Late last week, a group of some of the state’s foremost experts on how to respond to the coronavirus pandemic settled in behind their computer screens for another virtual meeting.
The Governor’s Expert Emergency Epidemic Response Committee, known by the acronym GEEERC, is made up of people from the worlds of medicine, public health, government and emergency management. Its task during a pandemic, dictated by a state law dating back to 2000, is to “convene as rapidly and as often as necessary to advise the governor … regarding reasonable and appropriate measures to reduce or prevent spread of the disease.”
But this was the GEEERC’s first meeting in a month, and the agenda was rather sparse — a presentation on the latest epidemiological data, an update on vaccine distribution, some standard training. At a time when Gov. Jared Polis is loosening restrictions across the state, changing the state’s COVID-19 “dial” framework, working rapidly to get vaccines into arms and closely monitoring the spread of potentially worrisome new coronavirus variants, there were no major items for the committee to vote or provide counsel on.
And, to some observers, that’s troubling.
“I just don’t understand it,” state Sen. Barbara Kirkmeyer, a Republican from Weld County, said in an interview. “It’s there. It’s not that difficult to do. These people are experts. This is what they live to do.”
When Kirkmeyer served in former Gov. Bill Owens’ administration, she used to sit on the GEEERC. (The acronym’s pronunciation rhymes with “perk.”) Now a state lawmaker, Kirkmeyer last month peppered Colorado Department of Public Health and Environment executive director Jill Hunsaker Ryan with questions during a legislative hearing about why the GEEERC was not meeting more frequently or giving guidance on higher-profile issues.
Polis has made himself a singular face of the state response to the pandemic in Colorado, typically hosting live-streamed press briefings twice a week and using his Twitter account to announce major changes in policy. But often less clear is how Polis arrives at his decisions.
Kirkmeyer linked Polis’ approach with the GEEERC to the state’s communication failures with local public health agencies, which have left local officials scrambling to adjust to announcements they didn’t know were coming.
“It appears that we’re kind of winging it,” Kirkmeyer said to Ryan, who is the chair of the GEEERC.
But Ryan said the 20-member committee isn’t set up to respond as rapidly as needed during the fast-changing pandemic.
The state legislature created the GEEERC in 2000, with the goal of helping the state prepare for epidemics and acts of bioterrorism. In pre-COVID times, it met only four times per year to review plans and get updates on comparatively smaller health crises, like a Hepatitis A outbreak. Those on the committee who don’t work for the state are volunteers. They have day jobs — often ones that now keep them plenty busy battling the coronavirus as doctors, epidemiologists and emergency managers.
“It’s not geared for really quick rapid decision-making or advisement to the governor,” Ryan responded to Kirkmeyer.
“It’s just the nature of how quickly the response moves,” she added. “… It’s not good for decision-making in a 100-year pandemic.”
Sidelined on big decisions
When the pandemic began, it appeared that the GEEERC would be a prominent voice shaping the state’s response.
“I want to thank all of you for serving on the GEEERC during the period of this emergency,” Polis said at the group’s first meeting during the pandemic, back in March. “You are really playing a critical role.”
Within hours after the GEEERC made a recommendation during the meeting that Polis order bars and restaurants closed to in-person dining, the governor did exactly that. Since then, though, the GEEERC has often seemed to have been left out of big decisions made by Polis, or at least left a step behind.
On the day in July when Polis issued a statewide mask mandate, the GEEERC coincidentally held a meeting, during which members discussed writing a letter to Polis recommending a mask order. The debate went back and forth until one member said they understood Polis to have already made a decision to issue the order.
“I’ll say that’s a not-public decision yet,” Ryan responded. Polis announced the order about an hour later.
The committee — and, specifically, a subcommittee of the GEEERC made up of doctors and other medical experts called the GMAG, for GEEERC Medical Advisory Group — did play an important role in crafting the state’s initial prioritization plan for who should be vaccinated first. But it was not consulted on subsequent changes to that plan.
Some of the changes to the vaccine plan came following new federal guidance. But others — such as the decision to remove people who are incarcerated from the priority list — stripped out parts of the ethical framework the GEEERC recommended.
“I would be remiss,” Dr. Stephen Cantrill, a Denver Health emergency medicine specialist who leads the GMAG, said during a GEEERC meeting the day after Polis unveiled the revised plan, “if i didn’t mention that many of the members of the GMAG are somewhat frustrated and dispirited by this in terms of the process and the fact that they really were not involved in the decision-making at a high level.”
Cantrill did not respond to an interview request made following that meeting.
During a training session in the meeting last week, GEEERC members were told they should not reply to interview requests and should instead refer them to CDPHE.
“The department will handle all of that for you,” Alexandra Haas, the CDPHE official leading the training, said.
“There is no transparency here”
To Kirkmeyer, Polis’ decision not to rely more on the GEEERC isn’t just about where the governor receives pandemic advice. It’s also about transparency.
GEEERC meetings are public. Some even allow for public comment. By seeing the debate that goes into the governor’s orders, Kirkmeyer said Coloradans can have a better understanding of them — maybe even more trust in them.
“This is exactly why you have a GEEERC, so you don’t look at this from political pressure or the political side of things,” she said.
As is, Kirkmeyer said Polis issues an order — such as loosening restrictions to allow restaurants to operate at greater capacity or moving workers in a certain industry up in vaccine priority — and people have no way of knowing whom the governor spoke to when making that decision.
“We don’t know because there is no transparency here,” she said.
In a statement, Polis spokesman Conor Cahill said the governor meets “daily and/or weekly” with state health officials, including Ryan, CDPHE Chief Medical Officer Dr. Eric France, state epidemiologist Dr. Rachel Herlihy, and COVID-19 incident commander Scott Bookman. Polis also meets weekly with Dr. Jonathan Samet, the dean of the Colorado School of Public Health, whom Polis has often referred to as “Colorado’s Dr. Fauci.” Samet leads a team of researchers creating modeling predictions for the course of the pandemic in the state.
Cahill said the GEEERC “is not structured, nor is it the right forum, for day-to-day operational decisions of the pandemic.”
And it is ultimately just an advisory committee, said Dr. Mark Johnson, the incoming president of the Colorado Medical Society. Polis is not obligated to do what the GEEERC says.
Up until a few weeks ago, Johnson had been a member of the GEEERC, serving in a seat designated for a local public health official as the then-executive director of Jefferson County Public Health. Now retired from that job, Johnson may soon become a GEEERC member again, when he officially steps into the president’s role with the medical society.
But during his hiatus, Johnson isn’t critical of how Polis has used the committee.
The GEEERC has never faced a pandemic of this magnitude, meaning its own members are learning how they can best be of service as they go, Johnson said. A Colorado governor has not faced a decision about where to get advice on a pandemic of this magnitude in over a century. On top of that, Polis was relatively new in the job when coronavirus struck, as were Ryan and France.
“I think it took him awhile to figure out whose advice he should listen to,” Johnson said of Polis.
And Johnson said there is a balance needed during the COVID-19 pandemic between public health and economic wellbeing. In previous pandemics — such as the H1N1 pandemic of 2009 — economic concerns weren’t as prominent, meaning leaders could focus more on public health issues.
“I think the governor does listen to public health experts, I do think so,” Johnson said. “But I think he is more comfortable in the business world and in talking to his business colleagues and has, to some degree, leaned more toward the economic impact of this than perhaps he has at times the public health impact.”
Policies for the present – and future
Though not involved in many of the management decisions of the pandemic, the GEEERC has been productive as a kind of sage for ethical decision-making.
The committee has produced nine substantial policy documents covering how to use scarce resources and how to choose who receives them — looking at everything from hospital beds, vaccines and medicines to EMS, behavioral health and palliative care. For some of the issues, such as establishing so-called crisis standards of care for when hospitals are overwhelmed, the GEEERC has helped lead the national discussion.
Ryan said France, the CDPHE chief medical officer, one time half-joked to her that members of the GEEERC and its subcommittees were putting in so much time on the policies that they should be paid.
“The GMAG group has been so valuable to us at the department and your work will live on past the pandemic,” Ryan said during last week’s GEEERC meeting. “A lot of this has had to be created from scratch because this is such a novel pandemic. … I know I just really appreciate you all.”
But Ryan’s comments also signaled a bit of an endpoint. With new coronavirus case counts and hospitalizations falling and vaccination rates rising, France said he would be deactivating some of the crisis plans the GEEERC helped draft. And he said he was standing down the GMAG, at least for the time being.
As for the full GEEERC, France and Ryan said there is no longer a need for it to meet monthly. Its next meeting is now planned for May.
“If we need to call you back,” Ryan said, “we certainly would.”
And, with that, she adjourned the meeting — 40 minutes ahead of schedule.