Thread by @shayshinecastle

I hate moving on from this so quickly, but we're jumping straight into COVID. Presentation: www-static.bouldercolorado.gov/docs/Item_1C_-…

There was a "short-lived" spike between Christmas and NYE, says Jeff Zayach of BoCo Public Health. Things trending back down since then.

Zayach: "We are now into a place we have the ability to do followup on contract tracing and case investigations. Across the state, looking good."

Still, the rate of new cases per 100K ppl and 5-day avg of new cases are high... higher than at any time except the fall CU spike and the holiday spike. Still not back down to the "baseline" of early COVID and non-spike times.

Hospitalizations: "We're on a downward trend; expect that to continue as we have more vaccine getting out to the community."

All long-term care facilities have been vaccinated with at least one dose, Zayach says. (Doesn't say residents or workers; possibly it's both) "This has been one of the most difficult things that we can see in this community."

Zayach addressing the COVID variant we have in CO. It's more contagious. With where we are now and "with vaccines getting out .... we see very little change in our overall hospitalizations and ICU."

But if we open things up more, don't wear masks as much and don't keep social distancing, Zayach says, things get worse. But even in "worst-case" scenario, we are not exceeding ICU capacity through May 24.

"This is of course assuming we maintain higher transmission control levels. The message here is not to give up. We need people to still maintain social distancing, wear masks," Zayach says.

County ICU capacity was pretty low this weekend: 12 beds, total, according to the dial. They must expect that to open back up in the future. It's the lowest I've seen it in awhile.

Zayach: "We still have a lot of infection in our community, but we are on a downward trend."

70% of the over-70 population should be vaccinated by March, so that should help RE: hospitalizations and deaths.

Zayach: "It's going to take awhile to make sure we have vaccines for the entire population. During that time, it's going to be critical we take these prevention strategies."

Zayach showing some apparently non-COVID data, but I'm guessing it's related. Suicide attempts, for example, went up in 2020 (data is from emergency dept visits)

As did drug overdoses in 2020. "A pretty significant increase," Zayach says.

Sexual violence as well "the biggest jump" of these three trends. "A very troubling trend, as we look at how this disease is manifesting in the type of emergency dept we are seeing."

OK, onto the "new" COVID dial, which the governor announced over the weekend. A brief feedback window closed today.

Hard to translate what he's explaining via tweet.

Zayach: The state is proposing whether hospitalized patients need to be transported as an indication for capacity stress.

Whereas now, I think they look at number of remaining beds available...?

Zayach: "We're not exactly clear of how they will include staffing" as part of hospital capacity. Throughout the fall, "our hospitals were reporting staff shortages" but not quite at "crisis-level situations."

We believe part of why the gov has proposed these changes is because more ppl are getting vaccinated, which will result in less-severe outcomes, fewer ICU admissions and fewer deaths.

(That was Zayach) He also says there are other public health crises being caused by COVID (as evidenced by suicide rates, etc.)

When Colo School of Public Health "ran the projections ... they were not seeing we would exceed any of our hospital capacity."

"Catastrophic impacts" are being balanced with more available vaccines, Zayach says.

"When we have ppl who are out of work or don't have housing ... that can have serious impacts on their health," Zayach says. So the state is considering that.

Also being revisited: How schools operate. We saw more cases from in-person school, Zayach says, so we'll see more cases, but fewer hospitalizations and deaths bc most vulnerable are being vaccinated.

Estimated 1 in 115 ppl in BoCo have COVID in the past two weeks, Zayach says; half don't know it.

"That's why the state is focusing so much on continuing to support testing," Zayach says. "Please take advantage of it."

"I cannot emphasize how important it is ... to keep focusing on preventative" strategies: Masking, don't mix your households, social distancing. "If we can keep it up as the vaccine rolls out, we're only going to be better in the long run."

Dr. Indira Gujal is going to address vaccinations in Boulder County.

32 providers have enrolled to administer vaccines

I don't have these slides so I can't look ahead

21,505 residents have received one dose of the vaccine; 7,097 are fully vaccinated.

Those are mostly healthcare workers, Gujral says. Also older adults: more than half of county's 70+ population have at least one dose so far.

County received close to 7,000 doses of vaccine this week.

Latinx and Black residents are behind on vaccines proportionately to their share of the vaccinations, but most residents of long-term care facilities are white, so that number should equalize as more ppl are vaccinated, Gujral says.

Gujral: 2,300 healthcare workers and frontline workers still need vaccinated.

Starting Feb. 8, teachers and ppl aged 65+ will also be eligible to get vaccinated.

That's an extra 18,000 ppl just for 65-69 y.o.

BVSD will work with BCH to get K-12 staff/teachers vaccinated; early childhood educators also eligible. "The logistics on that are a little more challenging bc there are a lot of unique players."

"We know that a lot of what we're talking about are traditional vaccination strategies," Gujral says. "We know those are limiting. There are systemic challenges that make barriers."

County also has an equity plan for vaccines. "We just want to honor that and recognize that these traditional strategies may not work."

References distrust based on past gov't/healthcare actions, like the Tuskegee experiments, Henrietta Lax, transphobia among medical professionals.

Also difficult to reach some older adults: "I have a 90 y.o. father who cannot go online and register for a vaccine," Gujral says.

Mobile vaccination clinics will help reach homebound or unhoused folks.

Must be a lot of council qs. Weaver asks if health officials can stay for another hour.

Dr. Chris Urbina is going to go over COVID variants. "All viruses mutate. This is a very common process."

"As they spread rapidly, it's a very common fact of life that viruses change," Urbina says.

(Which is one reason why the whole 'let it spread, herd immunity' thing is kinda dumb. It's just giving the virus more license to change.)

Urbina: Masking is still effective against all variants. As is social distancing. "We can protect ourselves."

OH SNAP, URBINA SPEAKS SPANISH AS WELL. Do not think I could like this guy any more.

Urbina: One variant IS more contagious. Not more deadly, but more transmission = more hospitalizations and more deaths, so it is worrisome.

Urbina: Will the current vaccines work against different variants?

And will the testing pick these up?

Yes to that last one; they test for "various pieces of the virus."

Vaccines may be less effective against other variants, some of which may also cause more severe disease, Urbina says.

Urbina: "We're watching this very closely."

"Vaccines are highly effective against the common" COVID strain, Urbina says. "We think it's prob a little less effective against the U.K. virus; and we're studying other variants as well."

"They still are very effective: probably 70-80%," Urbina says. Having effectiveness of 60% or more is "still very, very good. ... People shouldn't be discouraged."

Masking + social distancing + vaccines = success.

"If we put all those packages together, we're still in a good place" of controlling the virus, Urbina says.

Wallach: There seems to be confusion about enrolling (for a vaccine) and what the procedure is. Do ppl need to enroll with as many providers as possible? (As ppl he knows are doing)

Gujral: Not all the providers who have signed up with us have gotten vaccines for the general public yet. Some were handling long-term care facilities.

Here's where you can find a list of providers: bouldercounty.org/families/disea…

"It's not really the best to put your name on all the lists," Gujral says. Just pick one.

Gujral: "As soon as doses come in, providers are getting them out."

Wallach asks the question again.
Gujral: I'm really encouraging ppl to stick with their normal provider. Ppl can add their name to every list if they feel they need to, but "There's only so much supply, and there's a lot of demand."

Wallach: What determines how many doses we get? It seems to vary from week to week? Is there rhyme or reason to it?

Zayach: There's variation week-to-week from the national level. It's difficult for states to plan. That impacts local supply. "It is getting better, but there still are challenges."

Gujral: Original allocation was based on population, but the state switched last week to also include "occupational estimates" and "first dose completion estimates."

"They have not shared the formula with us."

Wallach: It seems like we didn't get a jump from Christmas/NYE holiday that we thought we might. Why?
Zayach: "We did expect a larger jump. And there was."

Zayach: "What we can do is thank the public. WE saw other states that had really serious spikes. ... People were taking it seriously. Some people restricted traveling. ... That made a dif in Colorado."

Colorado is at 75% masking, Zayach says; other states averaging 50%.

Friend asks about a "one-stop shop" system for signing up for a vaccine.
It's hard, Gujral says, bc every pharmacy, etc. has its own process. It will get better as more providers sign up and more ppl are eligible.

Another Friend q about different or more masks to protect against the variant.
Urbina: That was misinterpreted by the media. "If people choose to wear a double mask — surgical + cloth — that will protect you from whatever variant is out there, but it's not necessary."

What will help more is getting everyone to wear a mask, Urbina says. "If you wear a mask properly, you will have the same kind of protection."

Young: What does efficacy mean in regard to vaccine? Preventing the disease or lessening the severity?

Urbina: When you hear 94-95% effectiveness, it means that 94-95% of infections in the trial were in the placebo group (those who didn't get the vaccine). But also, those who got the vaccine has less severe illness.

Apparently dif between effectiveness (how it works in the real world) and efficacy (how it works in the lab).

Young: Is it true that providers with "left-over" doses at the end of the day will give it to whomever is signed up for leftovers?

"That is true," Gujral says. You'll hear stories about the end of a clinic in a Safeway, you run 400 ppl through, "you may have a few extra doses" from that last vial. "The rule that we work on is we never waste a dose. Ever."

At BoCo public health, we try to call those leftover healthcare workers ahead of time, let them know, we're doing a clinic, we might call you if we have leftovers.

"Every provider has their own system," Gujral says.

Young: "How do we know there is actual hesitancy" to get vaccines bc of historical mistreatment?
Gujral: Many, many studies have been done. The CDC has plenty of evidence on that. Not just for this, but all vaccines.

Zayach: Salud and Clinica have reported the same thing. One of their main focuses is to address hesitancy "or we're not going to be successful."

Urbina: "We certainly are not reaching everybody that we want to reach."

Gujral: The state's idea to do pop-up vaccine clinics is fine "from a logistics standpoint" but it doesn't address the trust piece.

Young: "Much of the historical injustices are unknown to people. They're not taught to anybody. They're swept under the rug."

Access barriers are being "lumped into" the hesitancy issue, Young says.

Weaver asked a long q about the project "peak" of cases in April, even with more vaccination. Do you think really that's likely?

Zayach: "Yes, I do. I was just in a meeting ... I think with that variant and with the projections ... I trust the numbers they are putting forth."

Weaver: I want to make sure what's the dif between 78% and 70% ICU capacity here? How do we translate that?

Zayach: "It's a combo of opening things up ... If you're going to more open places on the dial ... you have more gatherings ... all those projections are put into this model. ... And more."

Gujral: With the variant, the reproductive number is much higher. The transmission is going to be greater. "Hopefully, everybody will keep up ... wearing their masks and social distancing."

Weaver: "We all certainly hope that, but we want to work to make it so. ... If we let our guard down, and not much down, a little bit ... we could be looking at April numbers in the ballpark of where we are today...?"

Weaver: "As we look at changing our dial policies, we really want to be careful."

It's a "difference of thousands of deaths," in the state, Weaver says. (With an assist from Zayach)

Weaver: Since Dial 2.0 represents "substantial" change from where we are now — opening up much more stuff — what's your concern?
Zayach: My concern is much less after talking to the Colorado School of Public Health.

Zayach: "It's not going to make enough change in our state for us to exceed our capacity in any of those scenarios."

That's bc high-risk older adults are being vaccinated, Zayach says.

"If those predictions in the model hold. ... those numbers are looking pretty stable."

"We'll have more cases in our community, but it is not going to result in exceeding ICU or hospital capacity," Zayach says.

Brockett: How many more ppl are likely to die even if we don't hit ICU capacity?
Zayach doesn't say; he'll share that number with council

Friend: "I'm struggling with putting the two pieces together. On one hand, we're saying batton down the hatches. On the other, we're saying it's OK to loosen."

Zayach: "I think the rationale and reasoning is, we're seeing really significant and serious impacts on ppl's health from both sides of this."

Zayach: "It's really a no-win situation. We have serious economic, social and health impacts. And we have people dying" from COVID

Gujral restating in a dif way: We're going to have more cases, but fewer ppl being hospitalized and dying.

Not super comforting when plenty of not-old people have died, or gotten sick and have long-term impacts. IMO

Brockett: We just got approved for the 5-star program. If they're in that, whatever level the county is on, those biz can move down one level (even fewer restrictions)

So some biz will essentially be moving two levels down (in terms of restrictions), right? Brockett asks
Zayach: State is still looking at that. Not entirely sure what they'll decide, but no biz will be allowed to operate with 0 restrictions.

Young asks about the Johnson&Johnson vaccine, which will be one dose. Less effective (60-70%) and still under review, but looking "really good," Urbina says. Maybe more effective in younger age groups.

Young suggests tying looser biz restrictions to mandatory paid time off for employees to go get a vaccine.

With all the changes from the state, Weaver says, we'll have gone from essentially Level Red — lockdown, outdoor dining only — to Yellow in 6 weeks, and some biz will go to Blue through 5-star program: very few restrictions.

"This causes me great concern," Weaver says.

Weaver: "I'm flagging this for all of us. Everyone's going to need to watch it. This could move quickly."

He asks if we should change how the 5-star program works since the state is changing the dial system.

Zayach: By the end of this week, 70% of our 70+ year olds in BoCo will have received one dose of the vaccine. "That's a game changer for us."

Zayach: In BoCo, our 5-star program requires more than what's required (from the state, I assume)

Weaver: "I had someone in my close family die in the past week, and they had received the first dose of the Moderna vaccine. It takes awhile to confer the protection. I think we need to take with a grain of salt the first-dose numbers."

"I'm all happy we're getting our 70+ vaccinated. But that means we still have to be careful for the next month or two," Weaver says. "There are still elderly members of our community who are going to be in danger."

Urbina: To get full protection, you need both doses. Two weeks after the second dose to get full immunity.

Joseph: We talk about hesitancy. I think part of it is misinformation. Being a Black person, I've heard ppl in my own family say they're not going to take the vaccine bc of Tuskegee.

"Having ppl who look like you, who can bring you the information is very different from looking at the internet," Joseph says.

Weaver with one more point before we wrap up: Sometime in the summer, the general public will start being vaccinated. "We really do need to keep on all the things we've been doing."

@threadreaderapp please unroll. Thank you.