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Reopening Is a Risk

A pivotal moment has arrived for Coloradans and their fight against COVID-19.

The statewide stay-at-home order will expire in two days, on April 26, and be replaced with a Safer at Home policy, Gov. Jared Polis announced this week.

The slight easing of statewide public health orders could help some businesses survive, but it also carries risks that could allow COVID-19 to resurge. We see risks in three broad categories:

  • Readiness. Local and state health agencies don’t have as much testing and contact tracing capacity as they have said they need.
  • Muddled messages. Safer at Home is more detailed and nuanced than the stay-at-home policy, and counties can issue stricter or looser Safer at Home orders.
  • The great unknowns. Researchers constantly discover new things about SARS-COV-2 (the virus that causes COVID-19), but the mathematical models that are informing policymakers were built on an incomplete understanding of the virus and how it is transmitted.

What ‘Safer at Home’ Means

Safer at Home aims to maintain nearly as much social separation as the stay-at-home order, while also reopening a number of businesses over the next week. By May 4, retail stores, personal services like haircuts, real estate showings, child care, and elective medical procedures will be allowed. Companies can have up to half their office workforce present at any one time, although anyone who can telecommute should continue doing so. And older and medically vulnerable people are advised stay home at all times.

None of these places will look “normal.” Under the policy, workers and customers should wear facemasks, people should keep at least six feet apart and wash their hands frequently, and high-traffic areas should be disinfected regularly.

“We need to continue to limit our social interactions to the greatest extent possible — just individuals in your household, same as before,” Polis said.

Schools will remain closed for the rest of the academic year. Restaurants might be able to partially open by mid-May.

The COVID-19 Modeling Group at the Anschutz Medical Campus estimates that social interactions were cut by 75 percent under the stay-at-home order. They will need to remain cut by 65 percent for the foreseeable future to prevent Colorado hospitals from being overwhelmed, according to the study.

The Readiness Risk

By Colorado’s own standards, the stay-at-home order is not ready to be lifted.

Health authorities around the country use different trigger points to decide when to ease up on social distancing, but they all are broadly the same. They include a sustained reduction in cases, the ability of hospitals to provide top-quality care to every patient, and widespread testing coupled with isolation of anyone who tests positive and everyone they have interacted with recently.

The number of new cases in Colorado appears to have been dropping for the past two weeks. The most encouraging news is that hospitals still have capacity.

Polis expressed frustration about repeated questions from the news media over the lack of tests at an April 22  press conference. The state has 150,000 tests on the way from South Korea, he said. And testing is just one component of Colorado’s Safer at Home plan. The other big requirements are wearing masks when out of the home, continued social distancing, and strict isolation of the elderly and medically vulnerable, he said.

However, Colorado’s readiness to conduct the investigation and contact tracing needed to contain new outbreaks is in question.

Metro Denver public health agencies currently have 119 people to do contact tracing — not enough to meet even the current demand of roughly 250 cases per day. Public health experts estimate that Colorado will need another 1,000 workers to do contact tracing to meet the anticipated demand when increased testing reveals more cases.

Muddled Messages About the Rules

President Donald Trump sowed confusion on April 13 when he asserted that he alone would decide when to lift stay-at-home restrictions across the country. Four days later, he said that call was up to each state’s governor.

However, it’s even more complicated than that. In Colorado, mayors and county public health departments can adopt policies looser or stricter than Polis’ Safer at Home plan. Denver’s Mayor Michael Hancock has extended Denver’s Stay at Home through May 8 and other counties may follow suit, just as the statewide stay-at-home order is set to expire. On the other hand, Weld County commissioners have adopted a “Safer at Work” policy and will allow all businesses to reopen next week.

Safer at Home will be harder to understand than the stay-at-home order. The rules will vary from county to county. Different business sectors will have different rules, too.

When in doubt, Coloradans can fall back on this advice: Don’t leave home unless it’s absolutely necessary, and if you do, wear a cloth mask and follow the six-foot rule. And wash your hands.

What Don’t We Know?

Scientific knowledge of COVID-19 is growing rapidly. Clinically, doctors are learning how the disease can attack not just the lungs, but also cause heart attacks, kidney failure, and blood clots

Epidemiologically, new information is casting the pandemic in a different light. California officials announced April 21 that the state’s first COVID-19 death happened on February 6 — weeks before originally thought. Colorado traces the onset of its first case to the same day, February 6 — a month before the official announcement of the first case in the state.

It’s now clear the disease was spreading for several weeks before any public policy actions were taken to contain it. That could mean the real total number of cases is much higher than the official count. It remains a mystery why some infected people show no symptoms while others suffer and die.

The danger is that many people without symptoms probably are spreading the disease. Only widespread testing will be able to identify these “silent spreaders” so they can be quarantined.

The choices that Coloradans and their leaders face today are fraught with risk. There are risks to opening up businesses and risks to keeping them closed. The right choices are not clear.

What is clear is that we are dependent on each other to a degree few of us have seen in our lifetimes. A large majority of Americans understand this and support the public health actions taken so far. A new Kaiser Family Foundation poll shows 80 percent of Americans support the stay-at-home orders.

In the weeks ahead, our health and our economy depend on all of us making thoughtful and safe choices — starting with wearing a mask.

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