The pandemic's fourth wave in Colorado shows signs of waning, but cases and hospitalizations remain high compared to other times in the course of COVID-19's spread.
General spread across the community, particularly in settings involving school-aged and young adult residents who are less likely to be vaccinated, appears to have driven the fourth wave, said John Douglas, executive director of the Tri-County Health Department. That's the local public health agency for Adams, Arapahoe and Douglas counties.
Personal gatherings, restaurants and sports-related gatherings continue to be among the most frequently cited locations where people in Tri-County's area may have been exposed to COVID-19, Douglas said.
“High levels of the B.1.1.7 variant is making transmission in all settings more likely,” Douglas said, referring to the United Kingdom variant.
Several school districts in the Denver metro area have moved to more frequent in-person classes, but Douglas said it's difficult to tell whether that change has contributed to the fourth wave in Tri-County's area.
“We are seeing more outbreaks in school in which we think in-school transmission is responsible, but these account for less than 10% of cases in school-aged kids,” Douglas said. “My hunch is that schools remain relatively safe — also supported by the data the schools are gathering — and that transmission in the community settings mentioned above are the big factors.”
The era of metro Denver residents talking about “the dial” might be over for good now that several metro counties have lifted local restrictions and moved to what they call “level clear,” with statewide coronavirus data looking tentatively optimistic.
“We're actually seeing some very promising trends over the past couple weeks based on cases and hospitalizations both starting to decrease,” said Andrea Buchwald, a research associate with the Colorado School of Public Health.
Colorado's color-coded COVID-19 dial was the set of restrictions counties had to follow based on the local spread of the virus. The system affected capacity at restaurants, other businesses, indoor and outdoor events, and other settings. Colorado originally implemented the dial last Sept. 15.
Last month, when state officials stepped back and let local health agencies take the wheel on most coronavirus restrictions, health agencies in the Denver metro area extended the “dial” system locally as a rise in virus cases and the continued spread of COVID-19 variants kept health officials worried.
As of May 16, several metro counties are now operating in what they call “level clear,” generally with no local restrictions — and that's likely to continue unless things take a turn for the worse.
In Adams, Arapahoe and Jefferson counties, for example, level clear will continue unless hospitalizations trigger a “snapback provision,” where restrictions would return if a county exceeds 2 hospital admissions per 100,000 residents, measured a certain way over a 14-day period.
That bar is unlikely to be reached in Adams and Arapahoe counties, said John Douglas, head of Tri-County Health Department. That's the health agency for those two counties and Douglas County. Broomfield also moved to level clear May 16, and Denver said it was “planning to meet level clear standards,” according to a spokesperson. Denver's new public health order was to take effect May 16. Boulder County was to also move to level clear on May 16.
Some counties had already been living under no dial restrictions: Douglas County's elected leaders opted out of Tri-County Health's extension of the dial system during an April 13 meeting. Some other counties that indicated that they would not issue local orders included Elbert and Weld.
And with coronavirus cases on a downward trend, metro Denver counties might not see dial restrictions again — although it depends on how the virus fares this fall.
“We do expect over the summer months that the numbers will come down, and this may become more of a seasonal illness with numbers coming back up in the fall,” said Eric France, Colorado's chief medical officer, at a May 13 news conference.
Any consideration by the state of bringing back dial restrictions “will depend on the experience of the fall” and is “too hard to predict at this point, given there are variants to consider,” France added.
Although the state's dial system expired in mid-April, not all virus restrictions are local. On the heels of the state dial ending, Colorado issued a new public health order that maintains some limits on large indoor gatherings. Colorado's mask mandate is a separate order.
Despite all the news about restrictions fading away, Colorado has likely been experiencing a higher number of active COVID-19 infections than it did during the pandemic's first peak last spring — even when accounting for the lack of testing at that time, according to estimates by the Colorado School of Public Health as of May 12.“If people make major behavior changes right away that lead to a large increase in contacts and transmission, we could potentially see a lot of deaths,” Buchwald said. She added: “The pandemic is not over. We still have to be vigilant.”
Asked whether metro counties' move to level clear will have a large impact on coronavirus spread, Buchwald said it's difficult to predict.
“A lot of how people behave is dependent on the messaging they get and the messaging they believe. And I think the urgency for reopening is real,” Buchwald said. But “if the message is 'the pandemic is over,' I think that's a dangerous message because I think that'll lead people to do riskier behaviors.”
A big takeaway from Colorado's data is that the number of COVID-19 cases recently is still “very high,” particularly in comparison to the lows of last summer, Buchwald said.
“The thing that people have lost sight of is: Can you believe if five years ago there was an infectious disease and there were 600 people in the state of Colorado hospitalized?” Buchwald said. “It seems unimportant because we've gotten so used to it, but it doesn't change the fact that it's a major problem.”
She noted that even a person with COVID-19 who is not hospitalized may still face long-term health consequences, which some have called “long COVID,” she said.
On top of that, more than 700 more deaths could occur in Colorado from early May through the end of July even with “high levels” of vaccination and the current level of social distancing and mask-wearing as of early May, both of which are likely to decline, according to Douglas, the health chief.
But the choice to drop restrictions is “all about balances and tradeoffs,” Douglas said.
“I think it is likely that if we went into complete lockdown like 13 months ago, we'd be experiencing fewer deaths,” Douglas said. He added: “In the extreme case, you wouldn't shut down the whole economy to save one life. You'd hate to see that one life” lost, but that would be a reasonable trade, Douglas argued.
Figuring out what the right tradeoff is has “been absolutely agonizing,” he added. What makes the situation easier is the effectiveness of the vaccines, Douglas said.
“I want to badly urge everyone who can get this to get it,” Douglas said of vaccination.
About 48% of all Coloradans are estimated to be immune due to vaccination or prior infection, while 47% are estimated to have received at least one dose of a vaccine, the state public-health department said in a May 14 news release.“Herd immunity” — a term for when enough people become immune that the spread of a disease becomes unlikely — could happen when somewhere between 66.7% and 80% of people attain immunity to COVID-19, according to the Colorado School of Public Health.
During the Douglas County commissioners' April 13 meeting, when they voted to opt out of Tri-County Health's extension of dial restrictions, Commissioner Abe Laydon said he would like for residents to “break the delusion” that there is a need for a continuation of public health orders.
“I want … Douglas County to be the first county in the state to say 'this pandemic is over,'” Laydon said. Laydon again said “the pandemic is over” during a May 11 meeting.
Douglas, the health chief, said the comment is “completely inaccurate” from a literal standpoint.
“The pandemic, meaning a global epidemic, is far from over,” Douglas said. He added: “I actually think he was being somewhat hyperbolic to say Douglas County is not going to be threatened by the pandemic, we've got enough vaccination … that interpretation of his remarks is probably true.”
But Douglas doesn't think the way it was said was “helpful to the larger conversation,” he continued.
Buchwald, the researcher with the school of public health, said in Colorado “very clearly it's not over,” pointing to the high number of cases.
“I think it's important to step back and realize there are 600 hospitalized in the state of Colorado alone,” Buchwald reiterated.
“I wish the pandemic was over as well,” Buchwald said, “but wishful thinking is not enough.”
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