Lessons learned from the Waldo Canyon and Black Forest wildfires are helping the city and county fight the spread of novel coronavirus, or COVID-19.
“Every time we have a major event like that, we go back and we look at it and say, ‘How can we do things better?’” said Jim Reid, director of the Pikes Peak Regional Office of Emergency Management. “This is what we do, and we’ve been doing it for a long time. And I think we just improve every time we get into something.
“Remember, we’ve done this before. We did it with H1N1 [the influenza virus outbreak in 2009]; we did it with SARS [the viral outbreak in 2003].”
In fact, the regional effort it took to fight the wildfires led Colorado Springs and El Paso County to merge their separate emergency departments into the Pikes Peak Regional Office of Emergency Management in January 2019.
“As we have seen with fire, flood, and now the Coronavirus, disasters do not recognize municipal boundaries,” Mayor John Suthers said in an email to the Business Journal. “The unique joining of city and county talents and resources to form the Pikes Peak Regional Office of Emergency Management makes us better prepared to plan for, endure and overcome any challenge we encounter.”
Personnel from PPROEM, El Paso County Public Health and the Springs’ two major health organizations — UCHealth and Penrose-St. Francis Health Services — are collaborating to limit the transmission of COVID-19 and to marshal resources to treat cases as they develop.
Suthers is concerned, however, about cancellation of events.
“Those sorts of losses are not recovered from the city’s standpoint,” he said, “and also always translate to [lost] tax revenue. It means we have less money to spend next year.”
STATE OF EMERGENCY
Gov. Jared Polis declared a state of emergency in Colorado on March 10.
The declaration “gives us access to resources and more legal flexibility to take steps now to protect the most vulnerable and better contain the outbreak,” Polis said at a press conference in Denver.
The state is focusing on expanding testing capacity.
As of March 10, the state had about 900 test kits, Polis said, and he had contacted Vice President Mike Pence with “a direct appeal for more test kits to be released to Colorado.” Centers for Disease Control and Prevention Chief Dr. Robert Redfield had promised 1,500 additional test kits this week. Each kit can test multiple people.
Polis said Colorado’s Department of Insurance has instructed insurers to waive costs and fees associated with testing, to cut financial obstacles to getting tested.
In addition, the Colorado Department of Public Health and Environment has opened a drive-up lab at 81 E. Lowry Blvd. in Denver for testing patients who have a doctor’s order. Polis said additional labs will be opened in the coming days.
Polis also directed the state Department of Labor and Employment to make emergency rules “to ensure that workers in food handling, hospitality, child care, health care and education get paid sick leave to miss work if they exhibit flu-like symptoms and have to miss work awaiting testing.”
For workers who test positive and lack access to paid leave, Polis said he has asked the department “to identify additional supports and wage replacement such as access to employment insurance.”
For those who work with vulnerable populations and in areas where the likelihood of transmission is high, “it’s absolutely critical that they are able to take that sick leave when they are ill,” Polis said. “I’m also requesting that the private sector voluntarily offer paid sick leave to those who don’t have it already.”
Those measures are critical to contain the outbreak and prevent additional disruptions to the economy, he said.
Polis also asked the Department of Revenue to temporarily allow Coloradans 65 or older to renew their driver’s licenses online. Usually, people 65 and older are required to renew licenses in person.
These measures will come online within a few days and will be reviewed every 30 days as long as the emergency continues.
“I won’t hesitate to use my authority to take additional decisive actions to protect our most vulnerable populations, as well as the facilities that serve them,” he said.
Polis said he hoped to avoid the widespread disruptions that have plagued China and Italy.
“The actions we’re taking today … are aimed at [avoiding] broader disruptions to our economy,” he said. “It’s important for me to say that declaring an emergency does not mean that Colorado isn’t open for business or recreation or tourism. We are.”
Polis said he had studied the measures that have and haven’t worked to contain the virus in other countries.
“I’m basing our approach on what has been shown to work,” he said.
TRACKING THE VIRUS
El Paso County Public Health has been monitoring the spread of the virus closely since December and activated an emergency response team Feb. 14, Commissioner Mark Waller said at a press conference March 5.
“Within the health department, we have activated our incident command structure,” El Paso County Public Health Deputy Director DeAnn Ryberg said. “What that does is allow us to streamline our response and bring together our specialists to focus on specific areas, including our communications efforts, the logistical supports we need for this response, and our operations component that includes regular monitoring of the disease progression.”
A team of epidemiologists is working closely with the CDC and the Colorado Department of Public Health and Environment, Ryberg said.
“Although we are currently responding to a new virus, our approach is certainly not new,” she said. “El Paso County Public Health routinely plans, practices and prepares for situations just like this. Our board of health has proactively set aside reserve funds for situations such as this so that we can be poised to increase our capacity and respond to the situation. We are confident in our agency and our partners’ ability to respond.”
El Paso County Public Health’s epidemiologists follow the same established procedures to track the disease as they do to monitor the spread of the flu and other communicable diseases, El Paso County Public Health Regional Epidemiologist Marigny Klaber said.
Once a case is confirmed, “our responsibility is to try to determine where it came from, by speaking to that individual, as well as seeing where they have been in a certain period of time for which they would have been contagious to others,” Klaber said.
People who test positive for COVID-19 will be required to remain in isolation if they are not sick enough to go to a hospital, said Dr. Robin Johnson, El Paso County Public Health medical director.
She said the county is doing serological testing to determine when an individual is clear of the virus and can come out of isolation.
The current recommendation is for people who have been exposed to someone with the virus to remain in quarantine for 14 days.
“In these cases, we do have the authority to order that,” Johnson said.
Initially, El Paso County Public Health had to send specimens to the CDC for testing, but has since started working with the Colorado Department of Public Health and Environment, which has cut the time it takes to get results.
“If we have increasing numbers, there may be a queue, but we’re anticipating that we can get the test results back in 24 to 48 hours,” Johnson said.
Asked if El Paso County Public Health has the resources to conduct its epidemiological investigations, she said, “As this progresses, we will be reaching out to other counties or to the state for resources or sharing. … There is a lot of cross assistance between jurisdictions and we will adjust as we need to, knowing that this is evolving.”
For people who are uninsured, “we are already in conversation with community partners in philanthropy and our elected officials to discuss what opportunities there would be for support, and we don’t want any of those sort of barriers to keep people from being able to do the right thing, or to get the health care that they need.”
Numerous public events in Colorado and throughout the country have been canceled due to the continuing spread of the virus, including the National Cybersecurity Center’s Cyber Symposium 2020, which was scheduled for June.
El Paso County Public Health officials were asked at a press conference March 6, after the county’s first presumptive positive case was identified, if the department had the authority to order cancellations.
“I think if it were to come up, that would be something that [we would call upon our city and county partners] to help us provide guidance,” said Michelle Hewitt, El Paso County Public Health communications specialist. “So I think that that would just have to be a conversation when we get to that point.”
HOSPITALS AND SUPPLIES
Penrose-St. Francis Health Services and UCHealth also are preparing for an influx of patients, although they note that about 80 percent of COVID-19 patients have mild or minimal symptoms, will not require hospitalization and will be able to isolate at home.
“All of our hospitals have isolation rooms,” said Dr. Bill Plauth, chief medical officer at Penrose-St. Francis Health Services. “Out of an abundance of caution, we’re putting people in negative pressure [rooms],” which prevent the escape of airborne viruses. “If we get to a point that we’re having more people that we need to treat, then we’d likely use our normal droplet precautions, which don’t require the negative pressure but still fully protect the staff and others.”
As part of Centura Health, “we’d absolutely be able to call amongst our other facilities” if need be, he said. “We’re not anticipating any large influx at this time, but we’re prepared to address that when and if it happens.”
UCHealth also has the necessary resources to handle an influx of cases, said Dr. David Steinbruner, associate chief medical officer at UCHealth Memorial Hospital.
“We’ll ratchet up those resources as necessary,” he said. “If you get five, 10, 15 and 20 [cases], we do isolation rooms, and we can control for that. If you get 30, 40, 50, we have to just put them in separate rooms and control for that. If you get hundreds and hundreds, you put them in a tent outside, because you remember these people perhaps are not that sick at all.”
Steinbruner said it’s important for everyone in the community to protect people who are more vulnerable to serious complications, such as the elderly.
“The virus shows us that we’re all in this together, which is why the hospital systems are working together,” he said.
Plauth and Steinbruner said they are talking with each other and with health officials at the county and state levels several times a day.
Dr. Toni Green-Cheatwood, group vice president physician executive at Penrose-St. Francis Health Services, said hospitals within the system currently are well stocked with medications and supplies they need to treat all their patients.
“It’s important to know that drug shortages can happen all the time,” Green-Cheatwood said.
According to a Feb. 27 press release from the federal Food and Drug Administration, only one manufacturer has contacted the agency about interruption of the manufacture of a drug.
“The shortage is due to an issue with manufacturing of an active pharmaceutical ingredient used in the drug,” Commissioner of Food and Drugs Dr. Stephen Hahn stated in the release. The FDA did not specify the drug involved.
The release also stated that about 20 other drug manufacturers source their active ingredients or finished products from China.
None of those manufacturers have reported shortages, but if they do, “we have alternatives to each of those drugs that we have access to,” Green-Cheatwood said.
There is a shortage of N95 masks — those that protect the wearer from airborne particles and liquid droplets.
“We mask patients here regularly,” she said. “We’re well stocked at this time.”
Waller said the city, county, state and health care providers “have put a lot of brainpower and effort into making sure we’re as well prepared as we can possibly be.
“We’re game-planning scenarios if it becomes more significant than we think it’s going to be, and we’re trying to stay a step ahead of where we need to be,” he said. “We’re working really hard to mitigate the impacts of this in El Paso County. It’s a storm we’re going to weather.”