On April 27, Colorado Governor Jared Polis joined the governors of Washington, Oregon, California, and Nevada in the Western States Pact. The goal was to coordinate efforts to reopen society in a way that minimizes the cross-border transmission of COVID-19.
But, that same day, Polis veered off course. His pact counterparts opted to wait for more robust testing and contact tracing before lifting many restrictions. Polis, on the other hand, immediately relaxed Colorado’s stay-at-home order, even though the state at the time was testing at less than one-tenth the recommended rate. Within days, retailers were offering curbside pick-up, state campgrounds were open, and non-essential businesses could bring employees back to the office (albeit only at 50 percent capacity). Some cities, Denver included, maintained a stay-at-home order, but a good deal of pre-pandemic activity was allowed in Colorado so long as social distancing recommendations were met.
The governor’s calculation was, in no small part, economic. “Some people can [keep staying at home] because they don’t need to earn a living or they can have their groceries delivered,” Polis said in an interview with Colorado Matters. “Others can’t, because they simply can’t pay their rent or buy food if they’re not working.”
Polis’ justification might sound more Donald Trump than Anthony Fauci. But what Colorado’s governor offered up was an unfortunate meditation on survival during these pandemic times. Leaving your home could kill you, but it’s getting to the point that staying home much longer might, too. In easing restrictions before robust testing is available, Polis is taking a gamble, one he hopes will help the most financially vulnerable.
“Obviously the safest thing to do would be to shut down and stay in our houses until a vaccine appears — but we can’t do that,” Dr. Jonathan Samet, dean of the Colorado School of Public Health, told me. With a vaccine unlikely to be developed this year, Samet said leaders must decide how to reengage society with the virus still at play. “It’s far more complex balancing the economy against the epidemiology here,” he said, “but we’ve got to find that balance.”
The mantra of public health officials has been that society needs robust testing, contact tracing, and the ability to isolate infected people before it can reopen safely. By those measures, the plan rolled out by Oregon Governor Kate Brown might be the gold standard.
Oregon counties can open nonessential businesses — with social-distancing restrictions — if they meet seven criteria, including a decline in COVID-19 hospital admissions over a 14-day period and minimum levels of testing and contact tracing capacity. In addition, they must have adequate hospital surge capacity and quarantine facilities for folks who test positive but are unable to isolate themselves. Twenty-eight counties were allowed to proceed this week, and if things go well for another three weeks — enough time to see if more coronavirus cases emerge — they can lift even more restrictions.
“We’re going to have to rely on public health experts, epidemiologists, physicians, and nurses to help us through this transition,” Brown told Oregon Public Broadcasting. “And we’re going to have to do it gradually. And we’re going to have to do it carefully.”
The epidemiologists like her plan. “Oregon’s is the approach you want to take — if you can do it,” Stephen Hawes, chair of the University of Washington epidemiology department, said in an interview. But Brown’s method requires ample testing, the availability of which varies wildly across the nation. According to a Harvard analysis conducted for NPR, Oregon is near the minimum level of testing needed to begin easing restrictions, but Colorado isn’t even close. Researchers estimated that Colorado needs to be conducting about 23,000 tests per day, but it’s only doing about 3,000. (As of this writing, Colorado has had 20,475 confirmed cases of COVID-19 — six times as many as Oregon.)
Colorado isn’t falling short for lack of effort. Polis was an early member of the test-everybody crowd, but his logic shifted in recent weeks. For one, only the federal government has enough purchasing power to put in place a consistent, widespread testing system, yet it seems to be taking tests from the states as often as it provides them. Polis even kept a recent order from South Korea secret so the feds wouldn’t poach it. And even if Colorado had enough tests, the social distancing practices are going to be necessary anyway. So, Polis’ logic goes, why not focus on social distancing instead of waiting for testing that, given the bumbling federal response, may never be adequate?
“Here’s what people are failing to get with the data,” Polis told Colorado Matters. “This virus is here for the future. So you can do one of two things. You can either say, we’re not going to have salons as part of our society because we’re going to keep them closed in May and June, July, and August, September, October, November. … Or they open up with strict precautions, because it’s not going to be any safer now than it is in September or December.”
Polis’ argument is the inverse of Dr. Sara Cody’s. “We have exactly the same conditions we had in March,” Cody, Santa Clara County’s top health officer, said in a news conference. She concluded it’s no safer to ease restrictions now than it would have been in March; thus, the Silicon Valley stay-at-home order continues. Polis’ take is that it’s never going to get safer until a vaccine is available; might as well learn to live with it.
Oregon, though, is showing how states can get creative with the tests they’ve got. Over the next year, state health officials plan to monitor 100,000 Oregonians who will serve as beacons for larger outbreaks; if a cluster of folks tests positive, health officials can deploy more resources to those areas.
“That’s what an epidemiologist would want you to do,” Hawes said. “The idea of doing something in the general population, following people over time, and [tracking] people who become infected … that would be a great research-based, data-driven approach.”
Perhaps systems like Oregon’s will be rendered unnecessary by a national testing program, but until then, Polis argues that social distancing is what we should be devoting our attention to. During a late-April news conference, Polis told reporters folks were too “obsessed with testing. I wish everybody was asking about the other three things: the need to wear masks, the social distancing, and protecting our most vulnerable.”
There are signs Colorado is safe to begin easing restrictions. New COVID-19 cases, hospitalizations, and deaths have been on the decline since mid-April. As The Denver Post reported, there’s capacity in the state’s hospitals and overflow facilities that, thankfully, weren’t necessary during the initial bout with the coronavirus.
There are health concerns beyond COVID-19 that must be considered, too, Samet said. Laid-off workers are losing health insurance, and pandemic restrictions can exacerbate mental health problems. Fear and previous hospital closures have folks avoiding treatment for chronic illnesses, elective surgeries, and even trips to the emergency room. People thrust into poverty will find themselves facing health issues at a far higher rate than affluent Americans.
Opening up shop too quickly would wipe out economic gains, though. As Dr. Anthony Fauci told a Senate committee this week, widespread lifting of social distancing measures “could even set you back on the road to trying to get economic recovery” by forcing another round of lockdowns. Colorado already got a taste of this when a restaurant opened on Mother’s Day and was jam-packed. (The restaurant’s license was revoked.)
Economic relief on the scale of a guaranteed paycheck program, as proposed by Washington Congresswoman Pramila Jayapal, would dramatically ease the dichotomy of survival governors are grappling with. But such aid is unlikely at this point; the Senate has shown little interest in Jayapal’s bill.
Because COVID-19 lingers for so long in the body, we won’t know for weeks the implications of Polis’ easing of restrictions. If his calculation proves correct, Colorado might get a jump on Oregon and other Western states in restarting its economy. If he’s wrong, it could cause even deeper retrenchment and, worse, more lives lost.
