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Let’s start with some positive news: COVID-19 case rates in Colorado are plummeting.
After a record-breaking surge in cases caused by the Omicron variant, the state’s seven-day average positivity rate (a marker of the virus’ prevalence) has dropped from its all-time high of 29.23 percent on January 11 to just 5.81 percent as of February 17—a rate similar to what we saw in August and September last year.
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“We’ve come down a long way from our peak several weeks ago,” Dr. Rachel Herlihy, the state epidemiologist, said in a press conference earlier this month. COVID hospitalizations are sloping downward, too, according to data from the Colorado Department of Public Health and Environment (CDPHE).
Now, for the sobering reality: Future waves of COVID-19 seem inevitable, says Dr. Jonathan Samet, dean of the Colorado School of Public Health. That’s because, as we’ve already seen, the virus has the ability to mutate, giving rise to new strains that could cause surges. Moreover, because the majority of the world has not yet been vaccinated against COVID-19, the virus still has many susceptible hosts where mutation might take place. Couple that with the interconnectedness of today’s planet, and a novel strain could spread “seemingly everywhere,” says Samet. “That’s why I worry about the future.”
But there are things health officials in Colorado can do to prepare for the next viral wave. And according to Scott Bookman, the state’s COVID-19 incident commander, the state is already well-equipped in some respects for what lies ahead.
Colorado’s surveillance efforts—essentially, our state’s ability to track the virus’ pervasiveness, existing strains, and mutations—outrank those of many other states. CDPHE’s state lab ranks eighth in the country for the amount of genome sequencing it conducts, according to CDPHE, helping state officials understand the prevalence of current strains and identify the emergence of new ones.
The state has multiple programs in place to detect the presence of variants, and the state lab currently conducts genome sequencing on all eligible PCR positive samples, according to CDPHE. (In order for a sample to be eligible, it must have a certain amount of viral load; not all samples make the cut.) In December 2021, state and private labs sequenced about 16 percent of Colorado’s positive PCR tests, the highest amount to date. CDPHE can’t say what percentage of tests they’ve sequenced during the entire Omicron surge due to the high volume of tests, but did reveal that since December 27, they have sequenced 82,096 tests at the state lab.
Samet commends Colorado for its efforts with wastewater surveillance, which helps with early viral detection, and nuanced county-level data that’s allowed communities to develop localized, targeted strategies to combat the virus. Limitations at the federal level, including the lack of an integrated health data system (which has led to a patchwork approach for data collection across the nation), affect Colorado’s ability to track the virus. Overall, though, Samet says Colorado has done well with what it has.
There’s a chance Colorado’s surveillance efforts could expand in response to future waves, says Bookman. The state’s COVID-19 response team is evaluating which mechanisms they’ll need going forward, he says, adding that wastewater monitoring “will continue to be an incredibly important tool in our toolbox.”
Ensuring adequate testing will also be critical in combating the next wave of COVID-19. On that front, Colorado has recently made huge improvements. “You can actually walk into the drugstores now and buy tests, which you couldn’t do a month ago,” says Samet. “It seems like supply has finally caught up.”
Bookman points to the existence of more than 150 community testing sites throughout Colorado, as well as the state’s at-home free rapid testing program, which has distributed more than two million tests to date, according to a press release issued on February 8. “At this point, I have no doubt that we have all the testing out there that we need to have,” he says. And if we were to face another wave similar to or larger than Omicron? Colorado would “absolutely” have enough testing to meet demand, Bookman says.
Bookman adds that the state is looking into shifting away from drive-up test sites and focusing on testing done in conjunction with doctor’s offices. The benefit? “If you do test positive,” he says, “you can be connected with therapeutics.” In the meantime, as the lull in cases continues, Bookman says the state may scale back testing due to decreased demand.
Samet, however, feels there is still “a lot to do” around supply chain preparation for both testing and face coverings. As the chairman of a committee at the National Academies of Sciences, Engineering, and Medicine, Samet worked on a report released earlier this month that made a series of recommendations about the use of respirators (which include N95s and KN95s) in the U.S., including steps the federal government should take to prevent future supply chain issues and shortages, such as establishing a team within the U.S. Department of Health and Human Services that would work with respirator manufacturers to guarantee production capability.
For its part, Colorado has increased face covering supply, including distributing more than 3.7 million KN95 and surgical-grade masks through its free mask program, according to the February 8 press release. Bookman says the state will evaluate the need for that program in the coming weeks and months. However, while providing free masks is a good step, Samet believes more emphasis should be placed on teaching people how to wear respirators correctly and when they need them.
In the meantime, vaccination remains the most critical tool for fighting future waves. “The basic objective of getting as many people vaccinated as possible with that third dose remains,” says Samet. As of February 18, Colorado ranks 12th in the country in terms of the percentage of state residents who are fully vaccinated and boosted, according to data collected by the New York Times. Of the Coloradans who are eligible for a booster, 24 percent have not yet gotten that dose, per CDPHE data announced February 10.
Vaccination, across the country, remains a politicized issue: 91 percent percent of Democrats are vaccinated compared to just 63 percent of Republicans, according to a Kaiser Family Foundation poll released in January. “I’d like to see national leadership that would help break down some of the politicization,” says Samet. “I think that’s going to be really important.”
In Colorado, Bookman says the state plans to continue its efforts to combat vaccine hesitancy with “broad public messaging” and an equity team working with historically marginalized communities to communicate the importance of getting vaccinated and boosted. For now, racial gaps remain: 77 percent of white, non-Hispanic residents have been vaccinated with at least one dose, compared to 64 percent of Black Coloradans and just 39 percent of Hispanic residents, according to CDPHE data.
Bookman points to national confusion at the beginning of the booster campaign as a lesson to consider going forward. When the time comes for another round of boosters, which Samet and other experts predict will likely happen, “We need to look for a place where the science is as crystal clear as it can be,” says Bookman, “and we’re really able to message to people: This is who is eligible, this is who should get it, and this is when you should get it.”
For the time being though, as we approach nearly two years of pandemic life, perhaps a moment of respite is what is warranted most. “What everybody needs right now is a break, a chance to regroup,” says Samet. “Hopefully, we’ll have that.”