POST 211. November 4, 2021. CORONAVIRUS. Colorado – “…there are patients who really ought to be in an intensive care unit but instead they’re in an emergency room. Or they ought to be in a step-down unit but instead they’re on the floor. Or they ought to be getting one-to-one nursing, and instead they’re getting two-to-one, or three-to-one nursing….”
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“The trend in Colorado can be attributed in part to the almost 40% of the state population that has not been vaccinated and people again gathering indoors without masks. It also shows that, despite the national downward trends of infections, regional spikes can still happen that can cause havoc in state healthcare systems.” (A)
BREAKING NEWS: CDC RECOMMENDS PFIZER’S COVID VACCINE FOR CHILDREN AGES 6 VACCINE FOR CHILDREN AGES 5 THROUGH 11
Pfizer-BioNTech’s COVID-19 vaccine for young children is a lower-dose formulation of the companies’ adult vaccine. It was found to be safe and nearly 91% effective at preventing COVID-19.
The Centers for Disease Control and Prevention is recommending that all children ages 5 through 11 get a low-dose COVID-19 vaccine made by Pfizer-BioNTech…
Walensky’s decision means that approximately 28 million children ages 5 through 11 will be eligible for the shots. “ (B)
“Colorado continues to stand out as one of the only U.S. states with climbing COVID case rates.
Average new COVID case rates were only four cases a day different on Nov. 1, 2020, than they were the same day this year.
This is true for both U.S. and Colorado rates.
In Colorado, the new case rate on Nov. 1, 2020 was 39 cases a day. This year, it was 43 new cases.
In the U.S., the new case rate last Nov. 1 was 25 per day. On the same day this year, the rate was 21 per day.
The trends from last year to this year, however, are entirely different.
This year, Colorado’s new case rates are going up as the national rate is falling.
As recently as Sept. 1, the U.S. rate was 60% higher than Colorado’s. The national rate, though, dropped by 30 cases per day by Nov. 1.” (C)
“Colorado’s governor said hospitals can turn away new admissions as they deal with a surge of coronavirus cases that has strained the state’s hospitals.
Gov. Jared Polis (D) signed an executive order over the weekend authorizing the state’s public health department to determine whether hospitals or emergency departments are at or will soon hit capacity. The department can order such facilities to halt admissions and redirect or transfer patients, according to the order that will be in effect for 30 days starting Sunday.
The move highlights the continued trouble faced by parts of the country, even as numbers at the national level suggest that the delta-variant-driven surge that swamped emergency rooms this summer and fall has started to ebb. Officials say the state’s staffing shortages are also contributing to the burden felt by rising cases — and one bioethicist said the upward trend is particularly troubling without actions that can help bring numbers back down…
Right now there are “two Colorados,” said Matthew Wynia, director of the Center for Bioethics and Humanities at the University of Colorado Anschutz Medical Campus.
“If you’re in the health-care system — if you’re a patient needing services in a hospital or if you’re a medical practitioner, things are really bad,” he said. “But if you’re a regular citizen just walking around on the street, you wouldn’t know it. People are behaving as though things are normal.”
The governor said at a briefing last week that he was recently asked whether the pandemic is “over.”
“When we have 1,100 people in the hospital, the answer is no, it’s not,” he said.
In a separate Sunday order, the governor said: “Despite significant progress, there has been an increase in COVID-19 cases, largely due to the highly contagious Delta variant and the 20% of Coloradans who have yet to get the highly effective, safe vaccine.”
He said the state’s “severe staffing shortage,” combined with the case surge, has forced officials to “undertake targeted efforts to respond and mitigate the effects of the pandemic, prevent further spread, preserve our health care resources, and provide needed flexibility to address the collateral consequences of the pandemic.”
“Seeing the stress on hospital systems, certainly the staffing crisis standard of care is likely to be activated, and the hospital standard of care, where we look at principles by which hospitals can make decisions on triaging patients and using scarce resources, is another one that we’ll consider,” said Eric France, chief medical officer of the Colorado Department of Public Health and Environment, during Thursday’s briefing.” (D)
“Colorado’s new COVID case rates are going up as the national rate is falling. Dr. Richard Zane at UCHealth said Monday that healthcare is at its breaking point.
“If you have a heart attack, get in an accident, have a stroke, it’s likely that you are going to have delayed care, and delayed access to care because of the huge number of COVID patients that are hospitalized now. We simply don’t have room for regular care,” Zane said…
UCHealth facilities have been at capacity for weeks. Hospitals are already using atypical spaces, and for the last eight weeks, they have drastically limited scheduled surgeries.
“It’s not an easy thing to tell someone that we are going to postpone their cancer surgery, or postpone their hip replacement,” Zane said.” (E)
“Colorado now has the fifth-highest coronavirus case rate in the country, according to federal data. An estimated 1 in 51 Coloradans are currently contagious with COVID-19 as people hospitalized with the disease has surpassed 1,200 — the highest level since December 2020. About 80% of people hospitalized in the state with COVID-19 are unvaccinated.
There are fewer than 150 intensive care beds available statewide, and a 16-county region in southwest Colorado on Tuesday reported 0% available ICU capacity, though that percentage can change quickly in the region’s small hospitals.
In response to the alarming trends — more than 2,600 new coronavirus infections are now being reported per day in Colorado, a roughly 600% increase from case rates in July — Polis over the weekend issued executive orders giving the state greater authority to direct transfers of patients between hospitals and also laying the legal groundwork for hospitals to ration care if they become overwhelmed.
The state has also asked for federal emergency medical teams to come to Colorado to help with staffing shortages in the state’s hospitals. The Colorado Department of Public Health and Environment on Sunday ordered hospitals to suspend cosmetic surgeries in order to free up staff and bed space; some hospitals have already gone further, delaying needed but non-emergency procedures.
Asked Tuesday if he intended to issue more proactive orders to slow the spread of the virus, Polis balked. He said a statewide mask order isn’t a substitute for vaccination. He said it’s time for the unvaccinated to “quit procrastinating.”
Nearly 80% of people eligible for vaccination in Colorado have received at least one dose of vaccine. No one under the age of 40 who has been fully vaccinated has died of COVID-19 in Colorado, Polis said, and death rates are dramatically lower for vaccinated people in older age groups.
“The 20% that haven’t yet chosen to get protected are putting themselves at risk — which you can certainly argue is their own business, and I have no qualm if they have a death wish — but they are clogging our hospitals,” Polis said…
Dr. Rachel Herlihy said modeling estimates predict hospitalizations will peak later this month or early next month and are not expected to exceed the state’s capacity on the current trajectory. But, if virus transmission increases further, the state could see its hospital capacity breached.
“As you can see with the projections, it’s going to be tight,” Polis said. “It is tight, and it’s going to be tight for the next several weeks.”
Colorado governor says onus is on unvaccinated with “death wish” as coronavirus situation continues to worsen, by John Ingold and Jesse Paul, Colorado governor says onus is on unvaccinated with “death wish” as coronavirus situation continues to worsen
One out of every 51 Coloradans is estimated to be currently contagious with COVID-19.” (F)
“Last week, Polis said the state would take action in the coming days if trends didn’t improve. He laid out five possible options for dealing with the shortage of hospital beds: expanding access to a COVID-19 treatment to reduce the odds of hospitalization; taking control of the transfer process in order to use all available beds; calling on the Federal Emergency Management Agency for staffing help; stopping all elective procedures; and implementing crisis standards of care, which could involve care rationing or less-than-ideal staffing patterns in hospitals….
On Thursday, the state announced it would expand treatment starting this week. Sunday’s public health orders by Polis take control of the hospital transfer process, and partially limit elective surgeries. So far, the state hasn’t activated any crisis standards of care in this wave, though one of the weekend orders amending the governor’s disaster declaration would pave the way for it to do so.
The order on cosmetic procedures took effect Monday and expires Dec. 1. It applies to hospitals and to outpatient surgery centers, but only covers a fraction of all elective procedures. Any surgery that can be scheduled — ranging from knee replacements to removing tumors — is considered elective. Polis had floated the possibility of delaying all non-emergency procedures, as the state did last year, at a news conference last week.
There is an exception for cosmetic surgeries that have to happen in the next six months to prevent a person from dying or losing significant physical functioning. That would seem to leave the door open for certain reconstructive surgeries, which may have a cosmetic component, but also are intended to repair an injury.
The state didn’t release an estimate of how many beds might be freed up by halting cosmetic procedures. Some hospitals have been triaging surgeries for weeks, delaying those where the patient is less likely to suffer permanent harm.
A separate order, also released Sunday, gave the state more power to direct hospital transfers by forbidding hospitals to refuse to accept a patient they have the capacity to treat, or to refuse to send the patient to a different facility. Patients could also be transferred against their will if their preferred hospital is full. Polis had said last week that hospitals were trying to keep patients within their own system but didn’t specify how often that had happened.
Another order required counties to consult with the Colorado Department of Public Health and Environment about additional restrictions if at least 85% of their hospital beds are full in the next month, but didn’t specify what those restrictions might be, or if the state would choose to enforce them.
It also required almost everyone 12 and older to wear masks in long-term care homes, medical facilities and correctional buildings. Previously, only unvaccinated people were required to mask up in those settings.
A fourth public health order issued Sunday required vaccine providers to give second shots to anyone who is eligible, even if they didn’t give the first shot, and to give boosters to anyone who says they qualify. That order didn’t have a sunset date.” (G)
“The reasons behind Colorado’s surging COVID-19 cases remain somewhat of a mystery, according to some health officials.
Dr. Lisa Miller is a professor of epidemiology at the Colorado School of Public Health. She says nearly two years into the pandemic, there is a lot scientists are still trying to understand about COVID-19 and how the virus behaves.
“It isn’t really clear why these curves look exactly the way they do, how long the virus stays, when it leaves and why. I don’t think we know all those answers. I don’t think we have a good explanation,” Miller said.
Gov. Jared Polis said Tuesday that Colorado has become the fifth highest state in the country for COVID-19 rates. Miller said some health officials have used Colorado’s cooler weather as a possible explanation.
“I don’t really buy that, because there’s plenty of northern states that didn’t see what we saw and what we continue to see,” Miller said.
More than 78% of eligible Coloradans have received at least one dose of the COVID-19 vaccine — a rate that’s higher than many other states. Miller said looking at the state vaccination rate alone is deceiving and explains that disparities between counties may have something to do with the rising case numbers.
A dozen counties in Colorado have a vaccination rate of 80% or above, while 13 counties are sitting at 50% or less.
A team of experts at the Colorado School of Public Health regularly issue modeling data based on COVID-19 trends, like how many people are still susceptible and current transmission rates. Miller said even with solid data, they can’t predict how human behavior will shape the course of the pandemic.
“I do know that if we get to a certain point there may be no choice but to implement other measures that will prevent more cases,” Miller said.” (H)
““It’s not a choice whether to make these kinds of decisions,” said Wynia, who was on the team that helped craft Colorado’s Crisis Standards of Care during the pandemic.
The document details how decisions need to be made when healthcare institutions become overwhelmed.
Wynia said hospitals are being forced to use crisis care strategies right now.
“I think that it’s correct that no one is saying right now there’s a patient who needs a ventilator and can’t get one,” he said. “That’s not happening. What is already happening is that there are patients who really ought to be in an intensive care unit but instead they’re in an emergency room. Or they ought to be in a step-down unit but instead they’re on the floor. Or they ought to be getting one-to-one nursing, and instead they’re getting two-to-one, or three-to-one nursing because we just don’t have enough people to take care of all the folks who need care right now.”
The biggest ethical issue Colorado faces, according to Wynia, is choosing where to transfer patients and move staff, since hospitals in areas with a less vaccinated population are more overwhelmed than hospitals in areas with a higher percentage of people vaccinated against COVID-19.
“And that’s uncomfortable for the ones that have capacity still, because, you know, you don’t want to get to full capacity, but when we’ve got areas of the state, it is our responsibility to balance the load across the whole state,” Wynia said.
He said load balancing was the reason for the executive orders on Sunday.
Ultimately, Wynia said, people need to remember the actions we took last year to help ease the burden of healthcare workers.
“And we’re doing everything we can,” he said. “But we need the public to do their part as well, which means start doing the stuff that you were doing last winter when people were scared of catching this illness. I fear that people think that things are OK and they’re not OK right now. We’re not OK.”” (I)
Colorado Crisis Standards of Care https://cdphe.colorado.gov/colorado-crisis-standards-care
““The trend in Colorado can be attributed in part to the almost 40% of the state population that has not been vaccinated and people again gathering indoors without masks. It also shows that, despite the national downward trends of infections, regional spikes can still happen that can cause havoc in state healthcare systems.
“We clearly have events taking place in Colorado, as elsewhere, that are spreading infection,” said Dr Jon Samet, an epidemiologist who directs Covid-19 modeling for the state. “I know everyone would like for it to be 2019 all over again, but that’s not the case.”
The state had also not had surges on the scale of other states, said Dr Michelle Barron, senior medical director of infection prevention and control for UCHealth.
Other states “had flames from the get-go, whereas we have been smoldering along this whole time, and we are finally hitting that peak of saturation and seeing flames finally,” said Barron.
Thirty per cent of Colorado hospitals are anticipating a shortage in the number of intensive care unit beds and 37% are anticipating staffing shortages within the next week, according to data from the Colorado department of public health and environment.
“Staffing is becoming increasingly a problem, which is true everywhere throughout the country. We are seeing healthcare workers really burned out from everything the last two years,” said Mehta. “It just raises concerns that we are pushing the limits of how many patients we can take care of. We are still taking great care of everybody” at Denver Health, “but we are filling up fast.” (A)
- A.Surge in Colorado Covid cases could force hospitals to ration services, by Eric Berger, https://www.theguardian.com/us-news/2021/nov/04/colorado-covid-cases-surge
- B.CDC recommends Pfizer’s COVID vaccine for children ages 5 through 11, by JOE NEEL, https://kdvr.com/news/data/colorado-covid-rates-climbing-while-national-rates-fall/
- C.Colorado COVID rates climbing while national rates fall, by DJ Summers, https://kdvr.com/news/data/colorado-covid-rates-climbing-while-national-rates-fall/
- D.Colorado hospitals can turn away patients as state grapples with covid-19 surge, By Paulina Firozi, https://www.washingtonpost.com/health/2021/11/02/colorado-polis-hospital-turn-away-patients/
- E.COVID-packed hospitals delaying cancer surgeries, emergency care, by Kim Posey, Rachel Skytta, https://kdvr.com/news/coronavirus/covid-packed-hospitals-delaying-cancer-surgeries-emergency-care/
- F.Colorado governor says onus is on unvaccinated with “death wish” as coronavirus situation continues to worsen, by John Ingold, https://coloradosun.com/2021/11/02/coronavirus-unvaccinated-hospital-capacity-polis/
- G.Polis orders halt to most cosmetic procedures in Colorado as COVID strains hospitals, By MEG WINGERTER, https://www.denverpost.com/2021/11/01/polis-orders-halt-cosmetic-surgery-covid-hospitals/
- H.What’s driving up COVID numbers in Colorado?, by Rachel Skytta, https://kdvr.com/news/coronavirus/colorado-coronavirus-covid-rates-high/
- I.Colorado bioethicist calls hospital situation ‘dire’, by Katie Eastman, https://www.9news.com/article/news/health/coronavirus/colorado-bioethicist-hospital-situation/73-f522dd03-adc7-401f-a26d-12ab71c6629d