It’s early March 2020, and things are starting to happen fast.
In the first week of the month, Coloradans learned about its first cases of COVID-19, a highly contagious and deadly coronavirus. A week later, a woman in her 80s living in El Paso County died from it, the state’s first death. The next day, with the virus spreading quickly, Gov. Jared Polis made the “agonizing” decision to close the state’s ski resorts.
In hopes of figuring out where things were headed, Dr. Rachel Herlihy, the state’s epidemiologist, was closely following trends and studies from around the globe. One from Imperial College London made an impact.
“The timeframe wasn't weeks, wasn't months, it was years potentially of this extended period of time where we were going to see waves of disease transmission,” she said. “That has certainly turned out to be what we have experienced.”
The paper also spotlighted unfamiliar strategies to corral the virus Coloradans would soon know all too well: social distancing, home isolation, flattening the curve.
Two years later, the paper seems prescient. The pandemic took a heavy toll: Colorado recorded 1.3 million COVID-19 cases, nearly 60,000 people have been hospitalized and more than 12,000 died. At the same time, collective mitigation efforts to control the spread have flattened the curve, limiting the damage.
Now the state is ready to turn the page, to transition to an uncertain next phase.
It’s a “post suppression phase,” Herlihy said, “where we have high enough levels of immunity, where we really don't need these public health strategies that we've been using for two years now to suppress transmission and flatten the curve.”
Gov. Jared Polis and his team on Friday unveiled a transition plan, its Roadmap To Moving Forward.
“There is no declaring victory over this virus,” Polis said during a press conference outlining specifics. “But what we’re indicating is the people of Colorado should view the emergency phase as over.”
The multi-pronged plan lays out goals for hospital readiness standards, surge planning and normalizing COVID-19 patient care in traditional medical settings.
“We need to be ready and have those plans, ready to implement and ready to go,” Polis said in an interview Thursday.
In his comments, the governor threaded a needle between forward-looking readiness and the emergency footing the state has been on at times the last two years.
“The virus is gonna be here forever, presumably. We need to normalize our response as we do for other diseases,” he said.
He said that needed to be done in a way that doesn’t lead to things like restrictions on elective surgeries, which happened during COVID-19 surges.
“There could very well be additional peaks and valleys, just as we have seasonal flu season,” Polis, a Democrat, said. “Some of the scenarios might in fact show that if the vaccine protection wanes or there are variants that this is less protective against, there could be additional surges.”
The plan aims to help rebuild a battered health care workforce by investing “in health care workforce stabilization and expansion. This pandemic has been hard on everybody, but it's also driven a lot of retirements and people leaving the healthcare field.”
The move comes as most pandemic trends are giving Coloradans the kind of break they’ve rarely enjoyed the past two years.
On Tuesday, transmission, reflected via the state’s seven-day test positivity rate, dropped below the key 5 percent threshold to 4.71 percent. That was the first time it had reached that level in more than a half year.
The state recorded 372 COVID-19 hospitalizations on Thursday, the first time the gauge had been below 400 since early August 2021.
Still hospital staffing remains tight in some hospitals, with 38 percent of facilities saying they anticipate a staffing shortage.
“This does give us a breather,” said Jill Hunsaker Ryan, executive director of the Colorado Department of Public Health and Environment. “But we still need to pay attention to the rate of waning immunity from Omicron or more severe variants.”
Hospital staffing remains tight, with 38 percent of facilities saying they anticipate a staffing shortage and 26 percent anticipating an ICU bed shortage.
The roadmap rests on four pillars: establishing readiness standards and surge planning in hospitals, doing the same in public health, stabilizing the state’s health care workforce and engaging the federal government in national “endemic response,” including an updated and interoperable national surveillance system and flexible funding.
On the last point, Polis said “this caught everybody flat-footed two years ago, we cannot allow that to happen again.”
A spokesperson for the Colorado Hospital Association said many Coloradans delayed care during surges, and hospitals anticipate continuing to see high volumes of patients who are very ill or need more acute care because of those earlier delays.
"We also know that our workforce will need significant attention and effort in the weeks and months ahead," said Cara Welch, CHA's senior communications director. "We will have to find ways to support our current workforce, build our workforce pipeline, and thank those who have stood so bravely on the frontlines for the past two years."
She added that the virus has proven to be unexpected and adaptable to continue spreading, so she urged Coloradans to continue to pay attention to their community-level spread and other conditions and adapt as needed to help keep the state safe and protect the health care system.
A chance for health care reform and better-prepared hospitals
The plan calls for the state of Colorado to advocate for a number of federal policies, including one to prevent price gouging, especially for staffing agencies.
Hospitals out of state are luring Colorado nurses, through staffing agencies, he said with “hundreds of dollars an hour” wages and “the middle man makes a lot of money, but that is not good.”
The roadmap underscores a tension between public pandemic response and the for-profit health care system. The document states that the severe economic restrictions in the spring of 2020, when states had to issue stay-at-home orders, “were driven by a lack of national preparedness” including things like a lack of PPE, testing supplies and technology and access to staffed hospital beds and critical life saving medical supplies like ventilators.
“Leaders had to choose between bad and catastrophic outcomes of mass casualties or social and economic hardship,” the roadmap states. “We strive to never have to institute similar restrictions moving forward.”
But neither the federal nor state governments have yet passed laws or regulations to ensure the sort of readiness that would stop that from happening again, according to the document.
“Colorado cannot do this alone,” said Scott Bookman, Colorado’s COVID-19 incident commander. “We will partner with our federal government to ensure that the needs of all Coloradans and our nation are met.”
Bookman said the state would advocate for more federal research of long-term COVID-19 symptoms and an update hospital readiness standards, among other changes.
Readiness means maintaining hospital capacity by ensuring adequate levels of staffing, according to the plan. It noted that when fall’s delta wave hit, Colorado hospitals had 50-660 fewer staffed hospital beds than prior waves “leaving little margin to absorb a spike in patients.” The governor’s roadmap calls for enhanced transparency into capacity and critical supplies.
But Colorado hospitals have 1.9 hospital beds per 1,000 residents, putting us on the lower end of the spectrum for hospital capacity. The national average is 2.4 beds per 1,000, and the best performing states at more than four beds per 1,000.
“Colorado is not in the position to allow our hospital capacity to drift downwards,” the governor’s plan said. “We need oversight measures in order to ensure that we are prepared,” it went on, without specifying.
The plan lays out several recommendations to help hospitals prepare. That includes ensuring critical supplies and PPE, providing COVID-19 testing and therapy “in other settings” in order to maintain emergency room services, maintaining hospital bed and staffing capacity and surge readiness activation plans, and cross-training of health care workers for emergency response.
The plan also advises requiring all outpatient, hospital owner, health care providers to deliver COVID-19 vaccination and workers for all appropriated health care providers, like primary care physicians, to provide diagnostic testing and prescribe COVID-19 therapeutics.
When it comes to public health policies, questions remain
When it comes to ensuring public health readiness and surge capacity, the plan calls for updating disease investigation and surveillance systems, like via wastewater, continued outbreak prevention and response activities in high-risk settings and continued vaccination efforts for “hard to reach communities,” efforts to “protect the most vulnerable, and for indoor air quality improvements in schools and public spaces. The roadmap offers scant specifics about how those goals would be achieved.
Likewise, plans for health care stabilization and expansion lacked actionable specifics. The roadmap calls for a multifaceted approach, involving partnerships with healthcare providers, and institutions of higher education to increase wages and improve work conditions, invest in attracting new additional healthcare workers to Colorado and break down barriers to entering the healthcare profession in credentialing and licensing, facilitating mid-career change to healthcare and greater National Guard capacity in healthcare for emergency needs.
Two other questions that remain unanswered: Where would the money come to fund the transition plan and how would it line up with one for which the state recently put out a request for proposal?
According to the governor’s office the federal government has been fully funding the state’s COVID-19 response since the start of the Biden administration and is expected to do so through April. But in the coming months, the expectation is that the response would shift to be normalized through the broader health system.
“Over the last two years, we have built an enormous amount of systems to accommodate this new disease,” Bookman said. “We now need to normalize COVID within our health care system.”
A spokesman for the Colorado Department of Public Health and Environment said the state awarded two contracts for transition planning for the phase it described as “from pandemic to endemic.”
The state awarded the plan for the public health transition to Colorado Health Institute for $80,000 and the plan for health care to Jensen Partners, LLC., for $84,000. The next step will be building out “more robust plans based on the roadmap” details Polis shared Friday.
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