The Colorado Department of Public Health and Environment reported 28 new COVID-19 cases Friday — including five more in Eagle County — but none of them were in Pitkin County.
There are two primary reasons for that, and it’s not because the coronavirus-caused disease has plateaued in Aspen. Some tests that have been couriered to the testing labs simply haven’t been returned yet — and then there’s the fact that Pitkin County is no longer testing people not already exhibiting severe symptoms requiring hospitalization, according to local authorities during a press briefing on Friday afternoon.
Pitkin County Public Health Director Karen Koenemann emphasized in the most recent address to the press that at this stage, even though the 10 presumptive confirmed cases are all tied to a singular group of visiting Australians, authorities are assuming there are countless more cases, and the situation qualifies as limited community-spread transmission.
“We knew there would be a point in time in which we would have community spread, and that’s a point in time we can’t trace back the case to an original source, it’s an unknown,” she said. “What’s interesting in our community is we don’t have the data to show it’s community spread, but we are moving into a different response not having the data, but knowing it’s happening.”
As such, she continued, the county’s Incident Management Team, or IMT, is shifting from a strategy of containment to one of mitigation. That means rather than focusing on epidemiological case-by-case investigations tracking with whom someone may have had contact, the new message is one of social distancing. On Thursday night around 9 p.m., Pitkin, Eagle and Garfield counties announced that, with some exceptions such as restaurants, any gathering of more than 50 people will be prohibited until at least April 8.
For anyone who is exhibiting symptoms of the respiratory disease COVID-19, well, unless you’re already in need of hospital care, authorities advise self-care and self-quarantine.
“We need to move past kind of getting stuck on numbers of cases,” Koenemann said. “You’re seeing a shift in how the whole community is responding right now to COVID-19. Because there is no antiviral or vaccine for COVID-19, we have to implement non-pharmaceutical intervention.”
On Thursday, the IMT established a drive-through testing site at the Aspen Volunteer Fire Department’s Aspen Village location — earning Pitkin County explicit praise from Gov. Jared Polis — before ceasing the operation by 2:30 that afternoon.
Aspen Valley Hospital Chief Executive Officer Dave Ressler maintained that while testing was initially useful for confirming the virus’ presence in the area, since no specific treatment yet exists for the novel virus, testing no longer is an effective use of resources.
“With respect to testing, we know that the community has been anticipating testing, and we came out as a community aggressively once it was identified we might have the virus in the valley because we needed to know,” he said. “The testing was never intended to be a treatment of the symptoms and it doesn’t change the course. It doesn’t serve anybody’s purpose to continue that testing, considering there are limited resources.”
That’s a bit of a detour from Polis’ message earlier in the day Friday during his press briefing, during which he stressed the importance of testing and need for more testing capacity throughout the state.
“Aggressive and sustained testing is a powerful tool for fighting the virus,” Polis said. “It’s not necessarily clinically important, but it’s important because many [symptomatic people] want to know, ‘Can I get back to work in three or four days, or do I need to self isolate for 14 days?”
Koenemann acknowledged that quarantining for the full recommended 14 days without knowing for sure if someone is actually COVID-19 positive can create economic and social strains, but she stood by the IMT’s position that social distancing and an abundance of caution would serve as the best mitigating strategies in the community.
“I really hope employers are talking through and thinking through what they can do to support their workers to telecommute or provide flexibility,” she said. “This is where the community really needs to rally together so nobody is really impacted on a social level as far as what they’re able to do or not do.”
Of course, many organizations and businesses are already feeling an economic crunch as more and more events are canceled and markets continue their rollercoaster trajectories in response to the outbreak.
And while Polis has assured that getting tested for COVID-19 should not impose a financial burden on any Coloradan, with Pitkin County’s decision to suspend testing unless a patient is already in the hospital seeking treatment for other symptoms, that ostensibly means the only avenue for testing will come with a hospital bill that will vary with every patient’s insurance coverage, or lack thereof.
“The hospital has not become a testing site; it has become a treatment site. They should be coming to our facility if they are sick and are in respiratory distress and in need of care,” Ressler said.
AVH clinical nurse Lori Maloy echoed Ressler’s and Koenemann’s concerns that if everyone who wanted to get tested actually was, the increased demand would quickly overwhelm already stretched local and state resources.
“Right now, we are not testing anyone who is able to stay at home with the symptoms they have,” she said, adding that she herself has tested several people in the last few days. “Many of the people in our community, rightfully so, are afraid and are wondering. If they have enough symptoms that they would normally call 911, they should call 911, and when they call, they should say, ‘I have respiratory issues’ or I think I have ‘COVID-19.’ We will bring them through the back of the emergency department so we’re not taking them through where our visitors’ family are visiting or staff members may be exposed.”
Even Polis, who several times during his Friday address expressed his frustration that the state hasn’t received more testing kits and touted private sector partners that have expanded the state’s testing capacity greatly, noted that 90 percent of administered tests came back with negative results.
With intensely rolled-back testing, Pitkin County’s number of COVID-19 cases will likely remain relatively flat compared to surrounding counties. Officials are looking to the community to maintain a heightened sense of awareness and self-compliance with the order prohibiting gatherings of more than 50 people.
“Even though we can’t prevent, probably, widespread transmission, what we’re trying to prevent is explosive transmission,” Koenemann said. “COVID-19 will be in our community for longer, but we’ll have less cases at one time. That’s why you’re seeing this shift in how we're doing testing in our community as well as what you’re seeing with the public health order.”
Indeed, overwhelming the healthcare system is a concern voiced over and over, whether from local IMT authorities, Polis or President Trump, who on Friday declared a national emergency to combat the spread of the disease.
As for AVH, actual capacity for would-be COVID-19 patients varies, as every case will likely present different and require different responses, Ressler said.
“I wish I could give you just a hard and fast number, but like everything, it’s more complicated than that,” he said Friday afternoon. “We do have a negative pressure rooms — where you contain the air within the room — but also, there are some patients that don’t require that. Some patients may require an ICU level of care; others may be monitored on what we call the medical surgical unit, where we have 16 beds. It really depends.”
AVH has 12 negative pressure rooms; additionally, it keeps five mechanical ventilators.
“I will say that because we’re at 8,000 feet, the patients that are in significant distress and require mechanical ventilation, we can provide that here, but they’re generally better served at a higher-level facility at a lower altitude,” Ressler said. “At that point, that’s the highest level of care.”
Just because the mitigation strategy has shifted away from testing doesn’t mean the IMT doesn’t want to offer as much information to the public as possible, IMT public information officer Jenny Cutright said. The team will be hosting a virtual community meeting on Monday at 3 p.m. via zoom.us/j/571198559, meeting ID 571 198 559, or by calling (669) 900-6833. While questions will not be accepted during the meeting itself, members of the public can submit their questions and concerns ahead of time online at bit.ly/2TMyPvN.
“We want people to submit comments that can be answered during the meeting,” Cutright said in an email.