Vaccines still limited as state revises color-dial rules
Ouray County has reported 36 new COVID-19 cases in the last two weeks, the largest spike in cases since the November surge.
Ouray School quarantined three groups of students and Ridgway Elementary School quarantined one class after several staff members tested positive, and the county’s eighth outbreak was identified in Ouray County offices.
Public Health Director Tanner Kingery said it’s not clear why cases have increased so significantly, and noted the latest positive cases don’t seem to fit in any group or trend and have not been attributed to visitors or travel.
“Nothing seems to indicate a certain trend or a certain industry or occupation,” he said Tuesday. “It seems to be a range of people from their 70s down into their 20s. I don’t have a good answer.”
Kingery is working with contact tracers from the Colorado Department of Public Health and Environment to try to find connections. In the past, he and Emergency Manager Glenn Boyd have been able to identify related cases, but among the 18 cases reported in the last seven days, there have been few clear links.
One identifiable connection was the suspected workplace outbreak within Ouray County offices, with one confirmed and one probable case tied to workplace transmission.
While three staff members tested positive at Ouray School, it hasn’t been declared an outbreak because contact tracing indicated transmission occurred at multiple social gatherings, rather than within the school, Kingery said. They were identified through school testing.
The spike in cases has occurred even with the county testing fewer people over the last two weeks. Ouray County stopped offering asymptomatic testing due to state and federal advice against the use of Curative lab tests because of false negative results. For now, the county is using Curative nasal swab tests for symptomatic people, and a state lab test for people without symptoms who are known close contacts of positive cases.
They have temporarily stopped testing for discretionary reasons, which previously helped to identify people who are positive but have no symptoms. Kingery hopes to resume that soon through Advanced Testing in Clinical Genetics (ATCG) in Irvine, California, which is also being used in La Plata, Archuleta and Montezuma counties. He told county commissioners Tuesday the state is working with the county to launch that and resume asymptomatic testing.
“We only tested four people yesterday,” he told them, compared to the 20 to 30 people who were being tested each day before the pause.
Coloradans over 65, educators and childcare workers can begin receiving COVID-19 vaccines Feb. 8, under a new phased approach announced by Gov. Jared Polis Friday.
Vaccines are currently only available to people 70 and older, health care workers and first responders, who are in phase 1A and the newly-named Phase 1B.1. The state's goal is still to vaccinate 70 percent of people over 70, more than 393,000 people, by the end of February.
Starting Monday, those in Phase 1B.2 can be vaccinated: 65- to 69-year-olds, teachers, child care workers, bus drivers, paraprofessionals, administrative staff and other school employees. That phase also includes about 100 members of the executive and judicial branches of state government.
The state’s 120,000 educators and child care workers in licensed programs are expected to receive the vaccine through their employers, COVID-19 Incident Commander Scott Bookman said. The approximately 288,000 65- to 69-year-olds will receive vaccines from the same providers as people over 70, through hospitals, pharmacies and local public health agencies.
The goal is to have 55 percent of the new Phase 1B.2 group vaccinated by March 5, Bookman said. Kingery said meeting that goal may be difficult without an increase in supply to the Ouray County Public Health Agency, the only vaccine provider in the county. They’re still receiving about 100 doses each week, and have to divide those between first and second doses, which must be administered 28 days after the first.
There are still about 200 people over 70 who have signed up and haven’t gotten their first shots yet, he said. Some of those people may have already been vaccinated elsewhere without the county’s knowledge. While he hoped he would be able to keep count of locals getting shots elsewhere in the state’s immunization information system, that hasn’t been the case. Anyone who has received a vaccine from another provider can call the Public Health Agency to be taken off the list, which had 2,285 people registered as of Tuesday.
Shots for 65-to-69-year-olds will need to come from the same limited supply as those for people over 70, so while they’ll become eligible on Feb. 8, it may be later in the month or even longer before they get a call to schedule an appointment. The county can administer 500 doses in a week, but despite requests for more, is still receiving 100 at a time, because the state’s allocation is based on population.
The vaccines for teachers and school staff will likely come in their own shipment, Kingery said, though that hasn’t been officially confirmed. He’s working with Ouray and Ridgway school districts to prepare for vaccination clinics when the doses arrive.
There hasn’t been any indication yet of when that will be, though Polis said Tuesday educators will be able to get vaccinated within three weeks, starting Feb. 8.
The county has had about four days’ notice ahead of its regular vaccine shipments, but Kingery is hoping for five to seven days to prepare for the school clinics.
“We’d like to do the schools on a Friday, so they can have the weekend to lay low,” he said.
Polis said the changes are possible because of increased supply of vaccines coming to the state, and more transparency from the federal government about how many doses will be available over the next month.
In addition to moving up teachers and people over 65, he also moved people with two or more conditions that put them at high risk from COVID into the new phase 1B.3, alongside other essential workers outside of education. That phase, which Polis estimated could start in early March, includes 1.15 million people.
Phase 2 will include people who are 60 to 64, and 16-to-59-year-olds with one high risk condition. The "general public," or those under 60 without qualifying health conditions, are in Phase 3. "We hope early summer, could be late spring," he said of that group. "There's really very little I can offer in that regard in timing because it simply depends on quantity."
Ouray County commissioners agreed Tuesday to write a letter to the state seeking more vaccines, citing the high percentage of people over age 70 and the lack of providers in the community. Roughly 27 percent of the county’s population is estimated to be over 65.
Some counties are asking the state to send more vaccines to pharmacies, while others are asking for more at public health offices, she said.
“I’m very concerned that Ouray County is going to get lost in the shuffle,” Commissioner Lynn Padgett said. “Small counties like us don’t have the power to not get swallowed up by those bigger counties.” Without more vaccines, it’s going to take longer to vaccinate people than the state’s timeline calls for, she said, “leaving our citizens more vulnerable in a high-risk situation.”
Currently, about 10 percent of Colorado’s weekly supply of vaccines is allocated to local public health agencies, while more than half is distributed to hospitals and retail pharmacies, which Ouray County does not have.
COLOR DIAL CHANGES
Despite the spike in cases, the county isn’t likely to be moved into a more restrictive phase of the state’s COVID color dial, which is set to change later this week.
The new changes are an effort to be less restrictive, taking into account vaccinations and increased immunity.
The new dial, which Gov. Jared Polis said Tuesday he hopes to finalize by this weekend, uses seven-day metrics, rather than 14 days. The number of cases that trigger tighter restrictions, or the “cumulative incidence” rate will be higher, so more cases won’t necessarily force a change in the dial level, as they did in Ouray County in mid-November, when it was moved from yellow to orange.
To move to a lower level, counties will need to maintain lower metrics for only one week, instead of two.
With more than 30 cases in the last two weeks, and 18 in the last seven days, Ouray County’s cumulative incidence rate is well into the red level under the current dial rules. Currently, that threshold is 350 cases per 100,000 people, and as of Wednesday, Ouray County’s incidence was 648.6. The change to seven-day metrics, however, instead of two-week counts, would keep the county in orange.
Based on the county’s population, once the new rules take effect, more than 25 cases in seven days would move the county into red, while 15 to 25 cases would allow it to remain in orange, and with fewer than 15, the county could move back to yellow. They could then notify CDPHE in a letter that they would like to move down on the color dial, and could open up businesses and restaurants at higher capacities.
But according to the Dial 2.0 draft, the state won’t move a county from orange to red solely because of the high incidence rate. Instead, counties can move themselves to red for that reason, but CDPHE won’t force them if hospital capacity isn’t strained.
“We recommend counties do a local order for Red once they near 500/100,000 cases,” the draft said. “Lower incidence areas within a county can be carved out of the order. CDPHE will put a county in red when the county or regional hospital system is under pressure from a staffing or patient transport perspective.” In this case, Ouray County’s hospital capacity is based on Montrose Memorial Hospital, as well as other hospitals in Delta and Gunnison counties serving the region.
At lower levels, however, CDPHE will have a consultation with the county and move them to a more restrictive level based on incidence rates “even if testing rates are stable and hospitalizations are not yet impacted.”
There will be no changes to the capacity limits under Dial 2.0.Despite the high incidence rate in Ouray County, Kingery said it’s too early to say whether a local order moving to level red would be warranted. “Moving to red has a lot of consequences for a lot of people that we need to consider before making that decision,” he said. “It’s too early for me to say that without having that discussion with the Board of Health.”
The dial is expected to change again later this spring, with greater distribution of the vaccine, Polis said.