The outbreak of the new coronavirus in Colorado’s ski resort communities is very serious, and residents and visitors should take as many precautions as they can, according to a UCHealth neuro-infectious disease expert.

“These mountain communities are being hit hard,” said Dr. Daniel Pastula, who has worked on the front lines of epidemics around the world, including outbreaks of illnesses like West Nile and Zika and a rare polio-like illness called Acute Flaccid Myelits.

Pastula assisted local public health officials in Summit County in recent days as they try to fight the growing epidemic. He is now back home and minimizing social contact for 14 days as he follows current guidelines from the Colorado Department of Public Health and Environment (CDPHE).

“The mountains have had many travelers from out of town, which has likely contributed to why they are being hit so hard,” Pastula said. “Additionally, health resources are generally limited in mountain communities. They have small hospitals that are more focused on ski-related and altitude-related issues rather than widespread respiratory diseases.”

Pastula is a neurohospitalist at UCHealth University of Colorado Hospital and an associate professor of neurology, infectious diseases and epidemiology for the University of Colorado School of Medicine and the Colorado School of Public Health.

He did part of his training in epidemiology and infectious diseases with the Centers for Disease Control and Prevention.

He saluted public health officials and Gov. Jared Polis for taking very tough but decisive actions to limit close contact among people in hopes of slowing the spread of this pandemic.

On Monday, Polis ordered the immediate closure of gyms, theaters and clubs for at least 30 days. Restaurants may offer take-out services only.

Over the weekend, Polis also ordered the closure of all Colorado ski areas for at least one week.

And, on March 15, officials at the Colorado Department of Public Health and Environment (CDPHE) issued a very strongly-worded warning, urging anyone who has traveled to Eagle, Summit, Pitkin and Gunnison counties over the past week to “minimize all contact with other people, whether or not they are experiencing symptoms.”

The warning included this specific advice:

• If you live in Colorado and are leaving one of these communities, you should minimize contact with other people for 14 days and watch for the development of symptoms like cough, fever, and shortness of breath.
• If you are visiting Colorado from out of state and do not currently have symptoms (cough, fever, and shortness of breath), you can return home and practice social distancing there.
• If you have symptoms, stay where you are, isolate yourself from others, and call a health care provider or nurse line before seeking care. Do not fly. Do not use public transportation or ride-shares.

The counties are home to Colorado’s biggest and most famous ski resorts including Aspen, Snowmass, Vail, Beaver Creek, Breckenridge, Keystone, Copper Mountain and Crested Butte.

Pastula said Polis’ orders and the stern warnings about the mountain counties are warranted given widespread community transmission and the impending strain on health care systems.

“Avoid traveling to these mountain counties right now unless absolutely necessary given the public health emergency we’re facing,” Pastula said.

It’s impossible to know exactly when the outbreak began in the ski resort communities, Pastula said. Since resort towns attract visitors from around the world, it’s certainly possible that out-of-state or international visitors may have brought the first cases to the mountain areas.

“The virus likely has been circulating within the mountain community for the past few weeks,” Pastula said. “There are likely many more cases than have been reported simply because there aren’t enough test kit supplies currently.”

Compared to other outbreaks that Pastula has witnessed, he called the COVID-19 outbreak “very serious,” primarily because humans don’t have prior immunity to the virus.

“It appears to be highly contagious, primarily through respiratory droplets,” Pastula said.

For those experiencing symptoms, public health officials warned that they must stay isolated for at least 7-to-10 days after the onset of symptoms.

“It is only safe to leave isolation if your symptoms are improving and you don’t have a fever for 72 hours immediately prior to the end of your isolation,” the CDPHE advisory said. “Isolation may be longer for individuals who have more severe illness or who work in high-risk occupations like health care.”

Coloradans should brace for many more cases, public health officials said.

“Community transmission is likely increasing across the state, so these measures are important to implement everywhere but are particularly urgent for residents and visitors of mountain communities that are already experiencing high rates of community transmission,” health officials said.

They recommended that residents and visitors of the affected communities take the following actions: 

• Stay home or in a comparable setting as much as possible.
• Work from home if possible; if you can’t work from home, maintain at least 6 feet of distance between you and your coworkers or customers.
• Only go to public spaces for necessities such as groceries and the pharmacy.
• Continue healthy, non-group activities like walking, hiking, jogging, cycling and other activities that maintain distance from other people.
• Do not gather in groups.
• Avoid mass gatherings.
• Maintain distance (approximately 6 feet or 2 meters) from others.
• If you need to travel, use a private vehicle instead of taking buses, rideshares, flights, or other transportation that puts you in contact with other people.
• Continue to operate critical business functions, such as delivery of goods and operation of businesses, with social distancing and additional safety measures in place. 

“We’re seeing extensive outbreaks in these communities,” said Rachel Herlihy, State Epidemiologist at CDPHE. “We are asking people to take this voluntary action to slow the spread of the disease in Colorado and keep people safe. If we do this now, our hope is that we can slow down the spread of this virus and lessen the potential stress on our health care systems and workers.”

Certain people are at higher risk of getting very sick from COVID-19, including:

• Older people (over age 60), especially those over 80 years.
• People who have chronic medical conditions like heart, lung, or kidney disease, or diabetes.
• Older people with chronic medical conditions are at greatest risk.

Everyone should continue to take the following actions to protect themselves and those close to them: 

• Practice social distancing:  
• When possible, increase distance between people to six feet to help reduce spread.
• Do not shake hands. Instead, bump fists or elbows or simply wave.
• Do not attend public gatherings.
• Frequently and thoroughly wash your hands with soap and water for at least 20 seconds. If soap and water are not available, use hand sanitizer with at least 60% alcohol. 
• Cover coughs and sneezes with a tissue, then throw the tissue in the trash, or use your inner elbow or sleeve.  
• Avoid touching your eyes, nose, and mouth with unwashed hands.
• Stay home if you’re sick, and keep your children home if they are sick.  
• Clean surfaces in your home, and personal items such as cell phones, using regular household products.  

Pastula echoed Herlihy’s advice.

If Coloradans take the outbreak seriously and work hard now to isolate themselves if they are sick, we can dramatically reduce the number of people who get sick, he said.

“We need to make sure this epidemic does not overwhelm our health systems.,” Pastula said.

For patients who think they may have COVID-19, Pastula said it’s best to isolate yourself and recover at home. (Read more about caring for yourself at home.)

“If you have mild symptoms, you should call ahead to your doctor or nurse line and see what your provider recommends. They may ask you to stay at home and ride it out to avoid taxing the health system,” he said.

Pastula said only time will tell how many cases of COVID-19 Colorado will have, but the numbers will be far lower and the emergency will end sooner if all Coloradans work hard to prevent the spread.

“This is one of the most serious issues that I’ve seen. People shouldn’t panic, but they should take this very seriously,” Pastula said.

Washing hands regularly, cleaning frequently touched surfaces daily, avoiding unnecessary travel and large crowds, keeping your distance from others, staying home and isolating yourself if you’re sick will all collectively help.

“If enough people take precautions, we will break the cycle,” Pastula said. “In the meantime, do your best to support your affected friends, neighbors, and local businesses. We are all one community and need to fight this together.”