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Colorado has had coronavirus spikes before. Here’s why the current one could be different.
October 21, 2020

Rising numbers of hospitalizations. Cooler weather. Upcoming holidays. This is not the trajectory the state wants to be on right now.

John Ingold@johningold

The Colorado Sun — johningold@coloradosun.com

For the first time in months, state officials are in full-blown freakout mode over the direction of Colorado’s coronavirus epidemic.

Cases of COVID-19 are rising, but, in a way, that’s a smaller concern. Hospitalizations are increasing — and not just among older Coloradans. Deaths from the virus appear to be rising, as well. And, with cooler weather pushing more activities indoors, where viral transmission is more likely, and major holidays around the corner, this is most definitely not where the state wants to be, just weeks after kids in some areas returned to school in-person and as restaurants and others businesses are still struggling to find their footing. “We cannot go on as we have been,” Gov. Jared Polis pleaded during a news conference on Tuesday. “The status quo is not acceptable. We need to do a better job of wearing masks around others, staying apart from others, reducing our social interactions.” Here’s a rundown of where we are, and why state health leaders are so concerned about where we might be heading.


Recorded cases of COVID-19 have reached new highs

A Colorado Department of Public Health and Environment chart shows weekly reported new cases of COVID-19. Red bars indicate that cases increased from the previous week, while blue bars indicate that cases fell. The blue bar for the week of Oct. 18, 2020, farthest to the right, shows only a partial week’s worth of data, so it cannot be compared to the others. (Screenshot)

Last week saw more than 6,500 new cases of COVID-19 diagnosed in the state. That is by far a record. Prior to this current spike, the previous weekly high came in mid-July with about 4,200 cases. (The small bar on the far right of this chart is from this week, which, as it is still ongoing, can’t be compared to the others.)

But, though concerning, these numbers are also a bit misleading. Researchers at the Colorado School of Public Health who have been modeling the course of the pandemic in the state believe that the first wave of cases in spring was actually much, much higher than these official numbers show. A lack of testing at the time obscured the true figure.

Here’s a chart from a modeling report the School of Public Health team produced last month, showing that actual cases were as much as 10 times greater in the spring than what was reported, while the state is doing a better job capturing cases in official data now.

A chart from a Sept. 30, 2020, modeling report by researchers from the Colorado School of Public Health shows estimated number of coronavirus infections far exceeded documented infections early in the pandemic. (Screenshot)

The increase in cases is real, not the result of more testing

When the pandemic first hit Colorado back in March, Polis talked about the need for the state to ramp up to running tens of thousands of coronavirus tests a day. And then, for months after that, it looked like that was just wishful thinking.

But Colorado has now reached Polis’ long-hoped for testing capacity, with several days this month seeing more than 20,000 tests performed statewide. So how do we know that this increase in cases isn’t just the result of more testing?

In two ways. First, the percentage of tests coming back positive is also increasing — most recently creeping above 6%. If the state were simply testing more without there being more cases, you would expect that percentage to drop. And since a test positivity percentage of 5% is considered by health authorities worldwide to be the limit for having things under control, Colorado’s current positivity rate is definitely worrisome.

A Colorado Department of Public Health and Environment chart shows the number of COVID-19 tests performed per day in Colorado (the blue bars are tests performed by private labs and the tan bars show tests performed at the state public health laboratory). The red line shows what percentage of the tests on a given day came back positive for the coronavirus. (Screenshot)
But, apart from testing, there’s another signal that things are getting bad out there. Lots of people have started to show up to hospital emergency rooms with flu-like (and COVID-like) symptoms that aren’t caused by the flu. This isn’t a perfect signal — lots of these people probably don’t have COVID-19. But emergency rooms saw a big spike of these kinds of people in spring when coronavirus was also surging, so this is a way to double-check what is happening in the testing data.
A Colorado Department of Public Health and Environment chart shows data from a surveillance system set up at hospital emergency rooms to track people reporting flu-like or COVID-19-like symptoms. (Screenshot)

More young people are getting sick — really sick

Early in the pandemic in Colorado, there were almost no children being diagnosed with coronavirus, and cases among other young people also remained low. That’s no longer the case.

Cases among people age 19 and younger last week accounted for 17% of the state’s cases. And cases among all people age 39 and younger made up over half of the new cases. People in their 20s are now the most disproportionately represented age group for Colorado COVID-19 cases — making up only 15% of the state’s population but 22% of the state’s coronavirus cases.

A Colorado Department of Public Health and Environment chart shows the distribution of COVID-19 cases in Colorado by age over time. Cases among those 19 and under and those ages 20 to 39, the bottom two colors in this chart, have increased. (Screenshot)
In a way, this may seem like a good thing. Coronavirus is toughest on those who are older. Having a disproportionate amount of the state’s cases be among young people could mean the state has a comparatively milder epidemic.

But the increasing number of cases has now begun to lead to a rising number of hospitalizations.

A Colorado Department of Public Health and Environment chart shows the change in the number of patients hospitalized with confirmed or suspected COVID-19 cases. (Screenshot)
And it’s mostly not the elderly who are being hospitalized. Last week, more than half the coronavirus patients in Colorado hospitals were under the age of 60. More than 20% — one out of every five — were under the age of 40.

The most worrying data signals are also trending up

At its most fundamental, Colorado’s response to the coronavirus pandemic is about three things — saving people’s lives, preventing people from becoming seriously ill and making sure there’s enough hospital capacity to handle a surge in cases.

And now all three of those measures are moving in the wrong direction.

Nearly 80% of the state’s intensive-care hospital beds are currently in use, up from around 70% or below in early summer. Polis said on Tuesday that nearly a quarter of the state’s intensive-care beds are currently occupied by COVID-19 patients. A new surge in any health crisis — coronavirus, flu, car accidents, heart attacks — could push the state dangerously close to its capacity.

A Colorado Department of Public Health and Environment chart shows the percentage of available intensive-care beds in use at Colorado hospitals over time. The red line shows an average calculation intended to smooth out the bumps. (Screenshot)

There’s also been an increase in patients being placed on ventilators. Doctors across the state have gotten a lot better at treating coronavirus, and often this has meant they have been able to avoid using ventilators in situations where they would have placed a patient on one earlier in the pandemic. But a slight rise in ventilator usage in hospitals has paralleled the rising number of hospitalizations from COVID-19.

A Colorado Department of Public Health and Environment chart shows the percentage of available ventilators in use at Colorado hospitals over time. The red line shows an average calculation intended to smooth out the bumps. (Screenshot)

Deaths due to COVID-19 may also be increasing, though this is a little less clear. The state’s death tallies show an increase earlier this month, with a decline since then. But deaths can take a long time to officially document and categorize, meaning that the number of recorded coronavirus deaths for the most recent weeks could continue to rise.

A Colorado Department of Public Health and Environment chart shows deaths of people with COVID-19 over time. Each bar shows the average number of deaths over the prior seven days, in order to show the trends more clearly. (Screenshot)

Where outbreaks are occuring has shifted

Many of the state’s earliest — and most deadly — coronavirus outbreaks were at long-term care facilities like nursing homes. But those have largely leveled off, as the state imposed strict control measures and also got better at testing the people who work there.

Since the end of summer, outbreaks have been growing most prominently at schools and other educational settings. This chart shows the total number of outbreaks in the state, not just a weekly snapshot. And it shows clearly how outbreaks at education facilities (in orange, near the top) have eaten up a bigger chunk of the pie, now accounting for more than 10% of the state’s total outbreaks.

A Colorado Department of Public Health and Environment chart shows how the locations of COVID-19 outbreaks in the state have changed over time. The light blue at the bottom represents residential health care facilities such as nursing homes. The rapidly expanding orange wedge near the top shows the growth in outbreaks at schools. (Screenshot)

Polis has said he would be willing to order schools closed again to in-person learning if that’s needed to get coronavirus cases under control. But it’s clearly not an option anyone is excited about. Still, Polis said Tuesday that Coloradans will have to get used to the uncomfortable in the coming weeks and, perhaps, months.

“I know we are all very tired of the virus,” he said. “Fatigue is setting in. That’s why we’re seeing these numbers increase. But the virus is not tired of us. It’s still deadly.”