After changing out her PPE, ICU nurse Kristen Gooch double-masks before entering the room of a COVID-19 patient in September at Penrose Hospital.

Colorado’s COVID-19 death toll has climbed to its highest levels in a year amid the latest surge in transmission and hospitalizations, a trend primarily affecting the unvaccinated and a death toll that has surpassed the average number of deaths expected to be caused by cancer, the state’s leading cause of death.

The state surpassed 8,000 deaths on Oct. 12. It had taken more than three months to move from 7,000 to 8,000, but in the 22 days since the latter threshold was reached, the death toll has climbed to just over 8,600. The state has averaged more than 24 deaths per day since then.

“The COVID-19 death rates are really discouraging,” said Beth Carlton of the Colorado School of Public Health. “We have lost over 8,600 Coloradans to COVID-19, and I am afraid that number is going to grow substantially in the weeks ahead.”

A Centers for Disease Control and Prevention aggregated projection estimates Colorado will near 9,000 deaths by the end of the month. Under that pace, the state would reach 1,000 new deaths in less than two months, after a slow summer and spring. Some models listed by the CDC have faster and slower death projections; the agency provides an “ensemble” of these projection, which provides the end-of-month estimate of nearly 9,000 deaths.

Based on a Gazette analysis of data from 2015 to 2019, cancer kills an average of 156 Coloradans over a seven-day period. At multiple points in October, the seven-day average of deaths due to COVID-19 topped 200 and, at least twice, 300.

A spokeswoman for the state Department of Public Health and Environment said in an email that COVID-19 is the fourth-leading cause of death in Colorado this year; the disease has killed 2,548 residents. Cancer has far outstripped it over the balance of the year: More than 6,000 Coloradans have died of that constellation of illnesses in 2021 alone.

The spokeswoman said the department does “not have estimates of cause of death rankings for the most recent few months.”

In the eight weeks between Sept. 4 and the end of October, the state has reported more than 100 COVID-19 deaths seven times. The last time that had happened once was in January, when the state was recovering from its late 2020 surge. Recent deaths are still far eclipsed by that wave, when more than 400 residents died in three successive weeks.

State officials said earlier this week that deaths since the current fifth wave began have been overwhelmingly among the unvaccinated. Gov. Jared Polis said there had been roughly 300 deaths among the oldest Coloradans during that time. Two hundred of those were unvaccinated, which account for as little as 5% of that total age group. The remaining 93% to 95% who are inoculated contributed roughly 100 deaths. The numbers are even starker for younger populations.

Carlton said that state data indicates a nearly five-fold risk of mortality to the unvaccinated versus inoculated Coloradans. What’s more, she said, deaths are occurring at higher rates in parts of the state with lower vaccination rates. The unvaccinated are also dying at a slower pace in vaccinated areas, meaning overall high vaccination rates provide some protection even to those haven’t received the jab in the area.

Rachel Herlihy, the state’s epidemiologist, told reporters this week that the vaccine is 100% effective in preventing death for people under the age of 39; nearly 95% effective for those between the ages of 40 and 59; 93.8% effective for the 60 to 79 band; and 77.6% effective for those over the age of 80.

Those numbers, particularly for the older residents, will improve when boosters begin to flow more readily. Though exact explanations remain elusive, officials and public health experts have suggested one explanation for the recent surge in cases and hospitalizations is waning immunity: Some of the state’s most vulnerable residents were inoculated first, in January, and thus have had the longest amount of time during which their immunity could decline.

“Boosters are really important as they will help ‘boost’ immunity and provide people higher levels of protection against infection and, subsequently, severe disease,” Carlton said.

The doses have been prioritized in long-term care facilities, with clinics running throughout October. Residents in those facilities were among the first to receive doses in the state and have a higher risk of waning immunity than others who received it months later.

Glen Mays, also of the public health school, said recent outbreak data showing climbing numbers of clusters in those facilities is a “troubling sign ... because these settings have been major contributors to deaths during the earlier waves and also are settings where breakthrough infections occur.”

As of Wednesday, there were more than 150 outbreaks in Colorado’s nursing home and assisted-living centers. On July 21, as cases were beginning to increase in Colorado, there were 37 total, contributing to 268 total infections and 13 deaths. Now, there are 1,622 staff and resident cases; the current outbreaks have led to 43 deaths.

A year ago, when the late 2020 peak was starting to flood the state, there were fewer outbreaks: seventy in total, fewer than half the current amount. It’s difficult to draw direct comparisons between data then and now because the state included suspected cases then, which it no longer does. Without those suspected cases, there were 1,470 infections between staff and residents in long-term care outbreaks on Nov. 4, 2020, plus 83 deaths, fewer than confirmed cases now. When factoring in suspected cases into that total, the numbers now and then are comparable: 1,664 a year ago versus 1,622 now.

A key difference between now and then is overall mortality. Though there are more outbreaks now and roughly as many infections, there were 83 deaths associated with early November 2020 outbreaks; there have been 43 now.

The state should not simply accept the death toll without mitigation efforts, Mays said, even if the majority are among those who’ve willingly chosen to go unvaccinated.

It’s “problematic to simply accept those rates as a matter of personal (ir)responsibility and not try to mitigate them to the greatest extent possible because of their spill-over effects on vaccinated populations,” he said in an email. “Most deaths are preceded by a long hospital stay. If left unchecked, we know that high volumes of unvaccinated COVID-19 patients will over-crowd hospitals and diminish access to care and quality of care for vaccinated patients who need care for other conditions, ultimately leading to higher mortality for all patients.”

Carlton said there’s research indicating that as hospital capacity grows tighter — as it is in Colorado now — “COVID-19 mortality increases.”

“In our models, we see evidence of this, in that the actual COVID-19 deaths in the April and December 2020 peaks exceed what our model predicts for that period,” she said, referring to state-level projections issued by her and a team of experts. “This is worrying as we approach hospital capacity in the current wave.”

Gazette staff writer Evan Wyloge contributed to this report.

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