Six things Colorado learned — and unlearned — about coronavirus in the two months since its first case

Two months ago today, Colorado Gov. Jared Polis stood at the front of a small room at the Colorado Department of Public Health and Environment’s headquarters and made what will likely be the most significant announcement of his tenure.

“This afternoon,” he said, “I was notified that we have the first presumptive positive case of novel coronavirus, also known as COVID-19, in Colorado.”

Since then, Polis has navigated the state through a response that escalated quickly based on information that sometimes changed dramatically. There has been advice that later had to be reversed, assumptions that proved not to be true and goals that are still works in progress. Early hotspots have cooled, while new ones have emerged.

“This is a tricky, tricky virus,” Polis said Monday, summing up what his administration has learned. “… It’s a tricky, nefarious enemy that we have. And, yet, we’re also learning things that help us stay safe.”

Here are six things that we now know to be true and how Colorado’s evolving understanding of them informed the state’s response.

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We’ve learned a lot about how contagious coronavirus is, when it got to Colorado

When Gov. Jared Polis announced on March 5 that Colorado had its first case of coronavirus — a California man who traveled to ski in the high country — he told people not to worry about possible spread of the disease at the airport when the patient traveled through several days earlier.

“When he traveled at the airport, when he was on the airplane, he was asymptomatic, which means there was a low risk of transmission,” Polis said. “That’s according to the latest information from the CDC. Therefore, there’s no reason to believe at this time that other travelers were exposed.”

We now know that’s not true.

Coronavirus actually may be most contagious before someone who is infected shows symptoms, according to a study in the journal Nature Medicine. “Emerging research suggests that people may actually be most likely to spread the virus to others during the 48 hours before they start to experience symptoms,” a post on Harvard Medical School’s Harvard Health Publishing says.

We also now know that coronavirus was in Colorado at least days, if not weeks, before the first case was announced. Modeling from the Colorado School of Public Health estimates the disease may have reached the state in mid- to late-January.

By the end of February, days before the state’s first cases were announced, a deadly cluster was already forming in Colorado Springs.

We haven’t come close to running out of ventilators

Colorado health officials, along with doctors across the nation, spoke often in March about the fear of running out of ventilators — and, in worst-case projections, the dreaded decisions they would face if there weren’t enough ventilators for every patient who could not breathe on their own. 

In late March, Polis sent a letter to Vice President Mike Pence begging for more of the machines, along with personal protective equipment. “We are facing a crisis-level shortage of these essential supplies to protect our health care workers and first responders,” he wrote. “Colorado’s COVID-19 death rate is rising faster than any other state right now.”

The most dire disease projection models suggested Colorado was up to 10,000 ventilators short. 

But the ventilator crisis has not come to pass. Of the 1,082 available critical-care ventilators at Colorado hospitals this week, just 442 are in use. 

This is likely due in large part to the campaign to flatten the curve with a statewide stay-at-home order. But there are other reasons — discovered by doctors while treating patients the last two months. 

At the start of the outbreak, common thinking among physicians was that it was best to put COVID-19 patients on ventilators as soon as things got serious, sooner than was typical for a patient who struggled to breathe because of the flu. 

Back then, international and national health organizations recommended that hospitals avoid using non-invasive oxygen masks called BPAPs, which do not require intubation. So doctors instead were going straight to ventilators, intubating patients who were still alert and lucid. 

Dr. Chistopher Merrick, a pulmonary and critical care specialist at UCHealth Memorial Hospital in Colorado Springs, recalled intubating a man with COVID-19 who was otherwise healthy but was in the most at-risk age category of over 65. He was wide awake and scared.

“I will probably always remember looking down at him and reassuring him that he will get through this because he had been watching the news for days leading up to this and he knew he was going to die,” Merrick said in an interview videotaped and shared by UCHealth. “He made it through and did very well and left the hospital.” 

Several weeks into the pandemic, the thinking on ventilators has evolved, Merrick said. 

“Thankfully, now that we’ve learned a lot as we’ve taken care of these patients and as the international community is sharing their information, we’re learning that folks can stay off the ventilator much longer than we initially thought,” he said.

Doctors are now using “proning,” meaning they place a patient in a prone position, so they are lying on their stomach. And they are using a non-invasive device called a high-flow nasal cannula — a tube inside the nostrils — which can deliver 60 liters of oxygen per minute.

It’s important for people to remember that most patients recover, Merrick said. “Even those that come to the hospital, most of those are making it through and returning back to their lives,” he said. “Colorado has done a great job flattening the curve. We are ready if more cases do come.”

Colorado also has not run out of intensive care beds, as feared two months ago. Just three hospitals in the state are concerned about running out of personal protective equipment within the next week and zero are concerned about running out of ICU beds, according to state data released Monday. 

That means that, so far, Colorado does not need the make-shift medical wards it is creating to handle an overflow of patients. 

The initial plan was for 2,000 beds at the Colorado Convention Center in Denver, but that has been scaled back to 600 beds and scheduled for a June 4 opening. The Ranch at the Larimer County Fairgrounds and Events Complex was initially supposed to handle up to 1,000 patients, but that’s been reduced to about 200, and scheduled to finish by June 15, according to the state health department.

The state also signed letters of intent with St. Anthony North in Westminster, St. Mary-Corwin Medical Center in Pueblo and Western Slope Memory Care in Grand Junction to serve as alternative care sites. Construction is ongoing at St. Anthony North and St. Mary-Corwin, which would make those sites available to help with outbreaks at long-term care centers. Construction has not started at Western Slope Memory Care. 

Masks aren’t necessary. 

As the first confirmed cases were tallied in Colorado, public health officials told nervous citizens that masks were not necessary for regular people. Now Coloradans are glaring at each other for not wearing them and, in some Colorado towns, citizens can be ticketed for not covering their faces in public.

As late as March 30, the World Health Organization, the Centers for Disease Control and Prevention and local health authorities were reiterating that their experts did not recommend masks for healthy people. 

And then that advice took an abrupt turn. 

President Donald Trump announced April 3 that his administration was now encouraging Americans to wear face masks. That same day, as the number of COVID-19 deaths in Colorado reached 112, the governor donned a mask at a news conference and announced that Coloradans who leave their homes to grocery shop or buy gas should cover their faces. 

It was a recommendation, not a requirement. 

Polis on April 17 ordered that essential workers, including grocery store employees and workers at meatpacking plants, wear masks to work. And in the last week or so, multiple cities in Colorado have instituted their own mask mandates. 

Denver’s public health order requiring face-coverings while at grocery stores, bus stops, doctor’s offices and other public places takes effect Wednesday. The potential fine for getting caught without one is $999. 

“When we’re at the grocery store, work or any other business, my face covering protects you and your face covering protects me,” Mayor Michael Hancock said in an emailed statement. 

Other cities with similar ordinances include Aspen, Wheat Ridge and Glenwood Springs. 

From don’t change your routine, to don’t leave your home

When Denver’s first coronavirus cases were announced in early March, the head of the city’s health department was asked if people should begin avoiding crowded places like the Pepsi Center. 

No, said Dr. Bob McDonald, “people don’t need to start staying at home.” 

About two weeks later, McDonald and Denver Mayor Michael Hancock ordered hundreds of thousands of people in the city to stay at home unless absolutely necessary. 

Even Gov. Polis, who would go on to order all 6 million people in Colorado to stay at home for roughly a month, said he wasn’t planning on changing his behavior because of the virus in the early days of the state’s outbreak. “Take precautions,” he said. “If you are ill, don’t go to work. If you see somebody coughing or sneezing, it’s usually not a good idea to go right up to them. … At this point in time, there are greater health threats in Colorado.”

The change of heart reflects the change in understanding about the virus. As many as half of those who are infected don’t show symptoms, making them potent carriers of the deadly disease. 

Early guidance to stay away from people who were sneezing or coughing simply wouldn’t keep the masses safe because, in reality, there’s no way to tell who may be infected and who’s not absent a test.

“We want you to get tested.” Or, maybe not.

Early in the pandemic, Polis was bullish on testing. He talked about trying to follow the South Korea model of testing as many people as possible. He pushed the state to open one of the first drive-up testing sites in the country. He spoke of wanting to run tens of thousands of tests a day to track the virus’ spread.

“If you’re exhibiting flu-like symptoms, we want you to get tested,” Polis said at a March 10 news conference.

But, within a week, Polis and administration officials, facing the nationwide shortage of testing supplies and capacity, dialed back that messaging. Most people with COVID-19 symptoms do not need a test, they said. Stay home instead.

Perhaps no public guidance has swung as dramatically as that surrounding testing. And now the pendulum has begun to swing back toward the original goal again.

On Monday, Polis announced a new online map that will help Coloradans find a community-based testing site in their county. Hospitals have scaled up testing for their patients. The state is conducting targeted testing for workers at nursing homes and other businesses, and numerous other testing locations have opened up.

Polis said Colorado now has the capacity to process 10,000 tests a day, though the state’s most recent data shows around 3,000 to 3,500 tests being run a day. There’s still no central directory of all testing locations. 

“For most of us, your doctor is the gatekeeper to testing,” Polis said Monday, “and hospitals and clinics, all private providers do a lot of it. But we’ve also had great success with drive-through and community-based clinics.”

Testing criteria still varies. While the state is testing workers in nursing homes regardless of whether they have COVID-19 symptoms, other testing locations require a doctor’s note. Returning to his earlier vow, Polis said last week that he hopes anyone with coronavirus symptoms will be able to get tested in Colorado by May 15.

“We’re building this car as we’re driving,” he said. “It’s a labor-intensive effort.”

Colorado’s ski communities were the state’s hardest-hit. Not anymore.

In the early days of the pandemic in Colorado, it was the mountain ski communities that suffered the worst.

Gunnison and Eagle counties had some of the highest infection rates in the country. State health officials on March 15 warned that anyone who had visited Gunnison, Eagle, Summit or Pitkin counties should immediately “minimize their contact with other people” for 14 days. And, three days later, the CEO of Vail Health wrote in an open letter to his community that, “we are fighting a war of life and death right now.”

But now the tide has turned.

While still reporting high rates of people who have been infected, Colorado’s mountain communities no longer are feeling the strain of those past infections. Will Cook, Vail Health’s CEO, said two weeks ago that his hospital had zero coronavirus patients. Polis has granted Eagle County permission to reopen more broadly than the rest of the state and has praised the county’s work to contain the virus.

The state’s hotspots have shifted from the mountains to the plains.

Morgan and Logan counties, in northeastern Colorado, now have the state’s highest infection rates. Morgan is home to at least two food-processing plants with outbreaks; Logan is home to the state prison in Sterling, where more than 250 inmates and staff have tested positive. Driven by outbreaks at a meatpacking plant and in nursing homes, Weld County has the highest infection rate among the counties with the largest populations in Colorado.

It’s evidence of how the pandemic has changed course in Colorado — first brought in by people with money to travel and now zeroed in on those who have the least ability to protect themselves from it.