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Larimer County health director sets ‘lofty goal’: Coronavirus testing for half the county

Jacy Marmaduke
Fort Collins Coloradoan
Published 11:02 AM EDT Apr 15, 2020

Larimer County’s public health director has an ambitious plan for combating coronavirus that includes testing over 175,000 people, carrying out aggressive contact-tracing and antibody testing, and slowly, carefully backing off the county stay-at-home order that he credits for flattening the curve.

Public Health Director Tom Gonzales detailed his goals to Fort Collins City Council on Tuesday during a coronavirus panel with leaders of regional hospitals. The hospital officials shared patient data with council and told them that social distancing so far appears to have prevented a surge of hospitalizations and staved off supply shortages.

As of Tuesday night, 42 coronavirus patients remained at Poudre Valley Hospital in Fort Collins and Medical Center of the Rockies in Loveland. The two hospitals have 385 beds but could accommodate nearly 970 patients in a worst-case, filled-to-the-rafters scenario, said Kevin Unger, president and CEO of Poudre Valley Hospital and Medical Center of the Rockies.

Another 78 coronavirus patients remain hospitalized at Banner Health’s McKee Medical Center in Loveland and North Colorado Medical Center in Greeley.

“We are continually assessing where we stand with all of this, but we’re happily surprised that the surge hasn’t overtaken us and we’ve actually been able to keep up with it to date,” Unger said.

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He said the lack of patient overload “has everything to do with social distancing.”

That’s exactly why Larimer County needs to think critically about how to reopen the region without triggering a destructive spike in cases, Gonzales said. Models from the county and Colorado State University estimate that social distancing has reduced coronavirus spread by about 60%. As a result, about 90% of Larimer County residents probably haven’t been exposed to coronavirus.

“I don’t want to (sugar) coat it – the virus is going to spread” when the county starts to back away from the stay-at-home order, Gonzales said. “But we want it to spread at a level where we can give (Banner and UCHealth’s) teams a great chance to get folks out of that hospital, recovering. The more people they have in their waiting room, the harder it is for them to treat them.”

Banner Health has discharged 106 coronavirus patients from its Northern Colorado hospitals, primarily North Colorado Medical Center in Greeley. UCHealth had discharged about 120 coronavirus patients from its Northern Colorado hospitals as of Tuesday morning.

The UCHealth system saw a big spike in coronavirus patients between mid-March and early April, Unger said, increasing from 68 patients in the system to 232 by April 7. The number of cases at Poudre Valley Hospital and Medical Center of the Rockies increased from 15 in mid-March to 35 by April 7.

UCHealth has 134 ventilators, and 42 were being used as of Tuesday. The supply is good but could go away quickly if the region sees a patient surge, Unger said.

The supply of ventilators for Banner Health’s Northern Colorado hospitals is less exact because Banner Health is a five-state network and can shift resources throughout the region. As of Tuesday, 26 ventilators were being used at McKee Medical Center in Loveland and North Colorado Medical Center in Greeley. That’s about half the number of ventilators that were in use last week, said Margo Karsten, president of Banner Health’s Western Region.

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Banner is trying to keep its Fort Collins hospital coronavirus-free, so they’re moving patients who test positive to McKee and NMCM.

Both Banner and UCHealth’s Northern Colorado hospitals are faring OK so far in terms of staffing and PPE supply, the officials said, but they’re rationing supplies and could still use more. Banner staffing in particular is in good shape because the network is based in Arizona, which hasn’t seen as many coronavirus cases as Colorado and has been able to send some nurses here.

The increase in hospitalizations is mostly due to outbreaks in Weld County, Unger said. UCHealth is overflowing patients from UCHealth Greeley into MCR and PVH. He added he’s concerned about what the Weld County case count will mean for the rest of Northern Colorado because Weld County appears to have substantial community spread.

Weld County has reported 884 coronavirus cases and 55 deaths to Larimer County’s 196 cases and nine deaths. Weld’s death toll outpaces every county in the state, except for twice-as-populated Denver County (which had 56 deaths as of Tuesday). Officials haven’t tracked down a definitive cause, but the disparity has resulted in more options for hospitalizing Weld County patients.

“Weld County is dramatically different from Larimer county,” Karsten said. “I just want to appreciate the social distancing and the compliance, because it has made a really big difference in how we’re managing the care between the two counties.”

Unger and Karsten said their chief supply concerns are reagent and other coronavirus-testing necessities, PPE and ventilators – in that order.

Coronavirus tests remain in limited supply statewide because the federal government has provided few tests, labs can only process so many per day and red tape has slowed the opening of new commercial testing labs. But UCHealth and Banner have set up coronavirus testing labs, and a testing lab at Colorado State University is in the works.

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Gov. Jared Polis’s innovative response team members recently said their goal is to test over 5,000 people a day in all of Colorado. Gonzales wants to test even more – at least 2,000 to 3,000 people a day, working toward a goal of getting 50% of the county tested. Half of the county is about 175,000 tests. He said he doesn’t have a timeline for that target yet, and county officials don’t know how many people have already been tested because testing labs and hospitals aren’t required to report negative tests to the county.

“We’ve made a lofty goal: Let’s get at least half our community tested throughout this step-down process,” Gonzales said. “For our epidemiologists and our staff that can contain the disease, that’s the only tool they have when they’re doing the work.”

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Hospitalized patients and health care workers with symptoms will continue to be first priority for testing. An increase in testing capacity would allow Larimer County to more thoroughly test the next two tiers. Tier two for testing includes symptomatic patients in long-term care facilities and residential settings such as homeless shelters or correctional facilities, symptomatic people over age 65, symptomatic people with underlying conditions, symptomatic first-responders, symptomatic critical infrastructure workers and symptomatic people who work with vulnerable populations or in group residential settings. Tier three includes everyone else who has coronavirus symptoms.

Within two or three months, the county needs to be conducting large-scale testing in unison with antibody testing, Gonzales said. Antibody testing involves checking a blood sample for antibodies that indicate a person was exposed to coronavirus and may have some level of immunity to it. It’s not a catch-all solution to the pandemic, but officials are touting it as a way to determine who’s safe to return to work. That could make for a less hazardous path out of Larimer County’s stay-at-home order.

Effective antibody tests aren’t yet available on a large scale, and it’s not clear how much protection coronavirus antibodies offer the person who was exposed. Gonzales said the antibodies may only be useful for 1 to 3 years, similar to those associated with strains of influenza.

The other key component of Gonzales’ goal is contact tracing, which involves tracking down people who came into close contact with someone who tested positive for coronavirus and asking them to self-quarantine. The strategy is person- and time-intensive, but public health experts say it’s an important offensive measure that can be invaluable in reducing the spread of infection.

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Larimer County has a team of eight epidemiologists at Colorado State University working on contract tracing. They’ve streamlined the process over the last month and shortened it from about 4-5 hours for one positive to about an hour and a half, Gonzales said. The county is training more people to do contact-tracing and planning to ramp up those efforts, he said.

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Larimer County’s stay-at-home order continues through April 26 but can be extended. Gonzales detailed a potential framework for easing the restrictions at a virtual town hall last weekend.

The first step might be to allow gatherings of fewer than 10 people, but restaurants would remain closed and social distancing of 6 feet or more would still be required, Gonzales said.

The next step, if all goes well and an alternative medical care site is set up, might be to allow groups of less than 50, keep restaurants closed and continue social distancing of 6 feet with use of cloth masks.

Next, if there isn’t a surge at medical facilities, gatherings of less than 150 people might be allowed and restaurants might be able to open.

Gonzales said it’s too soon to tell when the order could be lifted.

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Content coach Rebecca Powell contributed to this report.

Jacy Marmaduke covers government accountability for the Coloradoan. Follow her on Twitter @jacymarmaduke. Support stories like this one by purchasing a digital subscription to the Coloradoan.​​​​​​​

This content was originally published here.