During Colorado’s monthlong statewide quarantine, the coronavirus’ spread slowed, deaths climbed, ventilators went unused and unemployment exploded.
Which is to say, it went mostly as expected.
As life in Colorado begins inching back toward normalcy, executives of the state’s major hospitals and some El Paso County business leaders are in broad agreement that the unprecedented social-distancing strategy and stay-at-home order was necessary and effective against the worst of a once-in-a-generation pandemic.
While coronavirus infections have continued to climb, the rate of doubling has gone from once every couple days to longer than once every couple weeks.
And while the disease ranks as the No. 1 cause of death in Colorado for the past month — rivaling cancer — experts think there would be thousands more deaths had social-distancing not been implemented.
“Had we not done any of this, and just let it hit the hospitals, you would have devastated the medical community,” said Dr. David Steinbruner, associate chief medical officer for UCHealth Memorial Hospital. “You would have devastated the patients who couldn't get the care they would have needed, because they (hospitals) were so overwhelmed.”
The consensus from medical experts contradicts the argument put forward by those who believe the stay-at-home order wasn’t worth the economic toll, advanced by some in the business community and embodied two weekends ago by more than 1,000 protesters who flooded the streets of downtown Denver, demanding the state lift the social-distancing policies.
Most business and economic leaders across the Pikes Peak region now have little doubt: The current economic tailspin likely pales compared to the damage of doing nothing.
Look at the economic ruin in areas of the world that were slower to act, said Tatiana Bailey, director of the University of Colorado at Colorado Springs Economic Forum.
“If you look at New York and Italy and Spain, that level of death and disease really ended up shutting down the economy anyway,” Bailey said. “That is the bottom line: The economic toll was going to be big either way, so why not save some lives in the meanwhile?”
And, health experts warn, the virus still poses a dangerous threat.
If cooped-up Coloradans rush back out of their houses, the virus could make a dramatic and deadly run that wipes out the progress made over the last month.
While hospitals in the Colorado Springs area report many open beds, others in the Denver metro area say they’re still struggling with lingering infections and relatively few open beds.
“While things are getting better, we’re not out of the woods yet,” said Dr. Bill Janssen, professor of medicine at National Jewish Health, which specializes in respiratory diseases. “And in health care, we’re all very nervous that this could flare again.
“It’s not a time for us to relax.”
Social interactions cut 75%
The predictions were dire: Without any reduction in social contacts, there would now be somewhere near 200,000 cases, 25,000 hospitalizations, 10,000 ICU cases, and thousands more deaths, a Colorado School of Public Health team predicted in late March.
As April passed, the state had counted about 15,284 known or suspected cases, 966 hospitalized, 429 of the state's 1,086 ventilators in use and 777 deaths.
The worst-case scenario laid out by the researchers would have put Colorado near the peak in tracked cases and in the middle of a still rapidly rising hospitalization and ICU demand.
But that catastrophe never came to pass, and the spread of the virus appears to have roughly followed the researchers’ predictions.
Social interactions were reduced by about 75%, researchers with the Colorado School of Public Health say.
As a result, in contrast with known infections doubling every two to four days in mid-March, positive test results most recently took 18 days to double. Hospitals have open beds, and their case counts and intensive care stays are holding steady in some parts of the state and dropping in others.
“When we look back in history, those communities that were willing to do more of the isolation … they have thrived better and recovered quicker than those communities that threw all caution to the wind,” said Dr. Robin Johnson, El Paso County’s chief medical officer.
The social-distancing measures have won over even at least some of the most skeptical business leaders.
Dirk Draper, head of the Colorado Springs Chamber & EDC, lobbied Gov. Jared Polis to resist shutting down the state in late March. He issued similar pleas to city and county officials — asking them to avoid “shelter-in-place” orders so that businesses could continue operating as usual.
Draper now wonders if he read it all wrong.
“Knowing what we know today, I’m not sure I’d write that letter again,” Draper said. “In the early days, it looked a little bit worse than a normal flu. And that’s one of the challenges of it being a novel coronavirus — one that’s never been seen before.
“This is not the normal flu.”
Public health leaders “make a pretty compelling case,” he said, that social-distancing measures were effective.
Preparing for possible disaster
Perhaps nowhere is the state’s “flattened curve” more evident than the five improvised field hospitals that now sit empty. Two thousand beds inside the Colorado Convention Center are still waiting to be filled. So are beds at the Larimer County fairgrounds.
In March, as the spread of the coronavirus accelerated across Colorado and the nation, public health workers prepared for a deluge of patients and feared supply and bed shortages. A report from the Harvard Global Health Institute in mid-March showed that if more than 20% of the state became infected in any less than six months, hospitals could be pushed beyond capacity.
By the time Polis implemented the state’s first social-distancing measures on March 13, limiting gatherings of more than 250 people, a Colorado Springs patient had died and the virus was already running rampant.
That day, there were 75 reported cases in Colorado, and the confirmed rate of infection was doubling every two to three days, state data shows.
Two weeks later, when Polis issued the statewide stay-at-home order, the number of known cases was at 1,403 and doubling every three to four days.
“I think six weeks ago, we were very, very nervous,” said Dr. Toni Green-Cheatwood, an incident commander for Centura Health.
It wasn’t just medical professionals worrying. Coloradans were nervous, withdrawing from normal life and preparing for possible disaster.
A state Health Department survey of 44,931 Coloradans during the days leading up to the statewide stay-at-home order found nearly everyone — 98% of respondents — had already begun social distancing. They were avoiding large gatherings, canceling vacations, wearing a mask or working from home.
More than one-third said they had already begun stockpiling food. About one out of every five already had their work hours reduced or lost their job permanently or temporarily.
Around the time Polis issued the stay-at-home order, however, some first signs of slowing emerged.
On March 30, more time began elapsing — four to five days — before coronavirus cases doubled in the state.
By April 7, cases were doubling every eight to nine days.
Hospitals saw a peak in COVID-19 cases during the first two weeks of April, according to the Colorado Hospital Association. By April 9, hospitalizations were on the decrease, after having peaked at 1,277.
The research team estimated each measure would need 12 days to take effect, meaning event cancellations and crowd limitations would begin slowing the virus’ spread on March 25, while the governor’s stay-at-home order would have begun helping out around April 7.
Denver ICUs remain very busy
Dr. Jon Samet, the dean of the Colorado School of Public Health and the leader of the local research team advising Polis and the state Health Department, said he’s certain that without the state’s shutdown order, the virus’ toll would have been worse.
While the slowing of new infections and hospitalizations are encouraging for Dr. Samet, the number of deaths have continued to steadily rise across the state. By the middle of April, COVID-19 had become a leading cause of death in Colorado, and the weekly death counts reached and surpassed average weekly deaths of cancer, heart disease and accidents—normally the three top killers in the state.
But that’s nothing compared to what his research has shown would have happened otherwise.
“What you really have to do, to make that comparison, is to ask what would have happened had we done nothing,” Samet said. “We would have quickly passed our capacity for intensive care cases. The numbers would have been immense.”
Hospital leaders across Colorado agree: Social distancing saved them —and the state — from a catastrophe.
“So in a sense, we were successful enough at mitigating this and preparing that we never even had to get to a serious rationing situation at all,” said Steinbruner, of UCHealth Memorial Hospital. “I want those folks who are skeptical not to punish people for being successful.”
The Pikes Peak region fared better than many other parts of the state — with no hospitals reaching capacity or running out of ventilators.
Other parts of the state struggled more.
In the Denver metro area, Centura Health shuffled ventilators between its hospitals — never running out, but repeatedly coming close during the first part of April.
At three other Denver metro hospitals — Swedish Medical Center, Rose Medical Center and Saint Joseph Hospital — the peak hit April 3. On that date, all of the 119 intensive care beds that are overseen by National Jewish Health were used, said Janssen of National Jewish Health.
Things haven’t improved much since then.
They’ve flattened the curve, but the number of cases hasn’t dropped much. Coronavirus-related hospitalizations have come down about 10%, Janssen said. He wishes the decline were more rapid, though, as the state begins to reopen.
“Frankly, we’re a little nervous about it,” Janssen said. “For this time of year, the number of patients we have in the intensive care unit is double what we’d normally have.
The more crowded ICU is due in part, Janssen said, to the fact that COVID-19 patients take two to three times as long as the normally five to six day recovery period for a typical flu patient.
Coronavirus patients have typically stayed 10 to 11 days. If they get admitted to the intensive care unit, the recovery takes 14 days on average.
“We do have a level of concern that if social distancing is relaxed too quickly, that we may see a recurrence of cases,” Janssen said. “I’d say everyone in health care is a bit worried.”
'I follow scientists'
Between April 15 and April 21, a sample of 1,000 Coloradans expressed pessimism about the state of the pandemic. More Coloradans said they think the situation will worsen.
The poll, conducted by Magellan Strategies, found 47% of households said at least one person had lost their job, their income or had their hours cut at work because of the coronavirus.
Forty-three percent said their financial situation has worsened. African-American Coloradans — a community disproportionately affected by the virus — were particularly pessimistic for the future.
Even so, 64% of those surveyed said they preferred keeping social-distancing measures in place until widespread testing is available. Even among those who had lost their job, lost income or had hours cut, the same portion — 64% — said they preferred the distancing policies.
Susan Edmondson, president and CEO of the Downtown Partnership advocacy group, said she doesn’t question the decision to shut down, arguing, “I follow scientists.”
“A lot more people would have gotten sick,” Edmondson said. “And the fear of being out among a sickness would have been bad for business as well.”
While the data indicates the virus is no longer spreading as quickly in Colorado now, the state leads most others in per-capita cases. And where ski areas had led the state’s infections in March, outbreaks in nursing homes, meat packing plants and prisons in rural northeastern Colorado counties have pushed rates there even higher in the past couple weeks.
As of May 1, with 15,286 total known cases and an average daily increase of 500 new cases, the number of cases has taken 18 days to double.
Even those figures are only a fraction of the actual number of coronavirus cases across Colorado.
Local researchers say two-thirds of all infections are now going uncounted — down from 72% in late March — meaning there are roughly 30,000 more untracked symptomatic cases.
Another 69,000 likely have asymptomatic cases, meaning close to 2% of the total population has contracted the virus.
New infections, deaths will be constant
To keep the virus from spreading faster, public health leaders say Coloradans must remain vigilant.
The Colorado School of Public Health research team estimates that if people maintain a combination of some of the social-distancing measures — like no large gatherings, partially-staffed workplaces, older residents staying at home and wearing masks — combined with significantly ramped up testing, the most severe restrictions could be relaxed while avoiding massively overrunning hospital capacity.
The exact timeline of further easing of restrictions will be determined, Polis said, after May 12, when the effect of the current easing can be evaluated. Samet said the effect of social-distancing policies will play out in waves that take four to six weeks, which is why decisions about next steps should wait until mid-May.
But even if the current easing works as intended and doesn’t cause an unmanageable surge, Samet and the research team predict that new infections and deaths will stay steady or rise slightly, then fall over the next several weeks and months.
In El Paso County, the number of new cases has been reduced to “a low background noise,” said Johnson, the county’s chief medical officer.
To keep that, the community must keep doing its part, she said: Wear masks, don’t congregate in crowds, try to limit in-person interactions to 10 people—not just at a time, but total. In other words, keep up the social distancing, she said, even if not required by law.
“We recognize that this is a process,” Johnson said. “So when we start looking at ‘normal,’ I think we may need to redefine that.”