{"id":31278,"date":"2020-04-27T11:15:57","date_gmt":"2020-04-27T17:15:57","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=31278"},"modified":"2024-05-13T09:29:50","modified_gmt":"2024-05-13T15:29:50","slug":"coronavirus-return-to-normal-models-in-colorado","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/coronavirus-return-to-normal-models-in-colorado\/","title":{"rendered":"Coronavirus models: what the numbers show in Colorado about how we may ‘return to normal’"},"content":{"rendered":"
<\/div>
\"Two
Models show that social distancing should be a big part of Coloradoan’s efforts to ‘return to normal.’ Photo: Getty Images.<\/figcaption><\/figure>\n

A miracle therapy or surprisingly quick-to-market vaccine could change the coronavirus-response game entirely. But absent big surprises, Colorado residents can expect a long, slow return to the \u201cnormal\u201d we knew before COVID-19. Along the way \u2013 and, probably, for many months \u2013 we will need to keep our distance from each other, wash our hands, disinfect surfaces, wear masks, and continue to urge older Coloradans and others at high-risk of serious complications to maintain substantial social distancing.<\/p>\n

If we don\u2019t do these things well, coronavirus cases will likely surge again, possibly swamping hospital and critical-care units and undoing what our weeks of staying at home have accomplished.<\/p>\n

These are the conclusions of the latest report<\/a>, released on April 20, from the state of Colorado\u2019s COVID-19 Modeling Group, a team of experts from the Colorado School of Public Health, the CU School of Medicine, The CU Boulder Department of Applied Mathematics, CU Denver, and Colorado State University.<\/p>\n

\"Jonathan
Dr. Jonathan Samet<\/figcaption><\/figure>\n

Models don\u2019t make decisions; politicians and the people and organizations they govern do. Even the best model is only as accurate as the information and assumptions feeding it. But a good model can tell a story that helps to predict the future. That\u2019s what this one does, and its projections are being used as a key basis for policy decisions affecting all of us in the state.<\/p>\n

\u2018Balancing dilemma\u2019<\/strong><\/h3>\n

The Colorado COVID-19 Model Group\u2019s April 20 report is an expansion and refinement of the team\u2019s first model released on April 6<\/a>. That earlier model considered how the statewide personal-distancing (also known as social distancing) mandates instituted on March 17 and 26 affected case numbers and particularly hospitalization and ICU demands. The model ran through several scenarios, varying the possible effect of personal distancing from 0% to 80% reductions in social interaction, the \u201ccontact rate\u201d among people.<\/p>\n

The new model uses the observed reduction in cases as an input to estimate just how much contact had been reduced: the closing of schools and many businesses, staying at home and other measures plunged Colorado\u2019s average statewide contact rate by 75 to 78%, the team estimates. For its April 20 follow-up, the group modeled how various scenarios for opening up society might impact hospital- and critical-care bed needs.<\/p>\n

Opening up depends on maintaining a delicate balance, says Dr. Jonathan Samet<\/a>, dean of the Colorado School of Public Health and the leader of the Colorado COVID-19 Modeling Group.<\/p>\n

\u201cWe have unemployment, the collapse of the economy, and other factors on the one hand, and human lives and the threat to health care workers and more on the other hand,\u201d Samet said. \u201cIt\u2019s the most incredible balancing dilemma that I think you could imagine at a societal level.\u201d<\/p>\n

The guiding principle in striking that balance has been straightforward: we must, in Colorado and beyond, collectively make sacrifices to keep coronavirus infection counts low enough that serious cases do not overwhelm hospitals and intensive care units where critical patients end up. If we don\u2019t, \u201cWe will have doctors deciding if Patient A or Patient B gets the ventilator, which would be an impossible ethical situation,\u201d Samet said.<\/p>\n

Thanks to widespread adherence to the March 26 measures, we\u2019ve been successful so far. But what happens when we relax those orders? That\u2019s what the modeling team set out to understand.<\/p>\n

The ‘return to normal’ model in Colorado<\/strong><\/h3>\n

The modelers started with three baseline scenarios. These assume personal-distancing decreases of 45%, 55%, and 65% from the typical contact rate before the pandemic. Various mixtures of changes to personal-distancing measures (in terms of such things as businesses opening and children attending summer camps or not) will correspond to these different contact-rate reductions, but there remains great uncertainty about these correspondences.<\/p>\n

\u201cWe\u2019re learning as we go, here,\u201d Samet says.<\/p>\n

\n

For all updates and to read more articles about the new coronavirus, please visit uchealth.org\/covid19<\/a><\/h4>\n<\/div>\n

But he does figure that the measures in place in Colorado between mid-March and the statewide stay-at-home order on March 26 brought about a roughly 65% reduction in the state\u2019s contact rate. (Among those measures were the closing of schools and ski resorts and the cancellation of NBA and NHL games and other events.)<\/p>\n

Assuming some ICU occupancy for non-COVID-19 patients and those who have elective surgeries, the team estimated there to be about 1,800 Colorado ICU beds available for a surge of coronavirus patients. Under the 65%-below-normal distancing regimen, the new model estimated that, without additional interventions, more than 3,000 patients could flood the state\u2019s ICUs at the mid-November peak. The looser 55% scenario would invite peak ICU demand of more than five times current surge capacity in early September; the 45% scenario estimated peak ICU need at nearly nine times capacity in early August.<\/p>\n

The modeling team then ran the same three distancing scenarios with the added assumption that adults 60 and older continue to observe the current, strict stay-at-home orders.<\/p>\n

Those in that broad age group could consider such a scenario to be discriminatory. But according to UCHealth Today<\/em>\u2019s analysis of State of Colorado COVID-19 data<\/a>, as of April 24, the 60-plus cohort had comprised 60% of the state\u2019s serious cases and 90% of Colorado\u2019s COVID-19 deaths. That cohort comprises just 20% of the state\u2019s population. Compare that to people under 30, who had accounted for 4.5% of serious cases and 0.74% of deaths\u2014despite comprising 39% of the state\u2019s population. Coloradans 60 and older were 23 times more likely to end up sick enough to be hospitalized and 230 times more likely to succumb to the disease than people half their age or younger. These facts are reflected in Colorado Gov. Jared Polis\u2019s \u201cSafer at Home\u201d executive order<\/a> effective April 26, which includes individuals 65 and older among the \u201cvulnerable individuals\u201d instructed to continue to stay at home with few exceptions.<\/p>\n

So it\u2019s no surprise that the scenarios assuming ongoing stay-at-home living among those 60 and older projected less than half the peak ICU demand as the baseline scenarios. Even then, though, peak ICU demand would stay below the red line of 1,800 beds only if a low statewide contact rate of 65% below normal were maintained.<\/p>\n

The modeling team separately considered the impact of widespread mask-wearing as well as heightened coronavirus testing and isolation.<\/p>\n

\"Covid-19
Projected timing and magnitude of the peak number of ICU hospitalizations for interventions including high levels of social distancing by high-risk groups (scenario B), mask wearing in public (scenario C), aggressive case detection and containment (scenario D), and combinations thereof (scenarios E and F). Scenarios assume implementation on 4\/27 and maintained indefinitely; the study assumes a coronavirus surge capacity of 1,800 ICU beds in Colorado. (Courtesy of the Colorado State COVID-19 Modeling Group)<\/figcaption><\/figure>\n

The team found that, taken independently, 1) wearing masks and 2) improved testing and isolation kept the number of peak ICU beds below the threshold of 1,800 \u2013 but also only if the overall contact rate were held at 65% below normal.<\/p>\n

Both masks and testing and tracing have their limitations. Masks only work if people wear them and do so correctly. For testing and tracing to be effective, Colorado needs far more testing and a much-enhanced ability to trace contacts. Both will happen over the next couple of months, Samet is confident. But COVID-19 is a tough disease to trace: it seems that contagiousness peaks about 17 hours before symptom onset. An estimated 44% of cases<\/a> in China were seeded by those who spread the virus during the roughly three days from the onset of contagiousness and first symptoms. That finding jibes with research that found 43% of those who tested positive for COVID-19 in Iceland<\/a> to have had no symptoms yet. In addition to hiring students and others to trace coronavirus contacts, technological aids such as the cell-phone-based system the Google-Apple collaboration<\/a> aims to produce could prove to be vital.<\/p>\n

By far the greatest benefits \u2013 ones that would save hundreds of lives in Colorado while lowering the peak case rates much earlier in time (otherwise, depending on the scenario, those peaks could come as late as December, the model showed) \u2013 involved the combination of maintaining social distancing for those 60 and older, wearing masks, and improving testing and contact tracing.<\/p>\n

That combination was the only one that kept peak ICU demand below the red line of 1,800 beds in the 55%-reduction scenario.<\/p>\n

No one knows what the difference between slashing our collective interactions 65% versus 55% might look like. Those 10 percentage points would translate into some degree of additional business, socializing, and getting out and about, assuming we decide the roughly 1,000 additional ICU admissions and perhaps 500 additional deaths at peak \u2013 another Colorado model estimate \u2013 are worth the price.<\/p>\n

No numerical model can make such a decision; no human wants to. But decide we must.<\/p>\n

Whatever balance we strike, it must respect frontline health care workers – that means staying below that ICU-surge red line.<\/p>\n

Samet and his team will be the first to admit that their model isn\u2019t perfect \u2013 no model is. But it reflects the team\u2019s best estimate of how nature works, Samet says.<\/p>\n

\u201cWe\u2019re susceptible, we\u2019re vulnerable, we get exposed, and we get infected,\u201d he said. \u201cWe\u2019re reflecting processes that we understand, so I think that the foundation is sound. Are all these assumptions perfect? Well, they can\u2019t be. But they\u2019re going to get better, and the model\u2019s going to become more certain over time as we learn more. And it\u2019s the best tool we have.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

A miracle therapy or surprisingly quick-to-market vaccine could change the coronavirus-response game entirely. But absent big surprises, Colorado residents can expect a long, slow return to the \u201cnormal\u201d we knew before COVID-19. Along the way \u2013 and, probably, for many months \u2013 we will need to keep our distance from each other, wash our hands, […]<\/p>\n","protected":false},"author":23,"featured_media":31285,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[6,8],"tags":[4859,4860],"class_list":["post-31278","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-healthy-living","category-news","tag-coronavirus","tag-covid-19"],"acf":[],"yoast_head":"\nWhat models say about Coloradoans' return to 'normal' - 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