Editor’s note: This story was originally published by The Denver Post and was shared via AP StoryShare.
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By the time he briefed city council on the coronavirus pandemic Tuesday, Boulder County’s public health director had already joined seven others in sounding the alarm over the state of the outbreak in Colorado in a letter to state leaders.
Now, Jeff Zayach had another dire message.
“Across the entire state, not just in Boulder County, we are beyond the ability to control the outbreak of this disease with case investigations and contact tracing,” he told city council members.
A rapid increase in new coronavirus cases is outpacing public health agencies’ ability to locate people with the disease, identify their close contacts and ask them to isolate and quarantine. Colorado has the capacity to trace contacts for between a third and a half of the total number of new cases that need to be investigated, Zayach said.
This means health officials are not only unable to identify how a majority of cases are spreading — information that helps guide what interventions to use to slow transmission — but they are also unable to make sure people who test positive and their contacts are isolating and quarantining properly so that they don’t further transmit the disease.
“We have just mushrooming of cases,” said Margaret Huffman, the director of Jefferson County Public Health. “It’s just blown up.”
Colorado is in its third wave of the coronavirus pandemic and inching closer to hospital capacity, which officials say could be reached in a month, just as cold temperatures and holidays are expected to drive people indoors and together.
And public health officials said one of the tools needed to contain the spread of the virus so that businesses can stay open and more people go out into the community is no longer effective.
“It’s kind of a moot point at this stage,” said Glen Mays, a professor of health policy at the Colorado School of Public Health. “There’s too many new cases to try to staff up.”
'There isn't an army of trained contact tracers'
Local public health officials said that the swift surge in new coronavirus infections — which arrived sooner than expected this fall — led to the state’s contact tracing abilities being eclipsed. But the shortage also reflects the challenges agencies have faced in increasing the workforce to respond to a major public health crisis following at least a decade of budget cuts.
“There isn’t an army of trained contact tracers sitting around waiting to be activated for this kind of response,” said Theresa Anselmo, executive director of the Colorado Association of Local Public Health Officials. “This has been the struggle throughout this entire pandemic. It is happening everywhere at the same time.”
The state’s 53 local public health agencies and two reservations received about $72 million in funding from various sources, including via the federal Coronavirus Aid, Relief, and Economic Security Act, or CARES Act. But the local agencies estimated that they needed three times that amount to handle a surge in infections like Colorado is now experiencing, she said.
Roughly 800 people are doing contact tracing and disease investigations in Colorado. Of those, between 350 and 375 staffers are working with local public health agencies, said a spokeswoman with the state Department of Public Health and Environment.
In the summer, the agency announced that more than 800 AmeriCorps members could come to Colorado to help with contact tracing and case investigations. But those volunteers are not serving all at once and their length of stay varies, according to the spokeswoman.
So far, 660 AmeriCorps volunteers have helped the state and another 140 will arrive in the next six weeks, according to the Department of Public Health and Environment.
“During rapid rises in cases, traditional contact tracing remains an important tool to identify and mitigate outbreaks,” the spokeswoman said in an email. “We are continuing to increase our contact tracing workforce in response to the rapidly spreading virus.”
Rising cases and hospitalizations
For five weeks in a row, Colorado has set records for its numbers of new coronavirus cases. Last week, the Department of Public Health and Environment reported more than 22,300 new cases of COVID-19, the disease caused by the novel coronavirus. (The number has increased since Tuesday after the health department added more cases following a delay in reporting test results).
The percentage of tests coming back positive over the past seven days is 11.51% -- well above the recommended 5% ceiling. The high positivity, along with hospitalizations, means transmission of the disease is increasing and that the rise in new cases is not simply due to more testing.
On Wednesday, 1,169 people were hospitalized with confirmed cases of COVID-19, and 84% of the state’s intensive-care unit beds were in use, according to the agency.
“We have such a high infection rate right now in our community that we need to be around 90% social distancing in order for us to get a handle on this disease,” said Boulder's Zayach during the City Council meeting.
Zayach was one of eight local public health directors who signed a letter sent to the Department of Public Health and Environment on Nov. 5, asking state officials to impose tough restrictions to curb the slow of COVID-19 in the community. State officials are reluctant to implement tighter restrictions, including a statewide lockdown.
The rise in COVID-19 cases has surpassed Boulder County’s contact tracing abilities for almost three weeks now. As of last week, the public health agency had more than 600 cases that it won’t be able to reach for contact tracing and case investigations. Instead, the agency is mailing those people letters with isolation and quarantine guidelines, said Carol Helwig, who leads the epidemiologist team.
“The transmission is so widespread that pinpointing that transmission is not as much as a priority,” she said, adding that it is more important to get people to stay away from others if they test positive or have been exposed.
In Jefferson County, the local public health department is only calling people for case investigations and contact tracing when their test results are three or fewer days old.
“It’s not a decision we want to make,” Huffman, the public health director, said. “We just do not have the capacity to do that.”
