A COVID-19 surge has Colorado doctors and leaders deeply concerned about a tough fall and winter, but Coloradans can drive down coronavirus infections if they act immediately.

Colorado is experiencing a third wave of COVID-19 infections that the governor and public health experts attribute to reopenings at colleges and schools along with relaxed behavior over the Labor Day weekend.

“We need to get this under control,” Gov. Jared Polis said recently. “If this continues, our hospital capacity will be in jeopardy.”

The first coronavirus wave washed over Colorado in the spring. A second wave hit soon after the Fourth of July, and state officials and hospital managers are seeing a third wave now. The number of new confirmed or suspected COVID-19 infections throughout Colorado in October have tied record daily tallies set in the spring. The new spikes prompted a dramatic new mask order in Denver. People in Colorado’s largest city must wear masks whenever they are outside, unless they are alone or with a family member. And no more than five people may gather at a time now, down from a previous cap of 10 people.

Public health experts estimate that when the pandemic first hit the U.S., as many as 4,500 people a day might have had COVID-19 in Colorado in March and April. But, there weren’t enough tests to detect all of the people who likely suffered from COVID-19. Over the past several days, about 1,000 people per day have been testing positive.

COVID-19 surge causes hospitalizations to climb again

Hospitalizations are climbing as well. During the spring, on the worst days, nearly 1,300 people with confirmed or suspected cases of COVID-19 had to be cared for in hospitals. The number of patients with confirmed or possible COVID-19 infections as of mid-October now is about 465 throughout Colorado and about 115 at UCHealth’s 12 hospitals. In the spring, at the peak of the wave then, providers at UCHealth hospitals were caring for as many as 263 patients at once who had either confirmed or possible cases of COVID-19.

Testing results across Colorado also are showing an increase in infections. Public health experts worry that COVID-19 is spreading widely in the community when more than 5% of people who are tested get positive results. In parts of Colorado, the positivity rates have climbed over 5%. The same has been true at UCHealth testing sites around the state. Altogether, since COVID-19 cases first were detected in the spring, UCHealth has provided more than 250,000 COVID-19 PCR tests. These are the nasal swab tests, also known as polymerase chain reaction tests. Lab managers have recently found that positivity rates among those tested by UCHealth now have risen over 5%. (Click here for information on COVID-19 testing through UCHealth and please click here to find community testing locations throughout Colorado.)

Medical experts say it’s critical for Coloradans to once again adopt all the behaviors that will drive those numbers down. Otherwise, as flu season collides with an increase in COVID-19 cases, some hospitals may struggle to provide care to all the critically ill patients who need it.

“That’s what keeps me up at night: the fear of us having to use the Convention Center or tents in parking lots to care for patients,” said Dr. Michelle Barron, one of the top infectious disease experts in Colorado and a chief architect of UCHealth’s response to the pandemic.

Pandemic fatigue may be prompting a surge in Colorado COVID-19 infections

Barron thinks COVID-19 fatigue has kicked in and caused Coloradans to let their guards down.

“Everyone is tired. I get that. We all want the world to return to what it was. But, this is our new normal for a long time,” said Barron who is also a professor at the University of Colorado School of Medicine on the Anschutz Medical Campus.

“People are not adhering to the rules as they should. They’ve been having gatherings with more than 10 people, they’re not keeping distance from others and they’re not wearing masks all the time,” Barron said.

“Initially, the rise that we were seeing was among the 20-year-olds who were getting sick when college kicked in. Now we’re seeing the secondary effect of all of those cases. The 20-year-olds aren’t necessarily just around 20-year-olds. They’re also around their parents and grandparents,” Barron said.

Normally an optimist, Barron is now worried. Unless Coloradans quickly change their behavior and commit to cutting cases of COVID-19, we are in for a very tough winter.

Changes in behavior can work to tamp down COVID-19 surges

The hopeful news is that behavior changes can have a dramatic impact.

“We know this works. There’s no question about it. If you look at our data, the stay-at-home order in the spring worked. Everybody has to be all in. It can’t be, ‘Oh, I’ll wear my mask in front of you, but not with my neighbor.’ I get it. Everyone is tired, but the impact of not being careful is somebody potentially dying,” Barron said.

So, she recommends going back to the basic public health measures that have been proven to work: wearing masks, washing hands, keeping your distance from people outside of your home and avoiding in-person gatherings with people outside of your household.

“Now is the time. After the 4^th of July, we saw a bump in cases. Everybody clamped down and we got back to doing OK. I just worry about where we are heading both because of the resurgence of COVID-19 cases and because we’re headed into flu season,” Barron said.

The flu could begin hitting Colorado in the next month. So, everyone should get their flu vaccine now.

“We know the flu is coming. Whether it’s a good year or a bad one, if you get the shot, you’ll have some sort of protection and it will keep you out of the hospital,” she said.

Coloradans have done well, but need to focus again on cutting infections

Dr. Daniel Pastula, a UCHealth neuro-infectious disease expert who helped combat Colorado’s initial COVID-19 outbreak in ski resort communities, said Coloradans should not be complacent. While the state is faring better than others in the Rocky Mountain region, like Montana and Utah, which have seen recent spikes, Colorado’s cases are going up at a worrisome rate.

“North Dakota is struggling with ICU beds. To prevent explosive growth in Colorado, we need to take this seriously and start bending the curve again,” said Pastula who is also an associate professor of neurology, infectious diseases and epidemiology for the University of Colorado School of Medicine and the Colorado School of Public Health.

Public health experts study how much people are interacting with one another to project how quickly the coronavirus will spread. During the spring lockdown, people dramatically changed their behavior and social interactions declined by about 80% from pre-COVID times, reversing the first surge. Pastula said the rate now is closer to 50% of normal, meaning that people have relaxed their behaviors over time and are gathering in person more than they did earlier in the year.

Time to ‘double down,’ known strategies will work

As the weather gets colder and people are tempted to gather indoors more, Pastula is concerned that more and more people will inadvertently host or attend superspreader events.

“We are not out of the woods yet,” Pastula said. “As the governor says, we may be done with COVID. But, it’s not done with us yet.

“We need to really double-down and refocus our efforts. The strategies are the same as what we’ve been saying all along. We sound like broken records, but these strategies work.”

Here are the strategies to drive down cases:

• Wear masks as much as possible when you are close to other people outside of your household.
• Attend as few in-person gatherings as possible. If you do meet with people, limit the size of the gathering, try to meet outdoors, socially distance from others outside your household and wear masks.
• If you are sick, isolate yourself and do not interact with people face to face.
• If you have any respiratory symptoms, behave as if you have COVID-19. Since it’s extremely difficult to tell the difference between a cold, the flu and COVID-19, “unless proven otherwise, a respiratory illness should be thought of as possible COVID,” Pastula said.
• If you have had close exposure to anyone who has tested positive recently, you must assume that you also could be infectious and you should get tested and limit your exposure to others.
• Continue to physically distance yourself from everyone outside of your household, meaning you should stay at least six feet apart (more is even better).
• Avoid spending time in crowded indoor environments, especially those that have poor ventilation.

“We’re going to need to get creative in the fall and winter as temperatures drive us indoors. As we spend more time indoors with others, there’s a much higher likelihood that this outbreak will get out of hand if we are not careful,” Pastula said.

Staying closer to home, as we did during the spring, may be quite helpful too. If you are venturing to a different area of the state, check in advance to see how other regions are doing. Colorado has a new county-by-county, color-coded tool where you can see rates for COVID-19 in various counties. The tool allows state officials to clamp down on counties that are coping with the worst outbreaks while reducing restrictions in other areas.

Currently cases are highest in the Denver area and nearby counties. That news prompted Denver and Aurora officials to cancel plans for some students to return to in-person learning.

Pastula said the new tool is very helpful since it allows public health officials to respond to outbreaks with more surgical precision on a county-by-county basis.

But no one should ease up.

“Our cases are going up, and the exponential rise this past week is worrisome,” Pastula said.

Colorado is at a crossroads now. We can drive rates down or face much tougher circumstances. To Pastula, the choice is clear.

“We need to hunker down this fall and winter and practice good COVID prevention so things don’t get out of control. And we need to start doing this now.”