Why Colorado Needs a Statewide Stay-At-Home Order

The CAFP recently issued a formal letter to governor Polis, where we in part urged him to issue a statewide stay-at-home order in response to the COVID-19 pandemic (we also urged him to take additional actions to safeguard the healthcare workforce through better communications and a greater effort to secure PPE).

We are asking for a statewide Stay-At-Home order for three reasons:

  1. Social distancing slows the spread of the virus;
  2. A slower rate of viral infections reduces the severity of the strain on limited healthcare resources; and
  3. Reducing the strain on the healthcare system allows more lives to be saved.

However, in response to our call for this commonsense request, we were baffled to see this objection by a professor of public health:

May Chu, a clinical professor at the Colorado School of Public Health, said a shelter in place order might make sense in denser parts of the state, like Denver and Boulder, but likely isn’t necessary for suburban or rural communities.

“In general, across Colorado, we don’t have a huge issue with density,” she said. “So I don’t think there’s a reason for a statewide shelter-in-place order right now.”

While density certainly plays a role in the speed of transmission, the assumption that density is the primary driver of COVID-19 infections is contradicted by multiple pieces of evidence. Seoul Korea, for example, has a density of approximately 16,000 people per square kilometer — far denser than New York City’s 11,000 people per square kilometer. Despite this, Seoul has managed to effectively thwart the spread of COVID-19, while New York continues to struggle, with new cases doubling every three-to-four days. While South Korea’s extensive testing and tracking systems are a part of this disparity, so too is South Korea’s far greater success in enforcing social distancing on its communities.

The biggest reversal in Seoul’s containment of the virus was when a cluster of infected patients ignored social distancing guidelines and infected hundreds of people. Social distancing saves lives and protects the healthcare system’s capacity to care for the sick.

Per-capita infection rates matter in this calculation, since they indicate how much capacity is available in a local healthcare system, and can suggest how likely a person is to experience community transmission as they go about their day. A higher rate of per-capita infection means fewer local resources and a higher chance of new infections.

Within Colorado, the highest per-capita infection rates are precisely in the rural communities Dr. Chu says don’t need a stay-at-home order. The data show the opposite: these areas desperately need a stay-at-home order. CDPHE has assembled detailed case data at the county level that shows this in action. On a per-capita basis, rural counties in Colorado are by far the hardest hit.

Data compiled by the Colorado Department of Public Health and the Environment and the Colorado State Emergency Operations Center, current as of 3/23/20.

Denver is the only urban area of Colorado to exceed the state’s average rate of COVID-19 infection. Gunnison County, a rural, mountainous region in the southwest of the state, has an infection rate that is nearly 14 times larger than the state’s average. Just as importantly, rural areas of Colorado do not have enough medical personnel or supplies to handle a surge of this size. The longer these areas do not have stay-at-home orders, the longer they will experience high rates of infection while posing serious dangers of infection in neighboring areas as well.

This is why we disagree in the strongest terms with Dr. Chu’s objection to a statewide stay-at-home order. In rural areas of our state, a lack of social distancing is causing severe disruption already and threatening the capacity of the healthcare system to care for the sick.

Issuing a statewide stay-at-home order will not stop COVID-19. But it will slow the rate of infection to a more manageable level, and reducing the strain on lifesaving equipment and supplies will make it survivable for a higher number of people. Pretending the rural areas of our state do not deserve the same protective social distancing as urban areas is not only ignoring the evidence — it places too many people at risk.

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