Opinion: An open letter to Gov. Polis
As residents of Eagle County, we are very disappointed with your decision to move to the #DoingMyPartCO plans announced on April 20 to let the statewide stay-at-home order expire on Sunday. We feel the primary job of our government is to keep us safe and this plan, as outlined, clearly increases our risk from COVID-19 in Colorado. To withdraw any protection now is to do it without, what you admit, to be a fully developed safety net.
In fact, we feel you are doing exactly what Dr. Anthony Fauci just warned against on the same day.
“If you jump the gun and go into a situation where you have a big spike, you’re going to set yourself back,” Fauci explained. “That’s the problem.”
These plans for Colorado, especially as outlined in the charts, are speculative at best. What is not stated, but should be, is that most of what is presented in these charts is, in fact, just models and estimations.
For example, there is no concrete, widespread testing data behind these models. The chart on the COVID-19 cases in Colorado is actually labeled “Estimate.” It states “65,000-75,000 have had COVID-19. 1.1% to 1.3% of Colorado’s population.” On what is that estimate based? To our knowledge, there has been no definitive work done on the rate of either asymptomatic or untested mild disease.
Why should we, as citizens, rely on projections when we haven’t even attempted to upgrade testing to a point where it gives a more clearly accurate picture of overall infection rates and the risk of lessening protections against COVID-19? Adequate testing of both viral DNA and antibody response to the COVID-19 virus is essential before any stay-at-home regulation should be lifted.
At this point, it appears that serologic tests for anti-COVID-19 antibodies are not well enough developed for widespread use as the accuracy of many of the antibody tests currently available is being questioned by the Food and Drug Administration. In terms of polymerase chain reaction testing, near-universal current expert medical advice is that, before current stay-at-home regulations should be lessened, capability for far more widespread testing should be available and undertaken to understand the prevalence of the disease.
We disagree with you that testing isn’t the most important thing right now for the very reason you say it is not important. Accurately estimating disease prevalence clearly requires testing of both asymptomatic and mildly symptomatic individuals, who, at least here in Eagle County, were told to stay at home and not be tested for much of the COVID-19 pandemic.
Indeed, in terms of the amount of PCR testing done, Colorado appears to continue to lag well behind a majority of other states in the U.S. in average daily tests per 100,000 people and remains well above the World Health Organization recommended maximum acceptable positive testing rate of 10%.
Gov. Polis, in terms of adequate testing, we fear this step by your administration is very much a cart-before-the-horse approach. We should have the increased testing first. If there is a recrudescence of COVID-19 infections with lessening of safeguards, we will need to doubly catch up to protect our citizens.
Equally as important and totally dependent on more comprehensive testing, we should also have contact tracing (case detection) capacity in place. But again, as you state, we do not. “Hoping to significantly increase the number of epidemiologists to help in contact tracing” is not the same as having an adequate number to be able to track the spread of COVID-19 intend to reduce safeguards. “Hoping” for the future does nothing currently to help the citizens of Colorado who will potentially be more exposed to the virus under these more relaxed plans.
We cannot help but look at this new plan and conclude that the goal is not to reduce infections, hospitalizations or even mortality. Your own data shows that hospital bed usage for COVID-19 infected patients has barely started to level off. The projections with each scenario show future, significant hospitalizations.
What they don’t show, and this is a serious oversight, is what the hospitalization rate would be if we remain with the current stay-at-home regulations. This is like doing a scientific study and neglecting to include a control group as a baseline. Furthermore, it would seem only logical to look at scenarios that show “stay-at-home” with the other variables, especially case detection and mask-wearing. You should show the public all options, especially those that would show the greatest improvement. (The same could be done for ICU occupancy.)
Moreover, the use of an artificial social distancing percent as a surrogate for infection incidence may be flawed, as it is not clear that measurements of behavior can be accurately accomplished and applied to populations in a state as large and diverse as Colorado. The observed behavior of a large Front Range urban population including Denver may not reflect the behavior of smaller more spread-out Western Slope and Eastern Plains populations and vice versa. How does an overall behavioral measure take into account what may be large regional differences?
Finally, the minimal disclosure of forward-thinking makes us ask, what number of new “disease transmissions” will be considered significant and trigger a “take steps back” action? Will hospital admissions, ICU/respirator usage, or mortality or just infection incidence be used in this decision? Will public health officials at the local level be able to independently determine what level of “disease transmission” will trigger a “take steps back” action or will the state set a target, such as a set number per capita population? Most importantly, are there any plans for controlling COVID-19 transmission with the approaching influx of summer residents and visitors?
Even without the influx of summer residents and visitors and of loosening of social distancing practices, it is already the case, per our observation, that grocery workers do not routinely wear their masks. In our observation (and we hope official social distancing observations are more accurate), the percentage of those workers both essential (grocery, construction) and non-essential (golf course maintenance, landscaping etc.) and also people out walking or biking is, at best, 35% now.
To paraphrase an analogy of Dr. Fauci’s, just because you may no longer be getting wet when you put up your umbrella in a storm, that doesn’t mean that you’ll stay dry if you take it down before the rain stops.
Our storm is COVID-19 and our umbrella is social distancing. If we are not ready for a continued COVID-19 storm, without the best possible testing and contact monitoring, we shouldn’t take down our protective umbrella.
James Richard Thistlethwaite, Jr., M.D., Ph.D., is a Professor Emeritus at the University of Chicago. Rev. Dr. Susan Brooks Thistlethwaite is President and Professor Emerita of Chicago Theological Seminary. The Thistlethwaites now make their home in the Vail Valley.