Coronavirus pandemic in Colorado has peaked in models, but state officials say worst is still to come
A prominent national model predicting the trajectory of the coronavirus pandemic seemed to offer good news Monday, suggesting the outbreak in Colorado already has peaked and the state has no shortage of ICU beds.
But state public health officials pushed back on those predictions, saying their own modeling — which they are using to guide social-distancing policies — shows the worst is still to come and that it may still be some time before Colorado recovers a sense of pre-pandemic normalcy.
“We are confident our peak has not hit,” Jill Hunsaker Ryan, who leads the Colorado Department of Public Health and Environment, said in conference call with reporters.
The number of coronavirus cases in Colorado is expected to peak sometime between May 8 and Sept. 14, depending on the effectiveness of social-distancing measures such as the statewide stay-at-home order, according to modeling released by the health department.
However, the widely shared national model by the Institute for Health Metrics and Evaluation predicts Colorado reached its peak for hospital bed usage on Saturday. The model, which assumes “full social distancing” through the end of May, estimated that on Saturday, Colorado needed 133 ICU beds and 113 ventilators — just a fraction of the resources currently available in the state.
Estimates of the number of ventilators available to Colorado hospitals has ranged from 900 to about 1,600. State officials have long predicted Colorado will need significantly more ventilators to care for critically ill coronavirus patients, with Gov. Jared Polis asking the federal government for 10,000 more of the machines.
Public health experts warned that all modeling of the trajectory of the pandemic should be viewed cautiously, given the significant limitations in testing for COVID-19, the disease caused by the new coronavirus, across the state and nation.
The delays in testing mean the number of confirmed cases is likely far lower than the actual number of people with the illness. While there are more than 5,000 confirmed COVID-19 cases in Colorado, state officials on Monday estimated that roughly 17,000 to 18,000 individuals have the disease.
“All of those models are trying to predict things that haven’t happened yet,” said Elaine Nsoesie, assistant professor of global health at Boston University’s School of Public Health.
It’s going to be difficult, public health experts said, to know when to begin rolling back rigid separation policies such as stay-at-home orders, because of the lack of data from inconsistent testing.
“What people want the most is certainty,” said Dr. Richard Besser, former acting director of the U.S. Centers for Disease Control and Prevention and president of the Robert Wood Johnson Foundation. “It’s the one thing that you just don’t have. There are a lot of models that attempt to give you a lot of control and certainty, but they aren’t based on hard data.”
The differences in the models is driven in part by the type of data they use in their projections. The Institute for Health Metrics and Evaluation model largely relies on death and hospitalization data. Whereas the state’s model relies on case data, said Elizabeth Carlton, assistant professor at the Colorado School of Public Health.
Carlton, who worked on the state’s epidemic model, said the date of when the number of coronavirus cases in Colorado could peak will depend on the effectiveness of social-distancing measures that have closed bars, theaters and other large gathering places across the state.
“In reality, we don’t know how much the social-distancing measures will impact the transmission of COVID-19,” she said, emphasizing that such stringent restrictions are fairly new.
Predictions and estimates
The Institute for Health Metrics and Evaluation Model predicts that by Aug. 4, an estimated 302 individuals will have died from the new coronavirus in Colorado. So far, 150 people have died of COVID-19 in the state, according to the state health department.
The institute’s predictions, which estimate daily COVID-19 deaths in the U.S. will peak on April 16, were updated to include death data from seven locations in Italy and Spain. Previously, the projections only included such data from Wuhan, China.
The Institute for Health Metrics and Evaluation Model used the data to base estimates of the time from when social distancing measures were put in place to the day the number of deaths peaked. As a result of this, the date of peak daily deaths are projected to occur sooner than originally predicted in several states, including Colorado, according to a news release.
The model predicts that the daily deaths peaked in Colorado on Sunday, with 14 deaths. However, in reality the state saw the number of deaths from the new coronavirus increase by 10 people that day, according to the latest data from the health department.
Social distancing can curb the spread of the new coronavirus by increasing the physical distance between individuals. But the measures have been economically devastating, shuttering businesses and leading to layoffs and less consumer spending.
It’s unclear when state and local officials will start to lift these orders; on Monday evening, Gov. Jared Polis extended the statewide stay-at-home mandate to April 26. Denver Mayor Michael Hancock extended the city’s similar order to April 30.
“I’m more and more hopeful that Colorado’s stay-at-home can finally end on April 26, 2020, several days before the national goal of April 30th,” Polis said in a Facebook message announcing the extension of the order.
Yet one concern is that if rigid social-distancing requirements are pulled back too early, there will be a spike in cases as people return to work. In South Korea, where life is slowly returning to normal, officials are preparing for a possible second wave of COVID-19 infections, reports NBC News.
The state’s coronavirus model is focused on examining where the state is in the pandemic and when it will hit hospital capacity. So it’s less focused on trying to answer the question of when state officials can start lifting social-distancing models, Carlton said.
The state’s model predicts ICU hospitalizations will peak between April 13 and Aug. 13, depending on the effectiveness of the social-distancing measures.
“The one big caveat on this… we are assuming the social distancing stays in place indefinitely,” she said of the state’s model.
When to roll back
Rachel Herlihy, the state epidemiologist, said that for Colorado to consider rolling back social-distancing measures there are several factors that need to be in place, such as rapid testing and disease control strategies, such as quarantines. The number of infections also needs to slow to the point that the amount of cases are manageable and “can be adequately controlled in the state,” she said.
“We need resources to respond aggressively to cases as they are identified,” Herlihy said.
One sign that it could indicate when it’s time to consider lifting the social-distancing measures is when the number of hospitalizations from the coronavirus start to decline, Besser said.
Centura Health, based in Centennial, endorsed the state’s social-distancing measures Monday, with its chief executive officer saying in a news release that the system expects to see a “significant increase of critically ill patients” who will need hospitalization and ventilation.
“In the next two weeks and at least through the end of April (or early May), we will be challenged in ways we haven’t been before,” Peter Banko said in a statement.
State health officials are concerned about a shortage of hospital beds, especially in intensive care units. Officials said that if the number of Coloradans needing ICU care for COVID-19 outpaces the number of resources, such as beds, ventilators and workers, then those people unable to get that high level of care will likely die.
As such, Colorado health officials have finalized guidelines for who should receive health care, including ventilator treatment, if the number of COVID-19 patients overwhelms hospitals. The facilities are preparing for a worst-case scenario in which they could short as many as 10,000 ventilators for COVID-19 patients.
“The more effective social distancing is the more we can reduce our contacts with other people,” Carlton said. “The more rapidly we can get out of this phase of COVID-19.”
But, she said, “It doesn’t necessarily mean COVID is going to go away. But it does mean we can protect our health care workers, and limit the number of deaths (in the short-term) in Colorado.”
Staff writer Shelly Bradbury contributed to this report.
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