How Effective Is Colorado's COVID-19 Dial? Public Health Officials Weigh In
As COVID-19 cases and hospitalizations continue to rise in our state, schools are closing and counties are moving to tighter restrictions. Theresa Anselmo, executive director of the Colorado Association of Local Public Health Officials, joined Colorado Edition to talk about the state's response and how that has impacted local public health officials.
These interview highlights have been lightly edited for length and clarity.
Henry Zimmerman: The state has developed this dial system with five levels that counties can move between depending on how COVID-19 is going there. The levels impact how much of the county can be open. How are local public health officials currently working with the state using this system?
Theresa Anselmo: The system was put in place at a time when we had a little bit of a reduction in case counts. It was determined to be an early warning system.
The way the dial works is state and local public health agencies review their data on a daily basis. If the cases start to increase at a level that triggers that early warning system, the state and that local public health agency have a conversation. The county can propose a mitigation plan to put in place to try to reverse that trend. If that trend is not reversed within a two-week period, then that is what moves a county from one level on the dial to the next level on the dial.
What are you hearing from local public health officials? Is the system working for them?
I think that depending on who you ask, it may be working fine for some and not well for others. I do have folks saying that they are moved on the dial over a weekend without that discussion happening with the state public health department. Others are feeling pressure to move, but aren't necessarily getting the support from the state based on the dial metrics, or from the local decision makers who are taking into account more than just the public health effects of the pandemic.
It's challenging to try to make sure that everybody fits into the box that the dial implies they should fit into when there is so much that has to go into decision making based on local conditions.
Some people are surprised that a statewide stay-at-home order hasn't been implemented. From a perspective of local public health, when should this measure be taken?
I think that each community will end up making those decisions for themselves. Obviously, that is what the intention of the dial was: to allow that local decision making. The challenge remains that just like air and water, the infection doesn't recognize arbitrary lines on a map.
Particularly in areas of the state where populations shift continuously — they either share a workforce or there is tourism — where people are moving from place to place frequently, the effect of a local stay-at-home was only as good as that local community because, frankly, if you have somebody coming in from outside of your community who’s carrying of the disease, they bring it in with them.
If you have somebody in your community that's a carrier of the disease, and they go out of your community, they take it with them. That makes it very, very difficult to strategically address measures that might stop the spread without a uniform type of approach.
The dial was put in place to give local control back to the decision makers in the counties. And yet at some point, I do believe that there needs to be some discussion around what other measures could be taken on a state level to make sure that we aren't seeing a number of unintentional and excessive deaths based on this infection.
We spoke to you over the summer about the strain that some of the people working in these local public health departments are feeling — especially officials who have to take on this public mantle of leading their community through a pandemic. Are officials still feeling the squeeze the way you described over the summer?
They certainly are and I think we're seeing a resurgence of it, particularly as people realize that the next move on the dial, or the most quickly effective mitigation strategy is a stay-at-home order where people are required to socially distance and not interact with people outside of their households.
Just this weekend, I received a message from one of my members that they received on their voicemail that was not very kind and friendly, and asking for their termination from their position because they weren't doing enough in their community. That’s kind of the opposite of what we've talked about. There are people that are very upset on both sides of this — you're not doing enough or you're doing too much to restrict our movements. That hasn't changed at all.
Over the summer, you had three different holidays, and cases boomeranged up and down around those holidays. The folks that I work with have not had a break since this started in late February, early March — and it's taking its toll. We had two or three directors that resigned, one was terminated. One agency has lost a director three times in the state of Colorado. So out of 53 agencies, that's a lot of leadership and institutional knowledge loss. That is pretty devastating in the middle of a pandemic.
This conversation is part of KUNC’s Colorado Edition for Nov. 16. You can find the full episode here.