Colorado’s COVID wave shows signs of receding amid omicron concerns
Colorado’s fifth COVID-19 wave may be starting to recede, but it’s too early to know whether spread over the Thanksgiving holiday or the concerning new omicron variant will stall or reverse the progress.
The number of hospitalizations for confirmed COVID-19 across the state dropped to 1,473 as of Monday afternoon, from a high of 1,576 on Nov. 23. Hospitals are still running near capacity, but the state reported more than 100 beds were available in intensive-care units for the first time in about three weeks.
Still, Colorado’s public health leaders are prepping in case those downward trends don’t continue. A group of experts advising the governor on Monday evening unanimously approved an amended document outlining what the state’s crisis standards of care would look like in the event hospitals are completely full and need to ration health care.
“We do want to have these revised recommendations approved… not because there’s any immediate need to activate them, but to have them prepared if the need arises in the coming weeks,” said Dr. Eric France, Colorado’s chief medical officer.
While some people delay seeking medical care over a holiday, Colorado’s new COVID-19 hospital admissions started to decline before Thanksgiving, suggesting the state may have passed a peak, said Beth Carlton, associate professor of environmental and occupational health at the Colorado School of Public Health.
New COVID-19 infections have been trending down and a lower percentage of tests are coming back positive, though the picture may be partly skewed by lower-than-usual testing over the last few days, she said.
“There’s some hopeful news there,” she said.
Still, the virus remains widespread in Colorado, and saying the situation is improving isn’t the same as saying it’s safe to throw away your masks and forget about scheduling that booster appointment, Carlton said.
“The risk of encountering someone with SARS-CoV-2 is still high,” she said.
Two big unknowns remain: what effect, if any, recent holiday gatherings will have on the virus’s trajectory, and whether the recently discovered omicron variant of the virus — not yet confirmed in Colorado — will spark a new wave of cases.
Last year, the third wave peaked in late November, and any effects from Thanksgiving were minimal, Carlton said. Of course, the situation is different this year: more people traveled, but fewer are susceptible to severe disease, with so many having been vaccinated.
“We needed a more general approach”
During Monday’s meeting of the Governor’s Expert Emergency Epidemic Response Committee, public health experts explained how the state would expand guidance to hospitals in need of relieving strain in the event they become overwhelmed with patients.
The guidelines adopted last year for crisis situations dealt mainly with how to parcel out life-saving ventilators and ICU beds. The new guidance, which awaits review from the governor, takes into account other factors critical to hospitals’ capacity for care, including emergency room capacity and non-ICU hospital beds along with staffing shortages, dialysis and medication.
“It became clear that we needed a more general approach,” said Dr. Stephen Cantrill, an emergency medicine physician at Denver Health, of the shift from focusing on ventilator availability.
The new guidelines focus on the lowest-risk patients and how hospitals might be able to ease strain by identifying people — particularly non-COVID-patients — who might be able to be discharged earlier than normal to receive out-patient care. These patients can always return to the hospital if needed.
“The perfect system is not that none of them come back to the hospital,” said Dr. Anuj Mehta, a pulmonary critical care physician at Denver Health, who outlined the updated document Monday. “If two or three come back, that’s a win.”
The omicron variant hasn’t been found in the United States yet, but Dr. Anthony Fauci, the nation’s top infectious disease doctor, said it almost certainly will be. He urged preparations, like increasing testing capacity and wearing masks again.
On Sunday, the World Health Organization issued a warning that omicron has a large number of mutations that could allow it to spread more easily, or make it harder for the immune system to recognize that this is a virus it has seen before and should attack. It will take two or three weeks to get enough data to understand how much we should worry about the new variant, though, Carlton said.
The United States, along with other countries, restricted travel from southern Africa, but it’s not clear if those measures will be effective, since the variant already has spread. Omicron was first identified in South Africa, but has been found in 11 European countries, Israel, Australia, Canada, Hong Kong and Botswana.
Keeping an eye out for omicron
In Colorado, essentially all virus samples chosen for genome sequencing have contained the delta variant. The Colorado Department of Public Health and Environment’s lab and some private labs sequence a random sample of positive COVID-19 tests in the state each week.
The state health department reported it will update its wastewater surveillance program to look for omicron. Testing wastewater can’t tell the state who has the virus — the sample is tested after many households’ and businesses’ toilet waste has come together, and about half of infected people don’t shed virus particles in their stool — but it can give a rough idea of how widespread the virus may be, and which variants are circulating. If a community’s wastewater has a high viral load, the state can send testing and other resources there, to try to get the spread under control.
“New variants of the virus are expected to occur. Vaccines are the safest, most effective way to slow the spread of COVID-19 and its variants, as well as help avoid the worst outcomes — severe illness, hospitalization and death — among those who do become infected,” a health department spokesperson said.
Most variants of SARS-CoV-2 come and go without making any real impact. The exceptions are alpha, which was first detected in the United Kingdom and became the dominant variant in the world for months because it was more contagious than other types; and delta, which was first found in India and dethroned alpha because it spread even more easily.
Since delta already pushed health systems in Colorado and around the country to the breaking point, a more-contagious version of the virus would be an additional challenge.
It’s possible that public health recommendations could change as we learn more about omicron and any future variants, Carlton said, but, for now, people need to keep doing the same things they would to avoid delta: getting vaccinated, or getting a booster if enough time has passed; wearing masks in indoor public spaces; and avoiding crowds when possible.
“The same tools we’ve been using for months are the most important ones to use right now,” she said.
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