Q&A: Jill Hunsaker Ryan on leading Colorado’s COVID-19 response, fighting disinformation and the road ahead

Jill Hunsaker Ryan worked 60 straight days at the onset of the COVID-19 pandemic in early 2020, often logging 15 hours straight in front of her computer while leading the state’s response to the crisis. Her husband would bring her meals at her computer at their home in Edwards as she worked around the clock, jumping from one virtual meeting to the next.

“My staff and I, we would jump on our computers somewhere around 6:30, and we’d be in meetings up until the evening,” said Hunsaker Ryan, the former Eagle County commissioner who was appointed by Gov. Jared Polis in Jan. 2019 as the executive director at the Colorado Department of Public Health and Environment.

Hunsaker Ryan, quick to defer credit, said some of her team members continued to grind without a day off even longer than her in the first few months of the pandemic.

“I mean, we worked weekends for, I don’t know, probably six months,” she said. “They were definitely like 15 hours days for a really long time.”

All that work has led to Colorado being “in a really good place,” Hunsaker Ryan said.

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To that point, nearly 80% of Coloradans have at least one dose of the COVID-19 vaccine, and the state is 11th in the country for residents with a third dose. Colorado also has the 10th lowest death rate in the United States and, throughout the pandemic, never exceeded the cumulative death rate of the U.S. average.

At the end of February, Gov. Polis told Coloradans in a press conference, with Hunsaker Ryan at his side, that it’s “time to turn the page and start a new chapter” and that those who are fully vaccinated “can freely live without undue fear.”

In a recent sitdown with the Vail Daily, Hunsaker Ryan reiterated that message, saying Colorado remains in a good spot after the surge driven by the omicron variant. She then reiterated that if a more severe variant emerges that again strains the state’s health care infrastructure, her office is always prepared to ramp systems back up.

Next month, Hunsaker Ryan will be honored by Polis with the 2022 Citizenship Award, which recognizes individuals who inspire excellence and public service. It represents one of the highest honors in the state.

The following interview has been lightly edited and condensed.

It’s been more than two years now. What emotions do you have? What’s the feeling you get when you think about it?

A big sigh of relief and just such a sense of pride in the state of Colorado team that has responded to this. It includes the state health department. It includes the Department of Public Safety, the governor’s office. We’ve had the same response team from the beginning. People have stayed with us, and Colorado’s just in a really good place right now.

When you were in grad school at the University of Northern Colorado, getting your masters of public health, you obviously trained for scenarios like this. Same when you were the Eagle County public health director. Describe all that training versus the real thing?

So in the late ’90s, Laurie Garrett came out with this book called “The Coming Plague.” She was a journalist, and everyone in public health read it and talked about the public health system being under-prepared and us being overdue for a pandemic.

And then, post-9/11 and the anthrax event that happened a month later, the public health system nationally was brought into this federal emergency management system. We were given a lot of funding to do training and pandemic planning. That’s when I was at Eagle County. And the most likely scenario, I think everyone thought, was a pandemic flu. And, of course, that came to fruition in 2009. And so we had thought a lot about pandemics and what they could look like. And we worked on our mass vaccination clinics and did a lot of fit testing around N95 masks.

But this virus is so complex, it is so novel, and it behaves so much differently than a flu. For one thing, it’s more severe. It’s more contagious. And the asymptomatic nature of it, which wasn’t known really for the first couple of months in general, like around the world, it just made it very challenging to contain the magnitude of it. The Colorado School of Public Health has some really great charts that just shows on our highest day of testing in Colorado, processing 87,000 tests, there were likely three to four times the number of people infected.

In fact, they said in early January, between one in 10 and one in 15 Coloradans were infected at that point. So vaccines offer a pathway back to a more normal way of life. And at the beginning of this, you asked me how I was feeling and I said relief because I think at the beginning of the pandemic, we didn’t know if there would be a vaccine for this. We didn’t know how long it would take to develop. And vaccines have really replaced the need for the social distancing orders and the kids having to do online learning and really the economic devastation to families and communities and businesses. So I’m very hopeful at this point. I’m very, very hopeful.

Colorado has entered a new phase in its response. All of this infrastructure we built up in these two years, now we’re sort of winding some of that down. Is this the right time to do that? Especially with what’s going on with the BA.2 variant?

So the level of disease transmission and the number of hospitalizations are as low as they have been since the summer of 2020. And part of that is because omicron was so contagious. It kind of left this natural layer of immunity, particularly for people that weren’t vaccinated. And we know immunity wanes, and we know natural immunity wanes faster. So how long will it provide this layer of protection? We’re not sure. But certainly, as we head toward warmer weather, people go outside, and then when kids get out of school, it’s why we tend to see low transmission levels in the summer.

Colorado has really built up its surveillance systems. We do wastewater treatment surveillance. We do genome sequencing in our lab. So we can tell when new variants have entered the state. We can tell when transmission is starting to increase even before the laboratory testing is showing it. You mentioned a new variant, BA.2, and it looks like that while it’s transmissible as the original omicron, it still has about the same severity, it’s more mild. And so while some people will get really sick from it. The vast majority won’t need to be hospitalized from it.

So we think that this is the time to try and head toward what we call endemicity, which is pushing a lot of these functions that have been provided at the highest levels by the state in terms of testing and vaccination. We had mobile buses that did those two things, plus administered therapeutics. Our lab was processing tests around the clock. We want to push those back into the health care system, so people can go to their medical homes for this type of treatment.

But certainly we recognize, if there’s a winter wave next year, if there is a more severe variant that out-competes omicron for contagiousness, we might need to ramp these systems back up, certainly. But this transition needs to happen, so we’re not in this emergency response. It’s a very costly emergency response. It’s mostly federally funded right now. And all indicators are that this is the right time to do some of that.

It has been said that epidemiology is a science of possibilities and persuasion, not of certainties and hard proof. And that being approximately right most of the time is better than being precisely right occasionally. I’m sure you have hindsight looking back on these two years and thinking we could have done some things differently. But in comparison to other states, we’ve done very well. Why is that?

We’ve had a very data-driven response. It’s been very methodical, intentional. We looked at daily indicators along with our partners at public safety and the governor’s office. And the combination of metrics, I think really helped us try to stay one step ahead of the virus. To your point, some of the measurements weren’t perfect because, for example, the tests weren’t picking up asymptomatic cases of people that didn’t feel ill enough to seek a test. But the Colorado School of Public Health was using our hospital data to model what true infection probably looked like. And so with all of the indicators that we had at any given time, we had a pretty good picture of what was going on. We used mobility data. We were able to track hospitalizations around the state. We could tell when hospital beds were starting to fill up. And then we were able to transfer patients around the state to sort of rebalance the patient load on our hospital system.

We looked at different populations. We looked at the county level, the regional level. We looked at racial and ethnic indicators for things like hospitalizations, ability to get a test, level of vaccination. And so we are able to tailor our response to certain demographics.

You bring up demographics. The Colorado Sun recently reported that Colorado has one of the lowest vaccination rates among its Latino population. As a state, we’ve got a high vaccination rate, but what are some initiatives going forward to deal with the pockets out there where the numbers are low or lower than you’d hope?

The data that we use is more robust and nuanced than what is reported to the CDC. We’ve actually done some modeling to better understand our true level of vaccinations in the Latino population. And part of that is people may not want to tell you their ethnicity when they get a vaccine. Particularly, if you think about just the climate for people who may be undocumented and in the country, or just kind of Latinos in general, it’s an undercount. So the numbers that we have are actually higher than the CDC’s. But to your point, there’s still a large disparity there. So we actually set up a new health equity branch within our disease control division, and they focus on health disparities.

We have a lot of different strategies around this. We’ve used community members as spokespeople. We’ve have had 2,197 equity pop-up clinics, and that’s where we have a clinic in a church parking lot in partnership with a pastor, for example. We offer our information in English and in Spanish. We have had a very large, very robust information campaign around vaccinations. It’s something I’ve never seen before in all my years in public health. And to form that campaign, we did a bunch of research to understand how, for example, communities of color, who they want to receive their information from. Like, who’s the most trusted messenger, what messages resonate, what methods.

We have contractors that are going out to immigrant communities and coordinating vaccine clinics there. We have a whole group called Vaccine Champions for Health, which are some of these community leaders, and they’ve been great at doing social media and commercials. So we’ve tried to get the word out about vaccines and that they’re safe and effective. And then we’ve tried to bring vaccines to people where they are and make them really convenient and have trusted messengers and present it in people’s native languages,

How stifled has that message been or how challenging has it been to get it out there with the state of media in this country, and in our state? How hard is it to convince people to do something they don’t want to do?

It’s very hard. The disinformation campaign around vaccines has been persistent and convincing. So it’s very hard when we’re up against that. And that is absolutely a real dynamic. And it’s one reason that we’ve done so much research, focus groups and interviews, and tried to understand what people’s fears are around the vaccine so we can try and counter that in our media campaigns.

But the other thing, we have had a disinformation strategy where we’ve been able to monitor some of the disinformation messages, and so then we can help counter those messages and we can see what populations are going to, where are they happening. But it’s been been difficult.

Those disinformation campaigns put you under the spotlight. You’re someone who’s setting these policies or working with the governor’s office to do these things. Have you received any threats from people who obviously see you as the person that’s ruining their lives in some way or another?

Particularly at the beginning of the campaign, I’ve had death threats. Some of my staff have had death threats. Throughout, I think the public health field has kind of been painted as the villain. And it’s really too bad, because this is a field that has just worked so hard. It’s a field of very passionate, mission-driven people who are going to work long hours to try to protect the public.

But I feel like we’ve had a really balanced response because it’s been data-driven. We’ve recognized that when we have social distancing orders in place, for example, that those do have negative consequences. So we’ve really tried to balance disease suppression with the negative consequences you can get from some of the suppression strategies. We’ve always held protecting the hospital system as our North Star. So that’s been our ultimate goal. And it’s really been in that sense that we have had to implement some of these strategies.

But again, with vaccines, and it’s why we have had mass vaccination clinics around the state, why we’ve had mobile buses going around the state trying to vaccinate people. This really is the strategy to us not having to go back to a place where we have to use restrictions to prevent transmission, to protect the hospital systems.

What is the future of this? You mentioned the word endemicity, which means that we’re going to have to live with this. It’s going to be here. But people want to know what’s ahead. To use a quote from the governor, he said, “We never declared victory over this, but we have reached a point where we can go back to trying to living our lives like we lived before the pandemic.”

That’s absolutely true, especially if you’re vaccinated. If you’re vaccinated and you’re boosted. And we want people to get their booster shots because vaccination immunity can wane. People should live their lives and know that their state is prepared for surges or new variants, but I think that this is going to be here to stay. And the goal of endemicity is really that there’s enough immunity that our hospital systems are protected without the state having to do an emergency response. And anybody who needs a hospital bed from an injury, or needs surgery, or the birth of a baby, or COVID-19, can get a hospital bed. And that they’re staffed and that they have the level of care that we have all come to expect. So when there is a certain level of immunity and we’re just able to ride out these waves without the surging some of these functions, that’s how we’ll know we are there. But we’re ready to surge if we need to.