5:00 PM 4/9/20 Update
For tonight’s update we have chosen to change the format and post a letter from Incident Command. As always, the By the Numbers spreadsheet will be updated with live information here.
A Letter from the Incident Command
We are receiving tremendous feedback regarding the maintaining of Gunnison County’s Public Health Order to Gunnison County residents and non-residents. The 5th revised Gunnison County Public Health order (PHO) issued April 3 prohibits all visitors (including non-resident homeowners) from visiting our county. Individuals may apply for an exemption by the Public Health Director online at covid19.gunnisoncounty.org. The PHO also eliminates the ability for any group size outside of immediate residence, from gathering. Further, the PHO requires all Gunnison County residents who leave the county for any period of time to self-isolate for a minimum of seven days upon return to Gunnison County.
Here is the “Why” behind the importance of maintaining the current Public Health Order:
- Safety: Gunnison is a poor choice to weather this storm given the huge impact higher elevations have on this respiratory illness, especially for individuals who are currently living at a lower altitude.
- Gunnison Valley Hospital has limited capabilities in caring for critically ill patients.
- There is significant community spread of the novel coronavirus (COVID-19) across the state and nation.
- Thirty percent of the public appear as asymptomatic carriers. The state of Colorado as well as the Centers for Disease Control (CDC) are calling for a time of isolation for each community.
- Gunnison County residents have responded to the early PHO by changing behaviors, limiting their activities and making a difference in the community by reducing the spread of COVID-19 throughout the county.
High-country environments amplify the physiologic impact of COVID-19
Gunnison County and the Crested Butte area range in elevation from 7,700 feet to 10,000 feet. Living at this elevation poses stress to the body in many ways, especially for unacclimated individuals. It takes a minimum of one month to build up additional red blood cells to deal with the lower barometric pressure of living at elevation. It can take months to fully acclimate. Some individuals will not acclimate or require medical support to acclimate. While there is still 21% atmospheric oxygen present at elevation, at 8,000 feet there is roughly 73% of the available oxygen compared to sea level. Crested Butte has approximately 68% of the oxygen present. The top of Mount Everest has 30% available oxygen.
In ordinary conditions, most people enjoy these higher-altitude situations. However, many individuals with cardiopulmonary medical conditions, among other preexisting conditions, often feel the negative stress living at elevation and find themselves in the emergency room at Gunnison Valley Health with a prescription for oxygen and order to descend to lower elevations. Even dropping down to the “The Mile High City” of Denver can be hugely beneficial.
COVID-19 is a lower respiratory tract illness that attacks the lung parenchyma. This anatomical tissue is responsible for gas exchange at the cellular level to the bloodstream. The lungs become clogged with mucus, fluid and inflamed tissue. This is a fancy description for the disease process of severe pneumonia, which COVID-19 causes. Those with many preexisting medical conditions as well as people in the 60+ club are at great risk of hospitalization or death if they contract COVID-19. Oxygenation of vital organs becomes a huge challenge made increasingly difficult in our high-altitude environment.
The virulence and danger of COVID-19 in Gunnison communities cannot be overstated.
Gunnison has limited capabilities in caring for critically ill patients
The Gunnison Valley Health hospital (GVH) is a 24-bed, critical-access hospital with limited resources. There is no Intensive Care Unit (ICU). Any critically ill patient, especially a patient requiring ventilator support, is transported via ambulance or air-medevac to larger medical centers in Grand Junction or Denver. Denver is 200+ miles away, which requires a 12-hour ground transport. Grand Junction is 130 miles away, which requires a transport of 6-8 hours. This is a major strain on EMS services in transporting critically ill individuals who require an exhaustive amount of care and personal protective equipment–gowns, N95 masks, HEPA filters, ventilator support, anesthesia, etc.
GVH has increased its capacity by 1,000%, building nine additional negative pressure rooms. These rooms are designed to care for the highly infectious. Additional ventilators have been purchased by the respiratory therapy and emergency department (ED) programs as well as the ambulance service (EMS).
Approximately 20% of all COVID-19 patients will require hospitalization. GVH does not have a certified ICU and has every intention to transfer all critically ill patients to higher levels of care at a lower altitude. Only under the most austere of situations would GVH keep a ventilated patient–a worst-case scenario situation that they have prepared for, but want to avoid at all costs. GVH had a record number of intubations placing critically ill respiratory patients on ventilators; nine patients were placed on ventilators in a 10-day period last week of March. This is an unheard-of volume of respiratory-failure patients in a small rural town like ours.
If the Public Health Order is lifted at this time, or relaxed to allow our 8,500 second homeowners and tens of thousands of vacationers to enter our county, a second spike could overrun our already strapped health care system. Yes, the health care system is in good shape at this time, but at our early peak, we managed four critically ill in a 24-hour period, which not only stressed our local resources, but also created the necessity for three separate air medevac programs to assist in the triage and transport of these ventilated residents. As this pandemic begins to hit our larger cities, transporting the critical patient to city ICUs will become less likely. Denver has built a 2,000-bed makeshift hospital at its stadium in anticipation of a major hospital bed shortage. Littleton in Colorado has created a 1,000-bed makeshift hospital.
Additional carriers entering Gunnison County
We are entering our best months in Gunnison and Crested Butte as the snow melts and spring sun brings welcome warmth. Our population normally doubles to triples. This opens the door to tremendous additional carriers entering the region. One of the greatest challenges with COVID-19 lies with the asymptomatic. Research is clear that asymptomatic COVID-19 carriers increase spread and a likely resurgence of the virus.
Gunnison Public Health and GVH are working tirelessly to bring more rapid testing options to our population to look for herd immunity, clusters of the virus and to assist in focusing the current Public Health Order in a scientific and strategic way. We aren’t there yet. We are close.
At this time, we must continue to prevent non-essential travel from adding to the already high carrier load we experienced early in the spread of COVID-19 through Crested Butte and Gunnison.
How long will this Public Health Order last?
We don’t know. The current Public Health Order is in effect through April 30. Albeit, these orders won’t and can’t last forever. This is temporary.
Evidence is suggesting we have leveled off from our peak (see Graph 1 below). The current Public Health Order is absolutely slowed the progression of COVID-19 in our region and prevented a total run on our health care system–as seen in neighboring counties. Our Public Health Order is working and being emulated around the country as one of the most successful models. Lifting the Public Health Order early has demonstrated in many pandemics an equal and furious return to disease. Lifting orders early is a mistake. We must continue to hunker down and focus on improved community testing as well as our future recovery effort. Additionally, most of the nation has not yet hit their virus peak, now predicted at mid to late April–but there are still huge unknowns from the Centers for Disease Control and Prevention (see Graph 2 below).
Allowing thousands of possibly contagious individuals–especially the asymptomatic–could be disastrous for our county as hospitals downstream of Gunnison become saturated with patients. We could be placed in a position to care for critically ill in Gunnison as seen in many other communities; New York, Washington and the state Louisiana have fully saturated health care systems. As talented and dedicated as our hospital staff are, GVH is not equipped to care for long-term ventilated ICU patients.
What has Public Health and the Emergency Management Team accomplished?
The Gunnison COVID-19 Incident Management Team’s three primary objectives were:
- To protect the health care system from a surge of sick individuals
- Protect at-risk populations from the spread of COVID-19
- Provide timely information to the public
Tremendous work was achieved to shore up our system:
- March 10, Seven-days-a-week call center established for locals to screen for COVID-19 and answer questions
- Five-days-a-week drive-thru COVID-19 testing for vulnerable populations initially
- Proactive Public Health Order to stop community spread
- Near doubling of EMS capacity between GVH EMS and Crested Butte Fire/EMS
- Huge increase of nursing and hospital staffing
- $852,000 spent to date in response to COVID-19 shared among the hospital, the county and all municipalities
- March 7, Standing-up of the county Emergency Operations Center (EOC) and Incident Management Team, comprised of individuals from nearly every municipality and public service group in Gunnison and Crested Butte
- GVH hospital construction of 10 negative pressure rooms, a 1,000% increase from one negative pressure room
- 248 volunteers worked 1,275 hours to deliver groceries to at-risk homes
- Tens of thousands in donations to the Community Foundation to help the local economy and provide for COVID-19 response
- Strong Science and Research Group creating projections and modeling
- Standing-up of a 20-40 bed alternate care site hospital overflow at the local fairgrounds–Fred Field Center
- Daily communication with the public and creation of a Health and Human Services website with daily briefings, videos and conference calls for community stakeholders
- City of Gunnison and County Economic Recovery Group in full swing preparing for a regional response to open our communities back up as the Public Health Order begins to change
We care about all of our community members
Residents, part-time residents and visitors are all of equal value to us in Gunnison County. We all contribute to the historic and magnificent vibe of Crested Butte, Somerset, Curecanti, Marble, Gunnison, Pitkin, Ohio City, Almont, Arrowhead and all those places that some of our families have lived in or visited for generations. Attempting to reduce our population to a manageable size is for the safety and protection of all. These are unique and brutal times. This Public Health Order requires a few months of pain that we haven’t needed to experience for a century. Hopefully as scientific advancement and technology improves, our nation won’t need to repeat this event for another century or millennium.
Our No. 1 priority at this juncture is to maintain the Public Health Order while the rest of the state and country begin to peak with hospitalizations. Our No. 2 priority is to continue developing an approach to adjust the Public Health Order with the goal to responsibly open the Gunnison and Crested Butte economies back up.
We are asking all of our neighbors, friends, visitors and residents to practice grace towards one another at this time. This is a new and alarming situation. Mistakes as well as great strides are accomplished daily. We are exceptionally confident in the shared management, remarkable community collaboration and inspiring leadership of this extraordinary effort to preserve life and get through this pandemic as quickly as possible.
For more information, visit Gunnison County’s COVID-19 website at covid19.gunnisoncounty.org.
Gunnison COVID-19 Incident Management Team
Graph 2: https://covid19.healthdata.org/united-states-of-america