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Health & Science

When will COVID become endemic in Colorado? Soon, the state hopes

Kathryn Scott
Special to The Colorado Sun
Julianna Sandoval, 24, pauses for a COVID-19 nasal swab test from Dr. Sarah Rowan from Denver Health Medical Center. Rowan and other medical staff administered a free drive-up COVID-19 testing in the parking lot of Abraham Lincoln High School on November 7, 2020.

This story was originally published in The Colorado Sun.

OK, so now is the pandemic almost over?

In a flurry of votes and orders issued over the past several days, both the state and local governments have begun to dismantle some of Colorado’s most visible remaining COVID restrictions.

Denver and Tri-County Health Department will allow their mask mandates to expire this week. Jefferson, Broomfield and Larimer counties are expected to do the same.

The state Friday night ended a provision of a public health order that required proof of vaccination for large indoor events in most metro-area counties. There is talk of new guidance for COVID precautions in schools.

The changes come at a time when COVID is still rampant throughout the state — a time when infection rates are higher in most places than when the orders were issued. And they also come as a new omicron subvariant of the virus has been found in the state, potentially threatening to stall the progress in beating back the disease.

But what’s most notable about these changes is that, according to the health officials implementing them, they are not meant to be part of the familiar tide of COVID restrictions, rising and falling as infections do. Instead, the end of these mandates is being talked about as the end of the emergency phase of the COVID pandemic. Period.

“I think we are moving toward that space where this is handled more programmatically,” Denver Department of Public Health and Environment executive director Bob McDonald said Monday, in announcing the end of Denver’s order.

McDonald used that word — “programmatically” — multiple times during his remarks Monday. What it means is that Denver no longer intends to treat its fight against COVID as an all-hands-on-deck situation. It will rather become just another function of a city agency, like collecting the trash or approving permits.

In a public statement last week, Tri-County Health Department headlined it more succinctly: “TCHD looking at light at the end of the tunnel.”

Finding the end of the tunnel

We’ve been here before, of course. Back in early 2021, when vaccines first began arriving for wide distribution in Colorado, health care leaders often spoke about the light at the end of the tunnel for the pandemic.

That light turned out not to be the end, though, but the headlights of several more waves of suffering bearing down on the state. More people with COVID died in Colorado in 2021 than in 2020. More people died after the first vaccine shipment arrived in the state than died before it.

And even now, as reports of new infections fall and the mandates meant to hinder the contagion fall with them, the state is seeing an average of more than 5,000 new cases reported per day, as high as during any previous wave of the virus.

As of last week, the state’s COVID-19 Modeling Group estimated that 1 out of every 19 people in Colorado was infected with COVID. The state epidemiologist warned that races against a virus don’t end at the top of a peak.

“It’s important to keep in mind that, when we think about an epidemic curve, we go up and when we get to the peak, that means we’re only halfway there,” Dr. Rachel Herlihy said Thursday. “So we have quite a number of additional cases and hospitalizations yet to come.”

The messages of caution underscore an important distinction in officials’ hope that the end of COVID’s crisis period may be near. It’s not about where we are now in fighting off the virus. It’s about where they think we’re heading.

“When I say we are feeling optimistic about the data, I mean we are feeling optimistic about the trajectory of the data,” Herlihy said last week.

Still, some of the state’s top pandemic experts believe there is genuine reason for hope this time around.

The opportunity of immunity

In 2021, state health officials largely settled on an explanation for why we were unable to shake the virus as expected: It was because the pandemic we all once faced had become a “pandemic of the unvaccinated.” The number of people who hadn’t gotten immune protection through vaccination was providing too many opportunities for the virus.

“You know, it’s a very clear-cut decision to get vaccinated,” Gov. Jared Polis told The New York Times podcaster Kara Swisher in an interview released Monday. “And you can lead a horse to water, but you can’t make it drink. So you do your best, and you go to sleep every night knowing that you did your best.”

There were other reasons, too. Immunity waned among the vaccinated. New variants capable of at least somewhat sidestepping the vaccines emerged.

In the optimism of the summer, the state appeared to be inching toward herd immunity from the virus. By the cold realities of late fall, herd immunity appeared to be an impossibility. The percentage of Coloradans estimated to be immune to the virus was dropping, not rising.

But the emergence of the omicron variant and its rapid conquest have changed Colorado’s projections again.

The university researchers who make up the Colorado COVID-19 Modeling Group now estimate that roughly two-thirds of the state will have been infected with omicron by the end of February, including most of those who are unvaccinated. Combined with the protection vaccines — and, especially, booster shots — provide, the researchers believe that 80% of the state will be immune to omicron by mid-February. Colorado has never seen such levels of immunity against COVID.

“This is so different than when we considered the indoor mask mandate back in November,” Dr. John Douglas, the executive director of the Tri-County Health Department, told the health board Monday evening as it debated ending its mask mandates. Douglas called omicron, “the biggest jolt to immunity.”

Colorado School of Public Health
These two charts, produced by the Colorado COVID-19 Modeling Group, show projections for the coronavirus pandemic under various scenarios of reduced precautions. The blue lines show the projected current trajectory. The other colors show lower levels of control of viral transmission, with the purple line showing the biggest drop in control. The top chart shows projections for hospitalizations. The bottom chart shows projections for infections.

Creating a bridge to summer

Experts are banking on this level of immunity being so strong that they believe it essentially makes no difference whether mask mandates are lifted. According to the Modeling Group’s latest report, even if control measures are dramatically reduced now, COVID cases and hospitalizations will continue to fall.

“The model’s projection is there’s really not a lot of difference,” Douglas said. “Maybe somewhat of a blip, but really not an upward blip.”

Douglas said the weariness people feel around pandemic precautions also factors into the discussions about shifting approaches to the virus. It’s just not clear how much impact the orders are having on a public increasingly wanting to put COVID behind it.

“I just want to note the obvious,” Douglas said, “that there has been difficulty enforcing the mandates. … We have seen more compliance fatigue.”

So this means the state is at a crossroads with COVID. While it is unclear how long the halo of widespread immunity will last in Colorado, it is expected to last long enough to get us into summer, when transmission of the virus is naturally lower.

That means experts predict Colorado is in for a monthslong reset on the pandemic, providing the opportunity to shift out of emergency mode and into what Douglas calls “endemic accommodation” — endemic being the term to describe when a disease becomes a mundane, recurring thing. It means living life as normal, with COVID in the background, just as we do with the flu and other viruses.

“I think it made sense for public health departments to do the admittedly unpopular things that we’ve done over the first two years of the pandemic,” Douglas said at the Tri-County board meeting Monday.

He paused slightly to pick his words carefully.

“I think it’s increasingly not the case.”

The caveat in the optimism

Lurking in the shadows of this discussion, though, is the same thing that has bedeviled optimistic predictions throughout the pandemic: We don’t actually know what COVID will throw at us next.

This is the major caveat in the COVID modeling group’s otherwise sunny report.

“Our projections do not account for the emergence of a novel variant as we cannot predict the severity or timing of its arrival,” the team wrote.

And that next variant might already be here. State officials last week said they have detected a case of the BA.2 subvariant of omicron. While it and the original form of omicron are technically siblings on the SARS-CoV-2 virus family tree, they differ by about 40 genetic mutations.

One study has suggested that BA.2 is 50% more contagious than the original omicron. Officials in Denmark believe BA.2 is responsible for a new increase in cases there.

It is unclear whether immunity to the original omicron variant will transfer over to provide protection against BA.2, said Talia Quandelacy an epidemiology professor at the Colorado School of Public Health who is also part of the COVID-19 Modeling Group.

“With BA.2 there are a lot more questions than answers,” she said.

But, even if BA.2 doesn’t emerge as a menace, state health leaders say it seems almost certain another variant will. Douglas said there is a “very high predicted likelihood” of more variants arriving to threaten Colorado’s longed-for COVID calm.

“We don’t know when the next variant will emerge,” Douglas said. “We simply need to acknowledge that uncertainty.”

And, when those menacing variants do arrive, officials say they may have to pull out some of the restrictions they are currently packing away. It may turn out that living with endemic COVID-19 occasionally looks a bit like living with pandemic COVID-19.

Near the end of the news conference Monday where Denver announced it would let its mask mandate expire, Mayor Michael Hancock was asked to guess when life would be fully back to normal.

He chuckled a bit, reflecting on all the times during the pandemic when COVID had upended his expectations.

“I would never guess,” he said. “Not with this virus.”

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