Just as Pitkin County has a much-touted “Roadmap to Reopening” that has guided local decisions and timetables for a phased economic reopening in the wake of shutterings ushered by the COVID-19 outbreak, public health and medical officials are also working on a “Trigger Map to Reclosing.”
That’s according to Pitkin County Public Health Director Karen Koenemann, who during Thursday’s Board of Health meeting warned that with the uptick in cases in the area and increased positivity rate among locally performed tests, officials are bracing for the possibility of having to take steps to slow or even move backwards from the current reopening plan.
“We’ve really been focused on containment strategies, but if those containment strategies aren’t effective … it will get us back to a tightening up in our community and will increase mitigation in our community,” she said.
But, she continued, the first approach to any reclosing will be as limited as possible — Koenemann described it as “very targeted, very scalpel-like.”
That is to say, any immediate closures would likely be limited in nature, perhaps to a single business or sector. Should the disease caused by the novel coronavirus spread beyond that immediately manageable scope, however, it is possible that county officials would feel it necessary to consider more dramatic measures.
“We can also look at a more generalized approach,” Koenemann said. “If we’re really having trouble managing the uptick in data, then we can have a more inclusive approach, where we would be looking at going back to some of the major changes we had in the public health order where we’re looking at sectors.”
The document is currently in draft form, but Koenemann anticipates bringing a finalized recommendation of a reclosing contingency plan — and it would be a contingency plan, she emphasized — to the next health board meeting, July 23, for consideration.
And if the data becomes too concerning before then, it’s possible an emergency meeting would be called in order for the health board to vote on reclosing measures.
“That's just where we are right now as a community,” Koenemann said.
Charlie Spickert, an epidemiologist contracted with Pitkin County who’s spearheaded much of that work since the COVID-19 outbreak in March, said that public health and medical professionals are eyeing three sets of data benchmarks before considering any sort of reclosing measures: the number of actual new cases, hospital thresholds and contact tracing capacity.
While Pitkin County Deputy Manager Phylis Mattice told the county commissioners on Tuesday that the Fourth of July weekend had largely gone “better than expected” in terms of general public compliance with the current public health order — which on Thursday was extended an additional 30 days to align with state directives, with some added language explicitly outlining enforceable mandates for cooperation with isolation and quarantine endeavors — epidemiologists are expecting further case increases in the coming weeks in the aftermath of the holiday.
There is a two- to four-week lag between a spike in social interaction, whether due to a relaxed policy change or large gatherings from such occasions as a holiday or protest, and corresponding available case data. Additionally, there is another 10- to 14-day lag between that case data and hospitalizations.
To that point, Spickert noted that one of the four available intensive care beds at Aspen Valley Hospital is currently occupied by a COVID-19 patient. And last weekend, another hospitalized patient was transferred to Denver for a higher level of care at a lower elevation — which is AVH protocol for anyone requiring ventilation for more than 24 hours.
Recently hired epidemiologist Josh Vance also broke down some of the data regarding causes of exposure among infected Pitkin County residents. Of most concern, perhaps, is the No. 1 culprit: community spread, which accounted for roughly 30% of cases, he said. Community spread is a vague category essentially noting that a patient and contact tracers aren’t able to identify a singular point of exposure.
Tied for second and third place, so to speak, were travel and workplace exposure, he continued, with 24% of cases attributed to each.
New research suggests that wearing masks is more important in prevention efforts than even earlier suspected by public health officials, Vance continued. Though there has been previous debate as to whether or not the disease is airborne, there is now general consensus among the global scientific community that the answer to that question is affirmative.
“What we’ve known about respiratory viruses for awhile is they spread via droplet. When someone coughs or sneezes, it travels six or eight feet, then it drops to the ground,” he said. “With it being airborne, it can linger in the air for minutes or hours.”
In addition to further public service communications about the importance of cooperating with contact tracing investigations and new emphasis on isolation and quarantine practices in the coming weeks, health board members again revisited ideas about “carrot and stick” measures to incentivize and enforce wearing masks.
The current public health order in Pitkin County mandates that masks be worn indoors and anytime six feet of distance cannot be reasonably maintained within 10 minutes of contact outdoors, and Aspen police took time over the Fourth of July weekend to hand out masks and information to visitors.
So far, law enforcement has served in a communication capacity to the public about the health order. Pitkin County Commissioner Greg Poschman, who also serves on the health board, moved to invite officials with both the Aspen Police Department and the Pitkin County Sheriff’s Office to join the health board and commissioners for what he described as a “meeting of the minds” to discuss their future roles as it pertains to public health.
“I think maybe we should have an invitation to have a lengthier conversation with law enforcement,” he said, adding he doesn’t want to “rush into” anything.