give people with symptoms instructions on how to prevent spreading the coronavirus. Polis on Wednesday said the state is hiring more epidemiologists for contact trancing.
The transition comes as the governor faces pushback from conservatives who are publicly criticizing him and demanding that they be able to return to work. Several hundred risked their lives and the lives of others by rallying at the statehouse on Sunday to protest his orders, many without masks, shaking hands and exchanging hugs.
But by cracking the door open on restrictions, Polis is betting on businesses and residents to comply with more nuanced restrictions. On April 27, personal services will be open with social distancing requirements, including tattoo parlors and salons. Retail will be open for curbside pick up. Gatherings will remain limited to 10 people or fewer. On May 4, large workplaces will be allowed to open at 50% in-person capacity. By mid-May, restaurants could begin reopening. Polis said he’s reserving the authority to ratchet restrictions back down if the state sees a bump in cases.
“We can’t lose sight of the fact that our job isn’t finished, your job isn’t finished, not by a long shot,” Polis said on Monday.
The Colorado Independent spoke with Glen Mays, a professor at the Colorado School of Public Health, to better understand the implications of the governor’s plans. The following interview, conducted Tuesday afternoon over the phone, has been edited for clarity and brevity.
What do you think of the governor’s plan to begin reopening Colorado next week?
Some of the signals indicate we have the [hospital] capacity to start loosening up restrictions. We’re starting to see a downward trend in the number of new cases detected. And we’re starting to see a downward trend in hospitalizations. Those are all indications that we are over the peak for at least the first wave. So I can certainly understand the governor’s decision to start loosening up some of these social isolation policies while still trying to maintain a high level of social distancing. There’s going to be a trial here. It’s some experimentation whether we can open some things back up but still maintain social distancing at a level that we won’t see another spike in cases.
Are we past the peak?
It’s hard to know for sure. It looks like possibly we’re on a downward slope. There’s a lot of noise in those numbers. And that’s affected by things like testing volume, which has been fluctuating. But I’m looking at things like the number of new hospitalizations. We’ve definitely seen a slowing in the number of new hospitalized cases.
Colorado is among the first states with a Democratic governor to lift its stay-at-home order. I know each transition plan is different, but why do we need to go so soon?
I don’t know what’s in the governor’s mind. But one set of factors that are informing this decision is hospital and health care system capacity. It does look like we’ve got slack in our health care system and we’re not at an immediate risk of exceeding capacity. That means we’ve got some room to start experimenting.
Why should we be experimenting?
The main reason is that there’s still a long road ahead. For herd immunity or a vaccine, it’s going to be a long time. And because we’ve been successful in slowing the transmission, we’ve spread out the curve. That’s a long time to keep things shut down in terms of economic and societal costs. A vaccine is at best still 18 months away.
What do you make of our level of testing as we begin reopening the state?
It’s not optimal. It’s still one of the most problematic aspects of our response at this stage in Colorado and across the county. We would like to see that capacity at a much higher level before we start looking at loosening restrictions. There’s some legitimate uncertainty about how long it’s going to take to increase testing. But the factors are outside the control of state health officials, unfortunately.
And what do you think of our ability to do contact tracing?
I think it’s really important to be looking at multiple ways to increase contact tracing. I think it’s going to be very important to managing the disease. There are a variety of approaches to getting people hired and trained. You don’t have to be an epidemiologist to do contact tracing. There are options like using medical and public health students to do that work.
Do you feel like we have enough contact tracing capacity?
Not today. But I think the state is working on increasing the capacity. And it’s not terribly difficult to increase that capacity fairly rapidly.
So we don’t have much testing or contact tracing capacity at this time, both of which are needed to begin lifting restrictions. And it’s unclear whether we’re past peak. How do you reconcile that with the governor’s plan to begin opening things back up on Monday?
I think in large part it’s the need to balance the risks and costs and do a little learning by doing, quite frankly, [meanwhile] slowing the spread and preserving capacity inside our health care system. We’re still preserving the option to reintroduce some of these measures. It would be preferred to have much more testing capacity and contact tracing capacity in place. [The governor] has the clear goal of preserving social distancing at a high level even while relaxing the orders. He still has the goal of hitting 60% to 65% social distancing. There’s the ability to make mid-course corrections.
Is it possible to course-correct, and reimpose these restrictions?
It certainly wouldn’t be ideal. But after relaxing, one thing you look at is compliance. We’re opening up new businesses but requiring the businesses to maintain social distancing practices. Certainly going back to closures after opening up would be very painful and costly.
The governor has also said he expects counties to implement social distancing more restrictive than the state, if necessary. But much like air pollution, this disease knows no political boundary. What’s the efficacy of that local control model?
Diseases clearly don’t respect boundaries. Having closures in one jurisdiction and in the neighboring jurisdiction not having those closures is likely to stimulate people crossing borders to access restaurants or businesses. And that can be a mechanism for accelerating disease spread. On the other hand, looking at it more from a regional perspective, we do have diverse regions across the country and across the state. In mountain areas, for example, compared to along the Front Range or in rural areas, there could certainly be some viability in looking at regional differences in policies.
So because we have hospital capacity, we can begin to experiment. The implication is that people who we could otherwise save will not have to die due to a lack of resources. At the same time, it seems if we lift these restrictions before we have herd immunity or a vaccine, more people are going to get sick and more people are going to die. Is that right?
That’s definitely correct. Until we have a vaccine, there is going to be some proportion of patients who get exposed, who are going to develop complications, who are going to be untreatable and die. That’s a fact of human existence until we have a vaccine. The issue is that a vaccine is shrouded in uncertainty. There is no guarantee that in 18 months we will have it. It could be three or four years. That’s the usual timeframe. And it could be even longer. We’ve been working on an HIV vaccine for decades and we haven’t gotten there. In the absence of a vaccine, the best thing we can do is that, if people get sick, we have the capacity to treat them. Short of that, as long as we’re not exceeding our health care capacity system to treat, from my perspective, it’s reasonable to start experimenting to see if we can open things up and still maintain a level of transmission that our health care system can accommodate.
I just want to make sure my understanding is correct. Going from 75% to 85% social distancing down to say 65%, that does allow the economy to start chugging along again and it gives some people some reprieve. But does that lead to more people being exposed and dying?
It wouldn’t necessarily lead to more deaths. It would lead to some of those deaths happening a little bit sooner than they would otherwise happen. So that’s the key thing. When you flatten the curve, you’re just spreading out over time the same number of transmissions, the same number of hospitalizations and the same number of deaths unless you’re exceeding hospital capacity and you’re experiencing excess deaths because we can’t treat everybody. As long as we’re keeping the curve underneath capacity, it’s just a matter of when those cases, when those hospitalizations and when those deaths occur. If we’re relaxing social distancing from 85% to 65%, we’re gonna see some of those adverse events happen a little bit sooner, not more of them. Theoretically, we’re getting to herd immunity a little bit sooner if transmission accelerates a bit. We’ve also learned increasingly about who our most at-risk populations are. At the same time, I think the state is really moving to double down on what it can do on a targeted basis for the highest-risk populations. I’m thinking now about our long-term care population. Our population in nursing homes. They are responsible for a growing share of hospitalizations and deaths. And they’re a special circumstance, they’re not circulating out there in the community. We can double down on nursing homes while also relaxing some of the social distancing restrictions for the general populations and that’s another pathway to continue to slow disease progression by really targeting high-risk groups and loosening up on low-risk groups.
In general, stepping back, even lifting the stay at home order will change little in terms of policy, it may change a lot in terms of the perception of the problem. But once we crack the door open, is Polis betting on people and businesses to follow his more nuanced orders?
There’s a big education effort that needs to come along with this. It is going to be very important to monitor compliance. It’s definitely a risk that we could see a more relaxed form of social distancing than what is the goal of this new policy.
Anything else you would like to add? Any lessons learned?
There are other countries beginning to experiment with relaxation of these policies. We need to be monitoring them closely and be sharing data and experiences. High-income countries will need to be ready to step in and help out our partners in the global South as they start to struggle with this.
If you have any questions about lifting the stay-at-home order or other COVID-19 news for Glen Mays, email me at John@coloradoindependent.com. We may write a follow-up Q&A later this week.