As coronavirus cases and hospitalizations due to the virus reach record heights in Colorado, there is one metric so far resisting the same kind of upward pull.
Deaths among people infected with COVID-19 have begun to rise again in recent weeks, but they are so far nowhere near the peaks of earlier this year. Data from the state Health Department shows that currently about 10 people infected with the virus are dying every day in Colorado. That’s up from three or four deaths a day at the end of summer, but it is far below the 30 or more people who died a day during the worst of the state’s spring coronavirus surge.
This is, of course, really good news, state health leaders say. It shows how much doctors and nurses have learned in fighting the disease.
In March and April, the fatality rate for people with COVID-19 who entered the hospital was around 20%, Gov. Jared Polis said. Now, with advances in drugs and treatment methods, it’s about 5%. Improved survivability means more people who get to watch their children and grandchildren grow, more people who might return to their jobs, more people who can enjoy visits with friends once more.
“Still very deadly, still very tragic,” Polis told The Sun last week, “but one-quarter the fatality rate of the initial wave.”
But state health leaders also caution that the improved chances of surviving a coronavirus infection are not reason to take the virus less seriously or to be less alarmed by the rising number of cases in Colorado. For a variety of reasons, they say, death rates and counts are not the numbers by which leaders should make decisions about restrictions, nor are they the numbers by which people should decide how cautious to be.
Reporting issues obscure trends
The first of these reasons is that the numbers may not be what they appear. If you look at the Colorado Department of Public Health and Environment’s chart showing reported deaths among people with COVID-19, it looks like deaths have been declining over the past week or so.
But this is something of a data illusion. On any given day you might look at this chart, it will always appear that deaths have been declining over the previous week. The reason is that death figures are probably the slowest public health data to be reported.
They lag in two ways. The first is the delay between when a person contracts the virus and shows up in the state’s tally of new cases and when a person dies — it can be two weeks or more. So you wouldn’t expect numbers of cases and deaths to rise at the same time.
The second lag occurs in how long it takes for deaths to be documented as COVID-19 deaths before being reported to the state. It’s a complicated process, and it means that the most recent data is incomplete. It will be updated as more deaths are reported, possibly revealing what looks like a decrease to actually be an increase.
“We are really just now starting to see an increase in deaths associated with this fall wave of illness,” said Dr. Rachel Herlihy, the state epidemiologist. “And I think unfortunately we’re going to see many more deaths over the next couple of weeks as that data catches up with our other case data.”
Improvements in survivability may not be sustainable as cases rise
Hospitals didn’t just magically get better at treating coronavirus. Improvements in survivability came through new advances and hard-learned lessons, but also through intensive effort by doctors, nurses, respiratory therapists and others dedicated to keeping patients alive.
And this special sauce gets harder to sustain as the virus rampages through communities and floods hospitals. In other words, it might get harder to keep the fatality rate so low if hospitals get overwhelmed.
Dr. Jean Kutner, the chief medical officer at UCHealth University of Colorado Hospital, said hospitals now have better drugs to treat coronavirus — remdesivir and dexamethasone, in particular. They are better at spotting and treating blood clots that can cause big problems in some COVID-19 cases. They are better at keeping patients’ oxygen levels up without using ventilators.
But these techniques require resources, and they require close staff attention. Most importantly, they require room in the hospital to hold the patients. Kutner said her hospital expects this week to exceed its spring peak for coronavirus patients. Statewide, CDPHE says 82% of intensive-care hospital beds and 79% of acute-care hospital beds are currently being used — by people with coronavirus or other ailments.
“If we don’t have actual physical beds in which to put patients, that is not good for patient care,” Kutner said.
Hospitals also need the staff to treat all these patients. But as cases rise in the community, it takes a toll on staffing. Workers get sick, or they have to go into quarantine because they were exposed to a family member with the virus. Across the state, 17% of hospitals say they are expecting staff shortages over the next week, potentially hindering their ability to care for coronavirus patients and others.
“We are definitely seeing more staff and physicians who are also either getting ill themselves because of community spread or are having to quarantine,” Kutner said.
Hospital staffing shortages have gotten so bad in North Dakota that the governor on Monday announced an order allowing workers who are infected with coronavirus but asymptomatic to continue working in their hospitals’ COVID-19 units.
Officials in Colorado have not talked publicly about taking a similar step here. But the state has created crisis standards of care that guide hospitals in how to triage patients if overwhelmed, a situation that could leave some patients without life-saving care.
Public health restrictions aren’t just about helping people avoid coronavirus
Public health officials hope tighter restrictions will keep people from getting sick with COVID-19. But the reason for trying to suppress transmission of the virus isn’t just to help people avoid coronavirus. It’s also to make sure hospitals have the capacity to treat all the other people they normally see — people suffering from heart attacks, strokes, aneurysms, trauma and other life-threatening conditions.
So, even if new advances keep COVID-19 fatality rates low, a severe uptick in coronavirus cases and hospitalizations could result in more deaths from other causes. This goes along with the idea of thinking about the true toll of the pandemic in terms of “excess deaths” — how many more people die from all causes during the pandemic than you would ordinarily expect to see.
“While there’s this growing sense that (coronavirus) is maybe not as severe, there’s still a lot of implications,” said Dr. Eric France, CDPHE’s chief medical officer. “And as the hospitals fill with COVID patients, it makes it more difficult for our staff to take care of the everyday.”
COVID-19 can still be devastating even when it’s not fatal
As the pandemic has progressed, researchers have begun to learn all the ways that people who recover from COVID-19 haven’t actually returned to normal.
The virus can potentially cause long-term damage to the lungs and heart. The disease may frequently cause neurological injuries. A new study this week found that one in every five COVID-19 patients develop mental illness within a few months after infection, most commonly anxiety, depression or insomnia.
During a press briefing last month, Polis brought in COVID-19 survivors to share their stories. One, Kim Powell, a Denver nurse practitioner, talked of her life before coronavirus — of playing drums and singing in a band, of hiking in the mountains and sprinting up ridgelines. She contracted coronavirus in May.
“Today, anything more than a slow walk to the mailbox requires oxygen,” she said.
This is perhaps the most common argument from state health leaders about why it is important to reduce deaths as much as possible but it can’t be the only goal. Yes, you might survive COVID-19 and be just fine afterward. But why the heck would you want to try?
“This is more than survivability,” said Dr. Jonathan Samet, the dean of the Colorado School of Public Health. “I think we are learning that there are lasting long-term consequences of having severe COVID-19. So I wouldn’t take mortality by any means as a single marker for the impact.”
Every COVID-19 death is awful
Quite often, the coronavirus pandemic is an invisible tragedy. There is no official government list of those who die, for their names are protected by medical privacy laws. Their deaths mostly occur inside locked hospital wings.There are no community candlelight vigils for the lives taken because that would only risk spreading the loss further.
But, in a pale version of a memorial, there is Legacy.com, the large, online aggregator of obituaries, and the ability to conduct a keyword search. Typing in “COVID” or “coronavirus” for Colorado obituaries mostly yields notices specifying that masks must be worn at the funeral or that services have been postponed indefinitely due to the pandemic.
But, every now and then, there is a hint of who coronavirus has taken from us. A longtime city attorney and 60-year season ticket holder to University of Colorado football games. A great-grandmother to 15 who opened her own hair salon in her 30s. A grandmother remembered for singing songs of her own invention at family gatherings. All within the past month.
Kutner, the CU Hospital chief medical officer, said continued visitor restrictions mean that patients still sometimes don’t have their family by their side as they are dying. The last touch they feel is a nurse or a doctor holding their hand.
“We’re seeing people die without being able to be with their families,” she said. “It’s really hard on their families. It’s definitely hard on our staff, too, to witness that.
“We want to avoid that. We want to avoid people getting sick and having to die alone.”