STEAMBOAT SPRINGS, CO, December 2, 2020 – The Board of Health held its weekly meeting today to discuss the case count in Routt County, recent deaths, preparations for COVID-19 vaccine distribution, new quarantine guidelines from the Centers for Disease Control and Prevention (CDC) and the Five Star restaurant program under consideration by the state of Colorado.
Roberta Smith, Director of Routt County Public Health have an overview of state data, “We probably won’t see the total results of Thanksgiving gatherings until December 6th or 7th. The good news from the state, however, is that travel was down from the same time last year. The modeling data shows a 71% transmission control, people are staying home and doing the things they are supposed to be doing. We hope to see those positive efforts reflected in the coming weeks.”
COVID- 19 in Routt County
On a local level, Routt County epidemiologist, Nicole Harty gave an update on COVID-19, “Our incidence rate continues to be well beyond the Red Level on the COVID-19 Dial, positivity is in the Yellow Level, and hospitalizations are in the Green Level We continue to increase in cases with 256 cases in the last two weeks and positivity remains elevated at 7.5%. We have already seen disease transmission over Thanksgiving. We have evidence of people gathering for Thanksgiving while under quarantine and gathering with other households. Case counts remain high, and we expect an increase due to the Thanksgiving holiday.”
“We continue to see outbreaks in a variety of sectors including businesses and personal gatherings. To help expedite our outbreak investigations and mitigate disease transmission as outbreaks arise, we have a new tool for reporting possible outbreaks to public health on the covid19routtcounty.com website. It is an that will share details with public health.”
Ms. Harty acknowledged the difficulty of staying apart from others and asked for our community’s diligence: “The numbers tell us it's going to be awhile before restrictions can be relaxed. It's hard to stay away from friends and family. It's hard to do all the things we need to do to mitigate spread. We need to push on. There is hope with a vaccine coming. Now is the time to find motivation and purpose by doing all the right things to support our community. Reach out to loved ones. Call your friends and family. Reach out. Find support within your networks. We are all in this together. We can do this. It will take all of us. Community health means community behavior.”
Public Health nurse, Brooke Maxwell gave some context to the COVID-19 cases, “We do continue to see a wide range of symptoms reported from mild to severe. Keep in mind that this disease process affects everyone differently. You personally may not get very sick, but you could transmit the disease to someone that is going to end up hospitalized. Between Nov 24 -30, we had six deaths, three of those were Casey’s Pond residents and three were community members living independently, all were above the age of 65. It is important to understand that this disease affects us all.”
She continued to ask the community to take action, “Please limit your social activity. We already have multiple cases that are linked to Thanksgiving gatherings. Either people that traveled out of state or people that hosted out of town guests. We hope that people that traveled for the holiday are quarantining upon arrival back to Colorado. The current Public Health Order for the state says to limit your interactions to only your household.
Please do not host social gatherings while you are placed in quarantine. It is also important not to share utensils such as silverware, drinkware, smoking accessories. On a positive note, we have spoken with several businesses that have had a positive case identified and have immediately contacted us for guidance on getting their other employees tested and have quarantined them while waiting for testing and for test results. This is the most responsible thing to do and is assisting with stopping the spread of disease. Please stay home from work and school when you have any symptoms and while you wait for test results.”
Ms. Smith added that the state has calculated that 1 in 41 people in Colorado are infectious. In some regions, it’s 1 in 29. She also stated that the concern about hospital capacity continues to be a discussion at the state level, “It’s not just the hospital beds, but it is also the health care workers. They are the ones providing care, they are giving the tests and will be the ones immunizing our population.”
Public health officials shared that the state now requires that all clinics and health care providers share their COVID -19 test results with the Colorado Electronic Disease Reporting System (CEDRS) electronically.
Vaccine Distribution Preparation
Ms. Smith also shared that Routt County Public Health received its vaccine refrigerator and will start tabletop exercise on Friday on vaccine distribution. She also stated that a Town Hall Series on Vaccines will start on Friday in collaboration with the City of Steamboat Springs, UCHealth Yampa Valley Medical Center, Steamboat Pilot and local medical experts, and invited the community to listen. “CDPHE is working within its prioritization list to narrow down who will get the vaccine first, like first responders, health care workers and those who have direct contact with people who have COVID-19. Public health agencies and hospital systems will be the first providers of the vaccine. In the first phase, the vaccine is coming to us free of charge. In the future, we don’t know if there will be costs. We do know the Federal Drug Administration is meeting on December 15th to discuss emergency use authorization of the various COVID-19 vaccines, including the one for Pfizer and Moderna.”
The Commissioners discussed herd immunity and Ms. Smith pointed out “Herd immunity in the United States has been achieved for other diseases through immunization, not disease transmission. That is why the vaccine program is so important. We are also still learning about this disease, just because you got COVID-19 in the past, does not mean you cannot get it again.”
County Medical Officer Update
County Medical Officer, Dr. Brian Harrington gave his weekly update, “According to our county coroner Rob Ryg, this year our county has seen six suicide deaths. Last year, Routt County had four suicide deaths. According to Rob Ryg none were explicitly connected to COVID issues such as job loss, but we cannot discount the impact this prolonged pandemic could have had on them. Of late much of our commentary has been pretty dour. I think it is worthwhile to consider some positive news. The recent Thanksgiving break was an opportunity to remind myself of things I am thankful for. Compared to this spring, we know effective behavior modifications that can significantly reduce the spread of COVID-19. We now understand the importance of mask wearing, social distancing, and frequent hand washing. We have adopted policies of testing people when they have symptoms, staying at home when sick, and avoiding gatherings of people outside of our immediate home living group. We are seeing more local availability of the newer therapeutics. I would qualify these is being only a single or double, and not a home run. Some have conflicting, and relatively small clinical benefits. They tend to be warranted for those with moderate to severe disease, which will often mean hospitalized patients. The rationale for outpatient use is rather limited, but at least we can now talk about these in some instances. Dexamethasone has always been available. There now is local availability for Remdesivir and Monoclonal antibody therapy as well. Some of these new treatments require infusions in the hospital.
“Our testing capacity has increased dramatically. Rapid antigen testing is now widely available and represents a growing, significant portion of our overall test count. We have an ability now to identify positive cases as soon as they develop symptoms, rather than waiting days for a PCR test to return. Early case identification and isolation should help reduce the spread of disease in Routt County.”
“We also know that the infection mortality rate in hospitalized patients has fallen over the year. One study in New York hospitals showed that infection mortality rate in the spring was 25.6%. By August, the infection mortality rate in the same hospitals had fallen to 7.6%. Other studies in the US and abroad have shown similar drops in infection mortality rates in hospitalized patients. Many things have contributed to this: new therapeutics, improved care protocols, a shift from mostly older hospitalized patients to having a larger percentage of younger patients, and so forth. But we should consider one caveat. In the spring our country was dealing with more of an outbreak situation focused on some locations, rather than the widespread disease we have now. In the spring there was an ability to shift staff and resources to those outbreak areas. We do not have that same staffing luxury now. It appears we have enough ventilators, but do we have enough respiratory therapists, nurses, and critical care providers to manage a large number of patients on ventilators?While we are seeing escalating hospitalization numbers in Colorado and the US, this comes at the same time health care providers are now managing more moderately ill infected persons as outpatients, who previously would have been admitted. We have learned how to sort through patients and better identify those who require hospital care. We are not intubating patients as early and have learned ways to safely treat some hypoxic patients as outpatients.”
“Soniya Fidler, UCHealth Yampa Valley Medical Center President, commented yesterday at the local stakeholder meeting that the local and UCHealth system hospital capacity is currently adequate. This morning on a CDPHE meeting Roberta and I just heard disease projections for the state. Most of the modeling predicts staying just below our state hospital and ICU bed capacities, but just barely. If these predictions underestimate disease prevalence though we are most likely to breach our ICU capacity.”
“And a last big positive news item continues to be our expectation that we will start vaccinations by the latter half of this month. Vaccinations hold the promise of putting the spread of this disease in check, and allowing us to return to the social, activity, and economic environment we appreciated before this pandemic hit. Therapeutics that treat COVID-19 have developed, none are home runs, but they do an impact. The infection mortality rate is going down. In the Spring in New York, there was a 25% mortality rate, by August, it was 7.6%. We are treating more people as outpatients and our local hospital has not breached capacity. Our testing capability is miles along where we were months ago, and we even have rapid tests that can tell people on the spot whether they have COVID. The vaccine news is good news and I predict we start the third or fourth week of December to immunize. We have to envision a different future and we need to continue to work diligently to get to the positive point. And we know that masks work. We have tools we did not have before.”
New protocols on quarantine
Roberta Smith gave an update on the quarantine guidelines, “The CDC changed their quarantine guidelines today. The incubation period for COVID-19 has not changed, it’s 14 days.
But the shortened guidance may alleviate some of the constraints on people staying home for 14 days. In some populations like congregate care and residential care, the guidelines will not shorten the quarantine times. But for the general public, contacts who have monitored themselves for symptoms and have not had any signs or symptoms of COVID-19 their quarantine can end after ten days; but they still need to monitor for signs and symptoms for 14 days. Additionally, if someone is monitoring for signs and symptoms and has either a molecular or antigen test performed on day five of quarantine and the test is negative, 48 hours later on day 7, you can end your quarantine, but you still have to monitor your symptoms for the full 14 days.”
“Hope is on the horizon. It will be quite a bit of time before we can go back to normalcy. We talk about tools; tools are only as good as the people who use them. I encourage everyone to keep it up. Social distance, wear a mask, wash your hands, get tested, stay home if you are sick and please don’t congregate,” said Tim Corrigan, Chair of the Routt County Commissioners.
Commissioner Beth Melton mentioned that Dr. Fauci joined Governor Polis at his press conference yesterday and she echoed his comments, “It’s good to understand the path we are on. Help is on the way, but it is not going to be easy. It’s a hard time of year to ask people not to gather but we all need to double down on our efforts. The end exists.”
As a follow-up to last week’s Board of Health meeting, the Commissioners mentioned that the state is asking for feedback on the Five Star program for restaurants by December 4th. Many of the requirements in the program are already in place in Routt County through its site mitigation protocols. If approved by the state, Routt County has an opportunity to allow restaurants to increase their capacity depending on the level of the County on the COVID-19 dial.