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A relatively healthy population, fewer people living in poverty and strong compliance with social-distancing rules have helped Colorado avoid the high death tolls some states have endured from COVID-19. But there’s no telling if the state’s luck will hold as the economy slowly reopens.

Just over a month ago, Colorado, Illinois and Michigan looked roughly the same, each with six deaths attributed to COVID-19 as of March 21. As of Sunday, Colorado had 678 deaths from the new coronavirus, Illinois had almost three times that many at 1,943, and Michigan had nearly five times as many, with 3,314.

Even after adjusting for population, Colorado has gotten off relatively lightly so far, though it likely doesn’t seem so to the more than 2,000 people who were hospitalized or to the residents of nursing facilities who’ve seen their neighbors get sick and die.

It’s not necessarily because the other states were slow to act. Illinois had fewer cases and deaths when it implemented its first restrictions on large gatherings and its full stay-at-home order than Colorado did when it took the same steps. Michigan had fewer cases when it started implementing restrictions, but took longer to implement a stay-at-home order, with its cases and deaths topping Colorado’s by the time it did.

Colorado has relatively low rates of most chronic conditions, unlike Chicago and Detroit, which are the epicenters of their states’ epidemics, said Justine Kaplan, interim director of the master’s of public health program at University of Illinois Urbana-Champaign.

Significant disparities in health and wealth exist between racial groups in Colorado, though, and are reflected in disproportionate toll the virus has taken on black and Hispanic residents.

Denver also has fewer residents living in poverty or depending on public transit than the other large cities, meaning more of the population can effectively insulate itself from the virus, Kaplan said.

And the risks compound for low-income people, she said, including:

  • Most can’t work at home and some have jobs like cleaning that could expose them
  • They’re less likely to have health insurance and the resources to manage any preexisting health conditions
  • They may not have cars, meaning they have to pack close together to get to work or buy food
  • They may be forced to rely on grandparents to help with child care while schools are out, increasing the odds those older relatives will be exposed to the virus

“It’s not about state policies, really,” she said. “Folks who are already more vulnerable, they’re always worse off,” in an outbreak.

Josh Petrie, an assistant professor of epidemiology at University of Michigan’s School of Public Health, said Michigan has more cases reported in older people than Colorado or Illinois, which might explain the higher death rate. Deaths also have centered around Detroit, where many people have chronic conditions and struggle to access health care, even in ordinary times.

Glen Mays, a professor in the Colorado School of Public Health, said Colorado may have been lucky that the virus first appeared in ski towns, where the population tends to be relatively healthy.

But he said not to discount the effect of strong compliance with social-distancing rules. Transit and cell phone data suggests people are moving around about 75% less than usual, meaning they’re most likely having fewer social encounters, he said.

“Definitely Colorado’s social-distancing policies are having a pretty substantial effect,” he said.

This content was originally published here.