Colorado should immediately increase COVID-19 mitigation strategies, state’s modeling team says

CDPHE calls on Colorado adults to get their booster shots as hospitals near capacity
Hospitalizations because of COVID-19 are also a concern, should there be a fourth - and potentially a future fifth - surge in coronavirus cases.
Posted at 5:57 PM, Nov 09, 2021
and last updated 2021-11-10 00:38:10-05

DENVER – Colorado should immediately increase its COVID-19 mitigation strategies, such as mask wearing, testing and the observance of physical distancing, to reduce the magnitude of the coming peak in the state’s fifth wave of the pandemic, according to the Colorado COVID-19 Modeling Team.

In their report from Nov. 3 released last Friday, the team estimated hospitalizations for COVID-19 could reach 1,393 by Nov. 26 and increase to 1,400 in early December if Colorado continued its current trajectory of transmission control, which is defined as the measures taken by the public to slow the spread of the disease, such as mask wearing, avoiding large gatherings, maintaining proper physical distancing, and testing and isolating if someone is experiencing symptoms associated with the disease.

The estimate for late November, however, was surpassed this Monday when Colorado reported 1,394 hospitalizations for the disease. On Tuesday, just four days after releasing their projections, the state surpassed the team's estimate for early December by reporting 1,426 confirmed hospitalizations for COVID-19 across the state.

As of Nov. 1, the COVID-19 modeling team estimated about one out of every 48 Coloradans was infectious with SARS-CoV-2, rates equivalent to last fall’s surge which are now approaching the highest levels of the pandemic, the team wrote in their report.

model estimated daily sars-cov-2 infection prevalence in colorado.png
Figure 3. Estimated daily number of people who are infectious and infected with SARS-CoV-2 (point prevalence). The estimate is shown per 100,000 population. The number of infectious individuals is inferred using the model and is based on hospitalizations. These estimates are sensitive to the model assumptions, including assumptions about the probability an infected individual will be symptomatic and require hospital care, which vary by age, and assumptions about the virulence of variants.

Across the state, only 101 ICU beds were available as of Tuesday afternoon, an increase of 21 beds compared to Monday, with a little more than a third of Colorado hospitals expecting ICU bed shortages by next week, according to the latest statewide data.

“Things are tight in Colorado, in many areas of the state,” Gov. Jared Polis said during a news conference Monday afternoon. “We’re experiencing a peak right now that many other areas of the country experienced a month or two ago. We’re down to less than 100 emergency beds across our state.”

To stymie the continued increase in cases and hospitalizations, the Colorado COVID-19 Modeling Team not only called for the increase in non-pharmaceutical interventions (NPIs) – such as mask wearing and avoiding gatherings in poorly-ventilated spaces – but urged the state to provide more access to monoclonal antibody treatment (which studies have found reduces severity of disease and hospitalization between 70%-85%) and increase COVID-19 vaccine booster intake as well as vaccinations in kids 5-11 years old.

The former is something the state is already doing as part of a five-strategy approach to protect hospital capacity, which includes calling on the Federal Emergency Management to request a medical surge team, transferring patients to hospitals that can take them, halting all elective surgeries, and moving back to crisis standards of care, which the state reactivated Tuesday afternoon.

In their report, the modeling team estimated the use of monoclonal antibody treatment could reduce hospitalizations across the state by 12-23%.

Regarding boosters and vaccine intake in children 5-11 years old, the modeling team projected that thousands of hospitalizations and hundreds of deaths over the next four months and beyond could be avoided, and wrote that vaccinating kids not only protects their health but also increases population-level immunity by preventing infections from children to older adults, who are at higher risk of hospitalization and death from the novel virus.

projected impact of boosters and vaccines for kids 5-11.png

If none of these measures are taken, the Colorado COVID-19 Modeling Team projected hospitalizations for COVID-19 could result in around 1,750 people hospitalized by mid-December, about 100 fewer people than the peak from December 2020, though at the time, hospitals across the state had more beds available than they do now.

It’s unclear if Polis will reinstate a statewide mask mandate or issue more aggressive public health measures to slow the spread of the coronavirus, even as the state reports fewer ICU beds than it did a year ago.

Responding to a tweet from a Colorado Sun reporter who pointed out that indoor dining was banned, personal gatherings between two different households were prohibited, and an indoor mask mandate was in place when Colorado was experiencing the same number of hospitalizations in December 2020 as it is now, Polis replied that policy decisions for curbing the spread of the disease are different now than they were last year because of the availability of the COVID-19 vaccine.

“The big difference now: 62.1% of total population is fully vaccinated and 86.9% of those most vulnerable 65+. Sadly, even tragically, too many Coloradans haven’t yet chosen to get protected. But for the large vaccinated majority, the risk is ten times or more less than last Dec,” Polis said.

But health experts across the world have repeatedly stated over the past several months that vaccines alone won’t stop community transmission and that other mitigation strategies like mask wearing, avoiding crowded spaces and limiting gatherings, are still needed to greatly reduce the spread of the virus during the pandemic.

A recent major study out of South Korea found mandatory mask wearing and practicing social distancing in public transport reduced infection rates by 93.5 and 98.1%, respectively.

The Colorado COVID-19 Modeling Team’s report concludes the surge in cases across Colorado – who now has the 10th highest COVID-19 hospital demand in the United States – is due to several different factors, including pockets of unvaccinated populations, waning vaccine efficacy, the gradual return of movement to pre-pandemic levels, and weather.

“In terms of measures to take to end the surge, this explanation points to the need for a two-pronged strategy of strengthening the application of non-pharmaceutical interventions while pushing to vaccinate the unvaccinated, provide booster shots, and vigorously implement vaccination programs for those 5-11 years old,” the report states.

CDPHE chief medical officer calls on all eligible Coloradans to get booster shots

As Colorado experiences its second-highest peak in COVID-19 hospital demand since the start of the pandemic, Dr. Eric France, the Chief Medical Officer of the Colorado Department of Public Health and Environment (CDPHE) called on all eligible adult Coloradans to get a COVID-19 booster shot due to the “significant wave of disease spread” across the state.

Current CDC guidance states anyone 18 years of age and older is eligible to get a booster shot if they have underlying medical conditions, live in a long-term care setting, or work or live in a high-risk setting that requires them to come in constant contact with other people.

Because Colorado is currently a high-risk environment for the disease, the CDPHE argued, all Coloradans aged 18 and older are currently eligible to get a booster shot.

Coloradans wishing to get a booster shot should be at least six months out from their second dose of the Pfizer or Moderna vaccines and at least two moths out if they were inoculated with the Johnson and Johnson vaccine. Any brand of the three currently available vaccines in the U.S. is good to use for a booster.

In a news release Monday evening, CDPHE officials reiterated that a new public health order prevents any vaccine provider in the state from refusing to give boosters to anyone 18 and older.

“The vaccine continues to protect against severe disease and hospitalization, but may allow persons to get mild disease, which leads to ongoing transmission. With the ongoing transmission, Coloradans -- and particularly unvaccinated Coloradans -- are at high-risk of getting the virus. As much as we’d like it to be over, the pandemic is still raging,” France said in prepared remarks.

On Tuesday, Pfizer and BioNTech announced they’re requesting for the Food and Drug Administration (FDA) to authorize their COVID-19 booster shot for all adults, specifically asking that the FDA amend the Emergency Use Authorization it granted for the booster dose to include all individuals 18 years of age and older.

The request is based on results from a Phase 3 randomized, controlled trial evaluating the efficacy and safety of a 30-microgram booster dose of the Pfizer vaccine, according to the companies.

Hospitals overwhelmed, doctors worry about potential ‘twindemic’ this winter

Over the past 20 moths, doctors, nurses, ER physicians and others across the state have sounded the alarm about ICU bed capacity during the pandemic. On Tuesday, one doctor at Denver Health told Denver7 he worried about a potential “twindemic” as Colorado deals with not only the surge in COVID-19 hospitalizations but an “unacceptably low uptake” of the influenza vaccine.

Dr. Ivor Douglas, a pulmonary special at Denver Health, said his hospital – like many in the Rocky Mountain region – are very close to maximum capacity, and it’s not just due to COVID-19 patients.

“They're not just now ICUs – which indeed, are under a significant strain – but hospitals, including our emergency rooms, and our general medical services,” said Douglas. “The key point that needs to be considered here is that while there are many, many COVID patients, there are a significant number of patients with general medical and surgical problems that need hospitalization.”

Douglas said today’s challenges across hospitals isn’t a shortage of ventilators like it was last year, but rather on caring for patients who come to the hospital suffering from other ailments not related to COVID-19.

“A significant challenge in finding dialysis could be renal replacement support for our patients, many of whom are gravely ill and need kidney replacement therapies as part of life saving care for COVID and other things as well,” Douglas said. “It's beyond just the ICU and beyond just COVID. We have many patients on life support right now with severe pneumonia or other causes, such as breathing failure from heart disease. And so, the impact has now extended beyond the constraints of COVID to really try to manage very high volume and complexity across the board.”

Douglas told Denver7 that besides following modeling from the Colorado School of Public Health, his staff also looks at COVID-19 modeling from other institutions, all which point to a capping out of ICU bed capacity in the next several weeks.

“My major concern in the next few weeks has as much to do with COVID as it does with influenza, because we had a mild influenza season last year aided by social distancing and facemask utilization,” Douglas said. “And because we have an exceptionally and unacceptably low uptake of our seasonal influenza vaccine, it is a point of major worry that we're going to see a meaningful and major influenza season along with our COVID pandemic occurring almost at the same time. If that really comes to fruition in the next six to eight weeks, we are going to exceed our capacity facility.”

In closing remarks, Douglas urged people to get their flu shots as soon as they possibly can to avoid a potential twindemic this winter saying, “while COVID-19 rages, influenza is something that we have a long track record of successful prevention.”

Denver7 Senior Content Producer Jon Ewing contributed to this report.