Colorado health experts warn that the surging delta variant requires a behavioral and public health response as federal officials say that the variant is as contagious as chickenpox and that even vaccinated people can still carry significant amounts of the disease.
"It does seem like you need to respond in some way, that we can't just say, 'Oh we’ve got this new variant and it's more transmissible and our vaccines aren’t working as well, we still have lots of people unvaccinated, but we’re not going to try to do anything else,'" said Lisa Miller, an epidemiologist with the Colorado School of Public Health. "That doesn't make a lot of sense."
The country's diminished response to the pandemic and any optimism that it was winding down were dealt repeated bodyblows this week. The delta variant, which now accounts for the vast majority new COVID-19 cases in Colorado, is believed by the Centers for Disease Control and Prevention to cause infections that are more contagious than the flu, chickenpox or Ebola. What's more, a study of a large outbreak in Massachusetts found that vaccinated people there carried as much of the virus as their unvaccinated peers.
The researchers found that the vaccine is still highly effective against the variant, and it provides significant protection against severe disease and hospitalization. Officials in Colorado have said that well over 90% of new cases and new hospitalizations since January have been among unvaccinated residents.
"Even though the vaccine is less effective against this new strain than it was against the previous strain, it’s still effective," Miller said. "It still reduces your risk of getting infected, period. And then even more it reduces your risk of hospitalization and death. I think the worst thing that could come out of this communication is this idea that the vaccine doesn't work. It does. It works. It’s just that the delta variant has thrown a wrench into some of the factors that were making it work even better."
But the troubling new details about the delta variant prompted the CDC to abruptly reverse course and recommend that everyone - vaccinated or otherwise - wear masks in schools, something that the state of Colorado is not requiring and many districts have yet to settle upon. The agency also advised Americans in counties with high degrees of COVID-19 spread to wear masks indoors. That would include most Colorado counties and the vast majority of the state's population.
Much of Colorado has had little to no COVID-19 restrictions on every day life since the spring. The state ceded to the counties much of its authority to institute health measures, and counties - gradually or immediately - unwound the methods used extensively during the first year of the pandemic.
This week, despite the CDC's guidance, none of the counties in the metro area - all of which would qualify for indoor masking - indicated they were planning on instituting any changes. Denver officials said there would be no changes right now, and several other counties said they were reviewing the new guidance and were awaiting the state Department of Public Health and Environment's direction.
Colorado's COVID-19 case totals are still significantly below where they were in previous peaks. But they continue to rise, despite a statewide adult vaccination rate of more than 70%: As of Friday evening, the state averaged roughly 740 new cases each day over the past week, more than double the average from two weeks ago and the highest since May. The seven-day positivity rate topped 5% Friday for the first time since May 12.
Hospitalizations, closely tracked to gauge the severity of disease spread and strain to hospitals, have not jumped, according to state data. There's been a small increase in recent days, but currently, there are only 10 more people hospitalized with confirmed or suspected COVID-19 than 10 days ago.
But that could change, said Glen Mays, also of the public health school, if the minority of unvaccinated Coloradans continue to become infected.
"These are the groups that could eventually contribute to a surge in hospitalizations," he said, specifically noting unvaccinated adults with health problems, like obesity or diabetes.
Cases and hospitalizations may be below what they previously were, Miller said, but the availability of the vaccine means the numbers should be even lower than they were a month ago.
"If we had done a better job vaccinating the rest of the adult population, we’d be lower than that right now," she said. "Yes, it’s lower than it has been, but we could be doing so much better."
Though none of three public health experts who spoke to the Gazette for this story endorsed requiring any specific measures, all said that some mitigation efforts are needed.
"For the moment, the next step is the suite of non-pharmacological interventions," Jon Samet, the dean of the Colorado School of Public Health, said, referring to things like masking, distancing and other behavioral changes. "I suspect that some people may already be altering their behavior to reduce contacts and returning to masks. For places with steeply increasing epidemic curves, returning to masks is very reasonable."
"The enemy is the virus here," Miller said. "I think people’s anger turns toward the government or public health in these situations, but these are just the facts. This virus is mutating, and we have to look at what is happening and what the best thing to do is in the face of these facts, right? (The virus) is in charge, despite what we can do. It’s really making the call here."
Gov. Jared Polis has said repeatedly that the state's role in controlling the pandemic response has ended because there's no threat to hospitals being overrun. Though on Friday he announced that all unvaccinated state employees will need to be tested twice weekly beginning in late September, he has not required inoculations.
But other institutions have: Both UCHealth and Denver Health this week said they'd require their entire workforce to be vaccinated in the coming months. Anyone who hadn't been vaccinated and hadn't received an exemption would face termination.
Colorado College announced in June that students and staff must be fully vaccinated when classes resume Aug. 30, and it could update its policies based on public health guidance. The college has not yet made any changes, spokeswoman Jennifer Kulier said.
“The (college’s leadership) team takes several factors into consideration, including the vaccination rate of the campus community, which is currently much higher than that in the broader El Paso County community,” Kulier said.
But El Paso County Commission Chairman Stan VanderWerf said Friday the decision to vaccinate is a personal one that shouldn’t be mandated by government agencies.
“It’s a difficult place for a public agency to get into because there are potential privacy violations,” he said. “Getting or not getting a vaccine should be a personal choice. People know best how to take care of themselves.”
Mays said there were three groups he was particularly concerned about: unvaccinated adults; older adults in long-term care facilities, even those who've been vaccinated; and schoolchildren.
"Without universal masking we are likely to see significant transmission in school settings this fall," he said. "Given the increased testing in schools, this means that even asymptomatic and mild cases will be detected, resulting in many disruptions to education as kids undergo rounds of isolation and quarantine."
While children will largely be shielded from the worst effects of the virus, the "educational disruptions" of spread will be "very detrimental," Mays said.
" ... (T)his will spill over into the workplace for parents who have to stay home with kids again," he said. "I think schools will need to seriously consider masking requirements, and eventually vaccination requirements, to avert these disruptions."
Many districts statewide have yet to make a decision on whether they'll require masking. Denver Public Schools officials said this week that they will likely announce what measure they'll take on Monday. Jefferson County Public Schools told families Friday afternoon that it would require masks for younger students who weren't eligible to be vaccinated but that it would only encourage all other students and staff to cover their faces.
If, Mays said, COVID-19 spreads within schools and hospitalizations surge among infected, unvaccinated adults, then "policymakers and the private sector will need to consider stronger measures such as masking requirements and vaccine requirements."
The Associated Press Contributed to this report.
Clarification: A previous version of this story said that the state had a 70% vaccination rate. The state has a 70% vaccination rate for adults over the age of 18.