by Rae Ellen Bischel, Kaiser Health News
San Juan County, Colorado, can claim 99.9% of the eligible population has received at least one dose of the COVID-19 vaccine, according to data from the Centers for Disease Control and Prevention, placing it among the top 10 counties in the nation .
If vaccines were the only shield against the spread of COVID, then on paper, San Juan County, with its 730 or so residents on file, would be one of the most bulletproof places in the country.
Yet the past few months have shown the complexity of this phase of the pandemic. Even in a highly vaccinated location, shots alone are not sufficient because the geographic boundaries are porous, the effectiveness of the vaccine may decrease over time and the delta variant is highly contagious. Infectious-disease experts say masks are still necessary to control the spread of the virus.
The county made its first hospitalization of the pandemic in early August – this year, not 2020. Five summer residents were hospitalized. Three ended up on ventilators: two recovered and the third, a 53-year-old woman, died in late August. All were considered unconnected.
Those cases, and even those that didn’t require hospitalization, raised the alarm for the county with a single incorporated city: Silverton. It is a former mining community in the mountains of southwestern Colorado, where blizzards and avalanches often block a lonely road passing by.
“The pandemic is still ongoing,” said DN Gallegos, the county’s public information officer and director of the local Chamber of Commerce. “We kept thinking it would be over before this summer. Then we were thinking November. Now we’re like, ‘No, we don’t know when.'”
So the county decided to back down: “We went back to the equipment we knew we had,” Gallegos said. “The mask is mandatory indoors and then discourages indoor incidents.” Outdoor events continued, such as a brass band concert on the steps of the Courthouse, and the area’s signature Hardrockers holiday mining competition, which featured pneumatic machining and spike driving.
Overall, once the under-12 set is taken into account, 85% of the county’s total population is fully vaccinated. But in the summer, the population nearly doubles as seasonal residents move to second homes and RV parks, some taking vacations while others working seasonal jobs. Then, there’s what Gallegos describes as a “tsunami of tourism”—the daily influx of people arriving from Durango on the historic railroad and dusty jeep trails through the mountains. Many of those visitors are of unknown vaccination status.
The county’s two-week incidence rate reached the highest rate in the state in August, and remained there for most of the month. Even though that spike totaled about 40 known cases, it was about the same as the county logged during the entirety of the pandemic – and cases spread to vaccinations as well.
Any number of cases in a small space without its own hospital would be a big deal. “We’re all a one-man band trying to make it happen,” Gallegos said. For example, the county’s director of public health, Becky Joyce, does everything from contact tracing and COVID testing to shot in arms. And when the county revamped its facade mandate, it was Gallegos who designed the signs and spent his weekend zip-tying around town.
The largest concentration of COVID cases occurred in an RV park and a concert operated indoors by the rain.
“It makes sense that people who worked at restaurants in RV parks were starting to get sick just by coming out of three or four weeks of jam tourism,” Gallegos said. “And then you bring all the locals together for a couple of nights of concerts and it was just the trifecta.”
Dana Chambers, who runs a hardware store in Silverton, was vaccinated as soon as possible. She said returning to a mask mandate felt like “a step back” in some ways. But, she said, businesses like hers need the rush of summer tourism to escape the cool winters, when there are only a few hundred tourists, who largely come from helicopters to jump over the ski area. “If we have to wear masks, that’s what we’ll do.”
Julia Raifman, a Boston University School of Public Health epidemiologist who has been following the state’s pandemic policies, is not surprised that COVID could strike a place like San Juan County, despite high vaccination rates.
Data shows that vaccines protect against death and hospitalization due to COVID. But even effective vaccines do not match Delta’s transmittance. Because of the recent spread of the virus, Raifman said, “Even in the best-case scenario — if vaccines reduce transmission by 80% — you’re actually twice as likely to get COVID now as in July.” have chances.” “It is statistically impossible to achieve herd immunity with the delta variant.”
Meanwhile, many local and national leaders, including Colorado, continue to focus almost exclusively on vaccines as the way forward.
Talia Quandellessi, an epidemiologist at the University of Colorado-Denver and the Colorado School of Public Health, said in this pandemic the concept of herd immunity has been simplified and over-reliant. “It’s a useful guide to have some sort of goal for the target,” she said. “But usually, if we hit a certain metric, it doesn’t mean that transmission or an epidemic is going to disappear.”
Many scientists agree that, especially with much of the world still unvaccinated, COVID is likely to be here, eventually turning into something more like the common cold. “It’s probably a matter of a few years,” Quandlessi said. “But that seems to be the trajectory we are on.”
For this reason, the “Finnish line” language used by many politicians has disappointed Anne Sosin, who was the Nelson A. Rockefeller Center for Public Policy studying COVID and Rural Health. Vaccines are doing what they’re supposed to do — keeping people from getting really sick, never protecting them from getting infected — but it hasn’t been well communicated. “The messages around it are not very nuanced,” she said.
She pointed to the experience of an epidemiologist who wrote in The Baltimore Sun in August that she had caught COVID at a house party where all 14 guests and the host were vaccinated. The host had infected him and nine others. Sosin said of vaccines, “As miraculous as they are at keeping people alive and out of hospital, we cannot rely on them alone to prevent infection.”
And public health experts said San Juan County shows that measures like masks, ventilation and distancing are also needed. They are channeling the “Swiss cheese” model of COVID defense, with holes in each containment measure (or layer of cheese), but when stacked together they form an effective defense. Sosin said rural locations, in particular, may need those layers of defense because residents are often tightly connected, and diseases travel quickly within social networks.
The public health director, Joyce, who declined an interview request, wrote on Facebook in August that the county’s recent experience proved that “the vaccine creates a line of defense but does not make us invulnerable to this disease or variant Is.”
Rifman views this realization – paired with San Juan’s impending need for indoor masks – as a breakthrough at a crucial moment. The month-long mandate was then lifted on September 10, as the county fell back to a low COVID transmission rate. At the time, it was the only county with such low transmission in Colorado.
“This is the moment where we define: How are we going to manage the virus over the long term?” Raifman said. “Until now, we’ve been defining that we don’t manage it; we let it manage us.”
Even after removing its mask mandate, the county’s Department of Public Health’s Facebook page urges residents to wear masks and “pay attention to the COVID-19 situation as you pay attention to the weather.”
Kaiser Health News is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.
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