Behind the reopening action: science team recommendations

Important to manage the virus going forward

By Mark Reaman

One set of recommendations the county is relying on to gauge how fast to reopen Gunnison County in the midst of the COVID-19 crisis is the data and conclusions of its Investigative Science Section. Nine individuals with science, medical and statistics backgrounds analyzed the local data and came up with suggestions on how to safely reopen business in the valley.

A guiding goal as stated in the group’s report to Gunnison County Public Health director Joni Reynolds is to minimize the probability of overwhelming the local health care system, defined as approximately 10 simultaneous hospitalizations for COVID-19.

The team stated in a cover letter, “The Gunnison health care system is the entity best positioned to articulate the appropriate rate and number of hospitalizations. While our conclusions are robust to modifying this number, we expect that the Gunnison health care system will want to refine this number. If further analysis by the local health care system identifies a more precise management goal substantially different than this, we would be happy to update the report.”

The science team did not want to present Reynolds with rigid “do’s and don’ts” about reopening the county. “We wanted to create a framework to help you analyze a series of steps Gunnison might take, without suggesting too rigid an approach, especially given how quickly we are learning about the disease and how rapidly the situation on the ground is changing,” the team’s cover letter explains. “We recognize that not all these recommendations will, or should be, adopted in the opening phase, and that you and your team may identify ways to safely open the community that we have missed.”

The report made clear that if the valley opens too soon and the virus is not adequately contained, it could lead to more mayhem and then further extended closures. The recommendations are focused on the first phase of opening. The team warned that a new wave of sickness could descend on the valley if care is not taken.

“There is strong potential for a second wave of infections of equal or greater severity if the virus is not carefully managed,” the report emphasizes. “Gunnison County is unlikely to stop transmission with herd immunity acquired through transmission.… Because the likelihood of an infected at-risk person of developing severe symptoms is so high relative to other groups, protecting our at-risk individuals will be critical to not overwhelming our health care system.”

The team laid out a series of measures to contain the virus as restrictions are loosened. “The primary mechanisms for limiting transmission of the disease involve minimizing the introduction of disease to Gunnison County from communities with higher rates of infection (movement), reducing contact between infected and non-infected individuals within the community (social distancing), using hygiene to reduce the likelihood of transmission of disease when an infected individual comes into contact with a non-infected individual and protecting at risk individuals who have a much greater likelihood of death or severe health problems if infected,” the report states.

As far as allowing non-resident homeowners back in, the team said that would be fine as long as the people followed appropriate protocol and isolated themselves from “at-risk” individuals for seven days.

Prioritizing protection of at-risk populations will reduce the area’s risk of overwhelming the healthcare system if transmission rates increase.

Moving forward, social distancing continues to remain extremely important. “Social distancing is important because asymptomatic or pre-symptomatic individuals are capable of transmitting the virus. By reducing their contact with others, we can reduce transmission rates,” the report to Reynolds states. “Most important, a single instance of one highly infective individual interacting with a large group of people could lead to rapid imposition of potentially prolonged closures for the entire county. Consequently, we recommend being highly cautious around group size until we know more about transmission, and have greater capacity to implement contact tracking.”

Because of that, the group recommends indoor group and events should be limited to no more than 10 people at first. Outdoor gatherings could include more than 10 people “but only if there is a strong plan for ensuring that the 6 feet social distancing requirement is maintained and that any one individual is realistically not coming within the range of 6 feet of more than 10 individuals.”

The continued wearing of facemasks is recommended, as is continuing to wash your hands.

While the team recommends that bars remain closed, their report says businesses that are able to maintain social distancing and hygiene requirements are encouraged to open because of the need to get the economy moving again. Some exemptions would be allowed and the report specifically mentions that religious organizations might be able to have groups of up to 25 gather under certain circumstances. Child day programs would be permitted but not overnight children’s programs such as summer camps.

The report encourages businesses to come up with their own plans on how to meet health and safety requirements and submit them to the county for certification. That way, business owners can use their skills to meet the parameters of the public health orders and open up to customers.

Other observations noted in the report are that public health orders that followed the initial changes resulted in greatly diminished transmission; most of the county’s severe cases are experienced by men, older people, or people with conditions that put them at risk; there is an approximately 13-day lag between the peak of when people reported first experiencing symptoms and the peak of people who were in the Gunnison Valley Hospital or another hospital; and a survey by the school of at-risk children revealed little to no significant problems.

As for monitoring, the report says by analyzing self-report data of individuals who test positive and/or randomly sampling self-report individuals who by current protocols are not tested, we may be able to link self-report data to testing.

It also suggests, “If we can acquire appropriate cell phone data we will be able to track changes in social contacts on a rapid basis, anticipating potential changes in transmission rates, including the impacts of updated health orders.”

Members of the Investigative Science Section  include Ian Billick, Jennifer Hoeting, Jason Hogan, Julie Marshall, Jeff Moffett, Erik Niemeyer, Mike Pelletier, Hannah Heinrich and William Spicer.

The cover letter to Reynolds, penned by Billick and Niemeyer, concludes, “Given how rapidly we are learning about the disease, both within our community and across the world, once we are ready to move beyond reopening, we recommend taking a fresh look at what is known about the virus and updating this analysis accordingly.”