Denver-metro public health departments are weighing localized stay-at-home orders as coronavirus cases climb exponentially.
Such orders could help protect regional hospitals from becoming overwhelmed, at a time when other measures are not yet showing results, said John Douglas, executive director of the Tri-County Health Department. The department serves Adams, Arapahoe and Douglas counties.
Adams County has the highest number of COVID-19 cases in the state, and the tri-county department is already expecting the virus to strain hospitals in the area, spokesman Gary Sky said.
Over the next week four hospitals may have staffing shortages, one hospital may have an ICU bed shortage and two hospitals may have a shortage of medical and surgical beds, the department forecasts.
The state’s level orange, or "high risk," rules have been in place in Adams County for 15 days, but have have yet to slow the spread in a county, Douglas said.
He is now skeptical that the rules, which limit occupancy in most places to 25%, can turn around the trend.
“We are not seeing any bending of the curve at all,” he said.
State officials in September debuted the virus “dial dashboard," available on its website, that tracks the progress of counties in controlling the sometimes deadly disease by colored levels, similar to fire-danger signs.
Attached to each level are corresponding restrictions and guidelines on gatherings or events, educational institutions, restaurants and other businesses. The least restrictive level for counties with the best control was dubbed "Protect Our Neighbors" and coded green. A middle set of levels, dubbed "Safer at Home," includes three sub levels, coded blue, yellow and orange, with qualifying incidence levels of 0 through 350 cases per 100,000 residents per two-week period. The fifth and most restrictive level, dubbed "Stay at Home" and coded red, is reserved for communities with more than 350 cases.
Adams County has seen an average of 1,122 cases per 100,000 residents over two weeks as of Friday, state health department data shows.
The other Denver metro counties have also crossed the state’s threshold for a stay-at-home order, but they are also in level orange of the state's rules.
If county public health departments acted independently of the state, Douglas would like to see a coordinated stay-at-home order across the metro district for it to be effective, because residents cross county lines all the time, he said.
However, county officials would prefer the state to act because it would carry more weight and potentially encourage compliance, Douglas said.
“We think a stay-at-home order would be taken more seriously and be more effective if it came from the state,” he said.
Congressional inaction on economic support for businesses has also made stay-at-home orders less appealing because there is not a safety net for businesses, Douglas said.
“It’s certainly hamstrung us in an enormous way,” he said.
Gov. Jared Polis said Friday at a news conference he didn't think the conversation is about "stay-at-homes or lock-downs anymore" because Coloradans know how to keep themselves safe, if they have the resolve to do so.
"I think the stay-at-home order was a very blunt tool that was needed at the time," due to a lack of surge capacity and personal protective equipment like masks, Polis said. "There would have been great loss of life from people who could have otherwise made it."
He also said he didn't want Coloradans getting "caught up" about where their county sits on the state's dial because one in every 110 Coloradans has the virus throughout the state, he added.
“It's not about the color at this point. It's about a statewide threat, a national threat," he said.
Patchwork of rules
Denver-metro public health agencies have instituted a patchwork of local measures, in addition to state rules to help slow the virus that they hope can be effective.
For example, Denver and Adams counties have implemented 10 p.m. curfews to help slow transmission.
Denver, Adams, Boulder and Jefferson have also prohibited crowds at sporting events to help limit the spread.
Jefferson County has not imposed a curfew but it has implemented a 10 p.m. last call for alcohol to encourage residents to go home, Jefferson County Community Health Services Director Margaret Huffman said.
Huffman said on Thursday that she felt her department’s measures are strict enough, particularly because they go further than the state’s measures.
“We are doing our very best to pull in as tight as we can and not really have to get so strict,” she said.
Imposing a stay-at-home order can be tough physically and emotionally on the community and should be driven by the needs of the hospital systems, she said.
It is too soon to say whether Jefferson County's stricter measures are making a difference, Huffman said.
Too late for a lockdown?
Experts who've studied lockdown orders from the spring say that one clear lesson emerged from the experience: The sooner the order is implemented, the better.
"It's entirely possible that we're too late in the game already," said Andrew Friedson, an economist with the University of Colorado-Denver, who's researched and published his findings on lockdown orders.
There's a lag time between implementation of such an order and the results it brings, which means that policymakers "need to be thinking ahead," said Glen Mays, the department of health systems chair at the Colorado School of Public Health.
"We can't wait until we're in a crisis," he said, adding that waiting until the last minute to take action will leave hospitals in a critical situation for a couple of weeks.
Asked if it was possible at this point for Denver and other hotspots to avoid a shelter-in-place order, he said that it was "theoretically possible."
"But I think there’s a reasonable chance that, based on the trajectory, we’re now seeing that we’re ultimately going to be in a place where we institute stronger control measures, including some period of time where we have a shelter-in-place order," he said.