Facing the possibility that the current COVID-19 surge could breach Colorado’s hospital capacity, the public health agency for Adams and Arapahoe counties Monday issued a new indoor mask mandate through at least the end of the year.
With rates of new coronavirus cases reaching levels not seen since last December — and daily deaths among those with COVID-19 recently hitting numbers higher than they did during the first wave in spring 2020 — coronavirus hospitalizations in Colorado may soon overtake last December’s peak. That mark was 1,847 confirmed COVID patients on Dec. 1, 2020.
The Colorado School of Public Health has estimated a 48% chance that hospital demand exceeds 2,000 beds in the next several weeks if coronavirus trends remain on their current trajectory, John Douglas, executive director of Tri-County Health Department, cited during Monday's meeting.
Hospital bed capacity in Colorado is now at an “all-time low” compared to other times during the pandemic, Douglas’ presentation said. That’s partly due to patients hospitalized for conditions other than COVID-19, although COVID-specific hospitalizations themselves have been on the rise for months.
Hospital demand was the driving force behind the action by the board of Tri-County Health — which serves Adams and Arapahoe counties and provides certain services in Douglas County — to approve the new mask mandate on Monday.
It applies to all people 2 and older in all public indoor spaces in Adams and Arapahoe with certain exceptions. It will take effect Wednesday.
Douglas, the health chief, mentioned recent requests to the state public-health department to institute a mask mandate — pleas that have gone unfulfilled.
“We felt that if the state was unwilling to act, metro-wide action” could help alleviate the hospital crisis, Douglas said during the meeting.
Also today, the Jeffco Public Health board voted 4-1 to institute a mask mandate for people 3 and older.
Denver is also considering implementing a mask mandate, according to Douglas. Broomfield had discussed it in recent days but had not decided yet, according to Douglas. Boulder and Larimer counties already issued mask mandates in recent months.
Tri-County's order will not apply in Douglas County, where the county's new health department — created amid county leaders' unhappiness over Tri-County Health's COVID-safety rules — has authority over countywide public health orders.
‘Tyranny and power’
During the public comment portion of the Tri-County Health board’s meeting Monday, Gregg McGough, of Arapahoe County, said Tri-County’s actions had been ineffective at controlling the virus.
“Your efforts have sacrificed the economy (and) destroyed education,” said McGough, one of roughly a dozen who spoke against the mandate at the meeting. He added: “Let us get back to the pursuit of life, liberty and the pursuit of happiness.”
Douglas dismissed the idea that Tri-County took the step of a new mask mandate “because we enjoy exercising tyranny and power.”
“We didn’t undertake this to win a popularity contest,” Douglas said. He added: “We undertook this because our reading of the situation is that there are substantial downsides that are going to (occur) if we breach hospital capacity and have to ration care.”
“Rationing care” is a term that means deciding which patients do — and don’t — receive certain types of care in situations where hospitals are stretched too thin.
Douglas touched on the question of why Colorado saw such high COVID surges last year despite the state’s now-defunct mask mandate being in effect at the time.
“The answer is masks are not perfect,” Douglas said, calling masks one part of a larger set of strategies to fight the virus. “Frankly, things (in terms of virus spread) didn’t completely shut down when we locked down last spring.”
He noted the “counterfactual,” or what would have happened if Coloradans didn’t have a mandate.
Evidence “suggests that in at least a short period of time, … masking does appear not to be perfect but to help make a difference,” Douglas said.
Melissa Rawsky, of Adams County, said during the public comment period: “I have no question in my mind that if we didn’t have a mask mandate last year, the cases (in the holiday season) would have been much worse.”
Board of health members Julie Mullica, Rosanna Reyes, Julie Schilz, Jan Brainard and Kaia Gallagher voted “yes” in favor of Tri-County issuing the mask mandate, and Thomas Fawell, an Arapahoe County representative, voted “no.”
Tied to hospital capacity
The public health order will remain in effect through Jan. 2 — and further after that until staffed intensive-care unit bed capacity reaches 10% or greater for 14 consecutive days.
The 10% ICU capacity mark was to be considered at a regional level because “no county is an island in terms of its hospitals,” Douglas said.
Currently, staffed ICU bed availability in the North Central Region that covers Adams and Arapahoe counties is 5.8%, according to a news release from Tri-County Health.
Hospital capacity remains extremely tight, with ICU bed utilization at 93% in Adams County and 100% in Arapahoe County, according to the health agency’s release.
As of Monday, Adams County’s seven-day rate of new infections is 346 per 100,000 people, and thus far in November there have been 232 persons hospitalized with COVID-19 and 40 deaths, according to the release. In Arapahoe County, the current case rate is 303 per 100,000 people, with 202 hospitalizations and 24 deaths thus far in November, the release said.
Statewide, Colorado has a growing crisis in hospital capacity — there are more than 1,500 individuals currently hospitalized with COVID-19, and hospitals are at about 95% capacity including non-COVID-19 patients, according to the release. Of the COVID-19 hospitalizations, 82% are unvaccinated, according to the release.
Business exemption with vaccine
The order is expected to allow owners, operators or managers of public indoor spaces who have implemented vaccination requirements for all individuals entering their space — such as employees, visitors and customers — to request an exception to mask wearing requirements for people in their indoor spaces.
Businesses can choose, but are not required, to implement a vaccine requirement.
Such a policy must require proof of vaccination and result in 95% or more of people in the space being vaccinated, according to the Monday meeting presentation.
Eligible spaces would include one-time events such as weddings or trade shows, a gym or other class held at a certain time of day, a single building or a single organization operating across multiple buildings, or a bar, restaurant or office.
On Nov. 14, the Colorado Department of Public Health and Environment ordered that anyone who attends certain public, indoor events with 500 or more people in Arapahoe, Adams, Denver and three other metro-Denver counties be vaccinated against COVID-19.
Recommendations come up short, Douglas says
Brainard, one of the Tri-County Health board members, harked back to when public health measures in Colorado were much more severe.
“We’re not closing bars, we’re not closing restaurants, we’re not closing schools. We’re trying to keep them open,” Brainard said.
The “level red” restrictions that took effect in November last year in metro Denver and other areas of the state banned private gatherings and indoor dining at restaurants, and it tightened capacity limits at some types of businesses. The state's now-defunct, color-coded COVID-19 dial was the set of restrictions counties had to follow based on local virus spread. Those “red” restrictions arrived amid last year’s steep fall COVID surge.
At a meeting of Arapahoe County’s elected commissioners [this year on Nov. 22, Commissioner Nancy Sharpe expressed frustration with having followed public health guidelines yet still being told to follow a new mandate, saying she received the COVID booster dose and the first two shots.
“I’ve done everything I’m supposed to do,” Sharpe said.
Douglas sympathized with her frustration, recalling the federal Centers for Disease Control and Prevention’s old guidance that masks are not necessary for those who are vaccinated.
But then, he said, Americans encountered the delta variant, which is more contagious than prior versions of the virus that causes COVID-19. The “exponential transmission capacity” means the delta variant is more difficult to fight against, Douglas added.
At the Arapahoe County commissioners’ meeting, Douglas was asked why health officials wouldn’t issue a “strong recommendation” or an advisory rather than a mandate.
But metro Denver health officials did urge residents to wear masks in public indoor spaces in a Nov. 5 announcement that was called a statewide “public health advisory.”
“We’ve been issuing quote ‘strong recommendations’ since the end of July when the CDC first came out and said if you’re more than (a certain rate of new cases, an area should mask indoors),” Douglas said. “Not much changed. We did put out exactly what you said, a public health advisory (on Nov. 5). And the mask wearing didn’t change at all. And the case rate didn’t stop going up at all.”