As Colorado continues to move toward post pandemic life, the state is still in a somewhat delicate position. More than 4 million Coloradans have received at least one dose of the COVID-19 vaccine, according to the state's website. But state health officials are warning that cases have been ticking up once again. To get a sense of where we are in this moment, Colorado Edition talked with Dr. Jonathan Samet, dean of the Colorado School of Public Health.
Interview Highlights:
These interview highlights have been lightly edited for clarity.
Erin O’Toole: What does the latest COVID-19 modeling reveal about where we are right now in the pandemic?
Dr. Jonathan Samet: Let me talk first about what the reality is, and some of the numbers. We track hospitalizations closely, and they have gone up over the last five or six weeks. So just by reference, March 14, we had about 280 people in the hospital with COVID-19 across the state. That number over the last few days has gone over 600. So, we've definitely seen a rise of our epidemic curve. With the modeling we say, “how fast is that rise?” and then we project out the future.
And, you know, I think we are not doing as well as we were, say, a couple of months ago where the epidemic curve had been descending. We were hoping that as vaccination kicked in, we would continue to see a descent, hopefully down to not having an epidemic in progress and to seeing (only) sporadic cases and outbreaks. What we see now with our modeling is that the epidemic curve is going to continue to rise for a while. And, you know, we're not probably going to see it come back down to the low levels — where we like to be — until sort of the midsummer range or into August.
What’s behind this recent rise in cases?
In terms of drivers, we have had the variants, of course — the B.117 — that's more transmissible that has now taken over the infection in the state. We've had changes in policy measures that have opened things up a bit. And I think many Coloradans have thought, perhaps prematurely, that we're back to 2019. We're not. So those are sort of drivers. And then of course, we have vaccination, which is so critical right now in bringing things under control.
It's so interesting that cases are rising, even as we know just over a third of Colorado's population is now fully vaccinated. Does it feel to you like kind of a balancing act, as more people get the vaccine, but more activities are reopening?
We have a number of competing forces, don't we? I named some of them. And I think, of course, right now, the major driver to bring the pandemic to a close is getting as many people vaccinated as quickly as possible. Our estimate of people in Colorado who are actually immune, which includes not only those vaccinated, but those who have been previously infected, is in the, say, low 40% (range) — 41, 42%. That's good. But we still have a ways to go. I think one other important feature of what's going on right now is that the cases, the hospitalizations are in people less than 65. Among the older Coloradans, we're realizing the benefits hit home, with quickly dropping hospitalization rates and far fewer cases projected for the future among older Coloradans.
The governor recently handed pandemic decision-making about health guidelines and mask mandates over to local governments. Was this the right time to do that?
I think the counties, local public health agencies, knew for a long time that responsibility would be devolving — to use the term that's apparently in vogue — on to them. I think in part, the governor was trying to respond to the variation in the epidemic across the state, and also, I think to the varying appetite for policy measures at the county level. So I think it was a recognition that one size may not necessarily fit all. The governor does not have a crystal ball, unfortunately, and if you look at the time when these decisions were made about devolving the dial, we were not at that time thinking that there would be a surge. I think we were hoping, in fact, that vaccination would be winning out.
So I think there's two factors about the timing. One is that I'm afraid that people have, between their COVID fatigue and some counties essentially choosing to open up, I think that sends a signal that it's 2019 again and people change their behavior again probably prematurely. So, I think there's a lot of factors in play. You know, we lived with state-level mandates and orders for a long time. And the governor made a decision that it was time to acknowledge the variation of what people wanted, and where the pandemic was, and devolve the dial.
I want to ask about K-12 schools, which are again seeing a rise in outbreaks, perhaps more than last December. Do we know what is driving that?
Well, for one, of course, schools were mostly back, which means that there's contact among the children. The reach of the pandemic down now into younger adults, certainly means that there's infectious transmission across age groups and with children and the congregate setting of schools and no 100% way to provide protection against transmission. I think that's why we're seeing this. I mean, the increase in young adults and younger and older children is probably a key driver for the pandemic. We're probably also picking up more cases among school-age children because of testing — when they're in school and outbreaks occur. Because by and large, we think that the infections in particularly younger children are asymptomatic. But if you're doing testing, you will pick them up.
In a recent commentary, you wrote that “patience is needed by all right now, particularly young and middle-aged adults.” What did you mean by that? And are young people hearing the right message about what's safe and what's not during the pandemic?
So, you know, my message around patience is that we have to wait a little longer to get the vaccination rate up higher, particularly among younger people and the middle aged adults, to begin to slow the epidemic in that demographic. And yet this is a demographic that's probably least adherent to the transmission control measures, whether it's masking or distancing. And, of course, venues where people gather and mix are now opening up, like bars and restaurants.
I think you started by saying we're at a critical juncture. Well, we really are. And I think in the end, hopefully, if we achieve our vaccination targets, we really should have the epidemic under control in the state. We're not there yet. And if it's a matter of hanging in for a few more months, whether with counties putting in some measures to control the spread or people doing what they can do; I mean, a lot of this is under our control as individuals. I know that everybody is really tired, but let me turn this around. A year ago, who would have thought we'd be where we are now with vaccines that work, vaccines available and a path forward to really get back to the lives we all want to live?
So, you know my message is, "Gosh, hang on a few more months," because our projection is, with this curve going up we could still experience substantial numbers of hospitalizations and deaths. And I think one other message to younger people is, you know, being under 65 hardly makes you immune to going into the hospital or even dying from this pandemic. And there are many people, particularly in the middle age group who have the other diseases that make them vulnerable, whether it's diabetes or heart disease or being overweight. So I think people still need to think about adhering to the measures that are provided as protection.
Colorado's major colleges and universities are largely on board with requiring returning students to be vaccinated. Is that something that you had been keeping an eye on?
Of course. It's really been discussions on our campus and of course, systemwide within the CU system about this. Returning to campus with everyone fully vaccinated certainly makes assuring safety easier. And if we have a mix of people coming in, some vaccinated, some unvaccinated, it becomes really challenging to think about, well, some people may need to distance more than others. I mean, it's not that we want to stigmatize the unvaccinated. So a vaccine mandate to me makes a lot of sense. I think, above all, with the goal of minimizing risk and then operationally, it certainly makes it makes sense.
Can you briefly explain how vaccines help stop the overall spread of the virus? I mean, we know vaccines protect the individual who's vaccinated, but does that play a role in stopping the spread overall?
The virus's goal in life is to find a susceptible individual and reproduce and then go on to the next one. If it can't find susceptible individuals, eventually it should die out. Each person who's infected needs to cause infection in more than one for an epidemic to propagate. So by being vaccinated, everybody is contributing to bring the pandemic under control, in addition to having their own protection.
From what we know, people who are vaccinated are very unlikely to transmit, which is really, really important. So I think, people should view vaccination as protecting themselves, and protecting everyone. And again, the path to herd immunity — having enough people vaccinated and not susceptible — is probably going to be a long one and then require, who knows, 75, 80, 85% of us to be vaccinated. But we should all be making that contribution of getting vaccinated.
The weather is turning nice once again. That's bringing people a lot of hope. What do you want people to be thinking about at this point in the pandemic?
Well — certainly enjoy the nice weather, but I think the message that I've given is it's just not over yet. And, you know, the path to it being as over as we can be is as vaccinations continue, particularly for the unvaccinated, is to adhere to the measures that we've heard so often: masks, social distancing, avoiding large gatherings. Right now, about 1% of Coloradans, we estimate, are infected. So if you think about being in large gatherings, there's a pretty good chance that you could come into contact with somebody who is infectious. Again, we're not out of the danger zone here yet. And again, the clear path for individuals is to get vaccinated. Luckily, vaccine availability is not limiting us now. We are so fortunate. So, take advantage of that opportunity.
I know we're at a bit of a tough moment, but we've been through far tougher moments. And, you know, I think in probably four or five (or) six months we’ll be far more able to do everything we want to do.
This conversation is part of KUNC’s Colorado Edition for April 29. You can find the full episode here.
