Public health officials are prepared to move quickly in event of new COVID-19 cases | SteamboatToday.com
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Public health officials are prepared to move quickly in event of new COVID-19 cases

Michele Lewis, public health nurse with the Routt County Public Health Department and a team of other public health officials administer tests for COVID-19 during a drive-through community testing event. The events will continue every Wednesday and Saturday through May. The location has not yet been announced.
John F. Russell

STEAMBOAT SPRINGS — The official number of positive COVID-19 cases in Routt County has actually decreased in recent weeks as the Colorado Department of Public Health and Environment has reassigned several of the earliest cases to the counties where those people live. Those include the county’s very first two cases, which were identified on March 13 in a daughter and father visiting from out of state.

By reassigning cases to a person’s place of primary residence, the information no longer reflects where the person contracted the virus or where they were tested, said Routt County Director of Public Health Kari Ladrow.

The seven Australians who tested positive after returning back to their home country were never included in Routt County’s numbers, she said.

Ladrow emphasizes that intensive contact tracing has been going on from the very beginning, though much of the information discovered through contact tracing is not made public.

With the Australians, however, Ladrow said health officials still don’t know where or how they contracted the virus. They weren’t in the county for very long, but there were so many of them — about 30 — and they went many different places while they were here, she said.

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In the case of the father and daughter, they likely did not contract the virus in Routt County, Ladrow said, but most likely contracted it elsewhere from a close contact of someone who was a known positive.

As the state collects more data and refines their methodology, the local COVID-19 numbers can look a bit confusing. They now also include probables, which were identified by the state health department through contact tracing.

Probables must meet one of four criteria: a person who had symptoms and known close contact with a positive case; a person who had symptoms and a positive antibody test; a person with an epidemiologic link and a positive antibody test; or a person who died with COVID-19 listed as the cause of death or significant contributing factor but who never had a test.

The epidemiologic link is defined by the state health department as someone who had close contact with a confirmed or probable case; someone who travelled to an area with sustained, ongoing community transmission; or someone who is a member of a risk cohort as defined by public health authorities during an outbreak.

“We are very familiar with every case,” Ladrow said of Routt County’s more than 60 positive cases. And while that contact tracing process has always been solid, she said, “It is better and more solid now.”

That process of investigation becomes all the more crucial as things open up, residents move around more and interact more and visitors come into the county.

One of the provisions of the recently approved variance that allows restaurants in Routt County to open to in-person dining is that restaurants will be required to keep a record of table assignments and seating and departure times. This information will have to be made available to the local health department upon request for contact tracing.

While some specific stores and restaurants in the Denver area are being publicized as sources of outbreaks — which is two or more cases — Ladrow said it is preferable for officials to be able to work one-on-one with business owners to follow through with the contact tracing.

“It is about the close contact, not the location,” she emphasized.

The more information they are able to get directly, the less need there is for more publicly visible outreach, she said.

Another critical part of contact tracing is working to identify asymptomatic carriers, Ladrow said. The most recent positive case — a staff member at Casey’s Pond identified on May 18 — was asymptomatic. And that was only caught because of the regular mass testing happening at the senior living complex in Steamboat Springs.

The contact tracing of that case is still an ongoing investigation, Ladrow said, and she was not able to say whether the staff member contracted it within the walls of Casey’s Pond.

“Finding asymptotic carriers is a positive thing in disease containment,” Ladrow said, adding that it gives officials a much better chance at mitigating further spread.

The county is now encouraging people without symptoms to get tested, so that a screening of asymptotic as well as symptomatic people can begin.

Ladrow also encourages anyone who is interfacing with the public on a daily basis to get tested. The county’s community testing days are not at capacity, she noted.

“We would like to get better data for the whole community throughout the county,” she said. “We would also like to get more data on asymptomatic carriers.”

The statistic for deaths also now include probables, which increased Routt County’s deaths from five to six.

There are two separate systems for recording deaths, Ladrow explained.

There are the Centers for Disease Control and Prevention’s vital records, which is based on the coding of death certificates, and the expert judgment of health care providers and coroners. In that database, the numbers come from death certificates where COVID-19 is listed as the cause of death or a significant condition contributing to death.

Then there is the state’s epidemiological death data, which reflects people who died and also had COVID-19. That data comes from health care providers and laboratories that report cases to the state using a national case definition and from state-reviewed death certificates where COVID-19 is listed as the cause of death or a significant condition contributing to death. Those death certificates may not have been coded by the CDC.

The sixth death attributed to COVID-19 in Routt County was someone who was never tested for COVID-19, Ladrow said, but the state health department reviewed the death, along with county officials, and determined it fit the criteria for a “probable” COVID-19 death.

As of May 22, the county’s data lists 59 total COVID-19 cases out of 1,748 tests administered. Five of those are listed as probables.

While at this moment the county is maintaining a very low incidence of the virus, moving forward, “a baseline of zero is somewhat unrealistic,” Ladrow said.

Containment is the critical goal as new cases appear, she said.

And local health officials will be looking very closely at any clusters of cases in order to move forward quickly on contact tracing and figuring out who to immediately test.

Those next cases will also become a crucial part of the metrics officials use to measure whether the lifting of restrictions is moving either too quickly or too slowly, Ladrow said.

The restaurant variance approved Sunday by the state comes with the warning that if there are 26 new cases in a week, the variance is automatically rescinded.

In addition to continuing to adhere to the preventative measures like social distancing, hand washing and wearing masks, Ladrow encourages people to help with the contact tracing.

“Being available and receptive to the contact tracing process will help us be more successful as a community,” she said. “The more actively people are involved in contact tracing, the more that increases our chances for success in disease containment.”

And as people from other parts of the state, country and globe come into Steamboat, Ladrow encourages local residents to be mindful if and when they travel outside the county.

“It’s sort of a double standard if we expect people not to come to us,” she said, if Routt County residents are traveling to other places.

In addition, people traveling need to be mindful of what they could potentially be bringing back to Routt County.

“We are in this for the long haul,” Ladrow noted. But she also fully acknowledges that “people are ready to move on with their lives.”

“We are in a much better place now than we were in the beginning,” she said of the county’s testing ability. “I can’t even begin to describe how frustrating and discouraging it was not to be able to test the way we wanted.”

Ladrow described a proactive and unconventional approach county officials took to obtain testing supplies, especially in being able to get into Casey’s Pond early and aggressively.

“It’s a hard time for all of us,” she said. “But the commitment of the entire community is paying off with low incidence of disease.”

To reach Kari Dequine Harden, call 970-871-4205, email kharden@SteamboatPilot.com or follow her on Twitter @kariharden.


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