Colorado surpassed 10,000 deaths from COVID-19 last week, but more than 2,900 of those came since the start of July, according to preliminary data from the Centers for Disease Control and Prevention. Those who died in the subsequent months were slightly younger than in previous waves, and the vast majority were unvaccinated.
Russell Thompson's uncle, Albert Martinez, was one of them.
Martinez, of Denver, died earlier this month after a short battle with the virus. He was 62 and had experienced lung trouble for years, but was more worried about the vaccine than the disease, Thompson said. It's an attitude he sees in others, including some who insist COVID-19 wasn't really what killed Martinez, he said.
"I know people who still don't believe it, and it's insane," Thompson said.
Despite many people's perception that COVID-19 is no longer a threat, the virus caused about 14 percent of all deaths in Colorado since the more-virulent delta variant took over in early July, according to the CDC data. That's similar to earlier stages of the pandemic — about 12 percent of all Colorado deaths between mid-March 2020 and the end of June 2021 were caused by the virus.
Even with the ongoing fifth wave, however, Colorado is in the bottom 10 states for COVID-19 deaths, compared to population. Almost every state has experienced an increase in hospitalizations and deaths since summer, and it's not clear how much severe illness the new omicron variant will cause as it starts to compete with delta.
In a statement, Polis said the state's COVID-19 death toll would have been significantly worse if fewer Coloradans were vaccinated. About 70 percent of Colorado adults had received at least one dose when the current wave began. Now, nearly 69 percent of eligible Coloradans — those 5 and older — are fully vaccinated.
"This pandemic has caused pain and challenges for families and kids across our state — every death is a tragedy and a loved one," Polis said. "Misinformation and disinformation have preyed on far too many Coloradans, making them unnecessarily the victims of COVID's most severe outcomes even though it was easily prevented."
Experts believe the virus's toll will gradually decrease over the coming years, as more people are vaccinated or survive the disease and develop some level of immunity. How long that will take, and how many more people will be lost, will depend on a combination of human behavior, biology and luck.
The other question is what level of death most people will decide is tolerable, said Beth Carlton, an associate professor of environmental and occupational health at the Colorado School of Public Health and a member of the state's COVID-19 modeling team.
People accept some flu deaths each year as a cost of keeping everything open during the winter months, but the current level of death from COVID-19 is much higher than what we've normally tolerated, she said.
"It's this constant tension," Carlton said. "How do we balance this need for infection control and to have a functioning society?"
Victims Were Younger, Mostly Unvaccinated
The people lost in the wave that started in July were younger, on average, than those who died earlier in the pandemic.
Older people are still at a higher risk of dying from COVID-19, and those 75 and older accounted for about 44 percent of deaths in the current wave, according to data from the Colorado Department of Public Health and Environment. That's down significantly from an average of 62 percent in previous waves, though, indicating deaths among middle-aged and younger people aren't as rare as they once were.
High vaccination rates among older people helped to limit the death toll, and fewer people would have died if more had received the shot, state epidemiologist Dr. Rachel Herlihy said. Even when the virus got into long-term care facilities in the last few months, it didn't cause nearly the rate of severe illness and death that it did in 2020, she said.
Nearly three-quarters of Colorado's COVID-19 deaths in October — the most recent month with full data on the vaccination status of those who died — were among the unvaccinated.
Jackie Washburn's son Ryan, 44, was one of those victims.
Washburn said she got vaccinated and urged Ryan to do so, but he believed conspiracy theories that the vaccine contained a tracking chip, and thought his active lifestyle would protect him.
"I said, 'Ryan, do you think the government wants to know where a 70-year-old woman goes? I go to Walmart,'" she recalled.
After he contracted the virus in October, Ryan couldn't eat more than a few bites at a time because of nausea, loss of taste and other symptoms, Washburn said. He went to the emergency rooms of two Colorado Springs hospitals, which turned him away because they determined he wasn't sick enough for a bed when they were so close to capacity, she said. One ambulance also declined to transport him, before his oxygen levels dropped enough that a second ambulance crew determined he needed emergency care.
Ryan's doctors and nurses said he seemed to be on the mend, though his oxygen needs kept increasing until he had to be intubated, Washburn said. He had a heart attack during his first night on the ventilator and died a few days later, on Oct. 31.
While there's no way to be certain, Washburn believes Ryan might have survived if he'd been able to get a bed sooner. Hospitals across the state were nearing capacity as they attempted to deal with an increase in patients with COVID-19 and other illnesses, with fewer nurses and other frontline staff than they had during previous surges.
It's difficult to lose a child under any circumstances, but what makes it worse is that Ryan's life finally was coming together after some youthful missteps, Washburn said. He'd recently gotten married and bought a house for his four children, and he was always there if someone needed help, she said.
"I have a strong faith and I know that he's at peace and in paradise. But I sure do miss him," she said, her voice breaking.
Low Vaccination Rates, Delta and Pandemic Fatigue
A year ago, when the first COVID-19 vaccines arrived in Colorado, it seemed unlikely the state would be worried about hospital capacity again.
Cases and hospitalizations were both dropping precipitously from the early December peak of the third wave. Instead of worrying about whether the state could run out of hospital beds, officials talked about when there would be enough doses available for everyone who wanted the shot and who should go first.
"In December of 2020, with the new vaccines being released... we at the state said that by fall of 2021, things will be much better," said Dr. Eric France, chief medical officer for Colorado's public health department. "I think by the summer it was less of a surprise" to see another wave.
More people hesitated to take the vaccine than expected, with demand plateauing after a rush in the first months that shots were available. Still, the level of immunity in the state was enough to significantly limit the damage from the fourth wave, in spring 2021, even as the state was loosening restrictions.
Colorado wouldn't be so fortunate with the delta variant, which was first detected in Mesa County in early May. Delta was more contagious than alpha — the so-called U.K. variant first identified in Colorado late last year — and displaced it within a month. It also brought an increased risk of breakthrough infections among vaccinated people, and caused more-severe disease in those who were still unvaccinated.
Scientists don't have one clear explanation for why some waves prove self-limiting while others cause so much more illness and death, Herlihy said. Seasonality is one factor. So is the virus's tendency to run through the susceptible people in an area with a large wave of infection, die down to more manageable levels and flare up again when it encounters another large group that's not immune, she said.
By late summer and early fall, immunity was starting to wane for people who'd been vaccinated over the winter or recovered from the virus last year, while more than 1 million people remained unvaccinated and potentially vulnerable.
"That's a lot of people for the virus to infect and kill," France said.
The desire to get back to normal and the effects of the delta variant compounded to produce "catastrophic loss of life" in Colorado and around the country, said Carlton, the associate professor at the Colorado School of Public Health.
"Delta ended up being much more virulent and making people a lot sicker," she said.
That wasn't immediately obvious, though, and a week after the first delta cases were found, Polis largely lifted the mask mandate, declaring it applied only to unvaccinated people in certain settings, like health care facilities.
The state rapidly got a preview of what delta might do, though, as Mesa County intensive-care units were pushed to capacity by early June. About two weeks later, Herlihy warned unvaccinated people were "more vulnerable than ever."
Still, Polis declared the state's public health emergency was over on July 8.
"Our hospital capacity is no longer in jeopardy," he told The Denver Post at the time.
Within two months, that was no longer the case. By late August, some hospitals already reported they were delaying non-emergency surgeries to free up space, and the number of patients being treated for COVID-19 was at levels last seen in mid-January.
In response, Polis issued an order requiring state employees in settings like health facilities and prisons to get vaccinated and asked the state Board of Health to require almost all workers in the health field to do the same.
Still, by mid-September, the state had fewer beds available in intensive-care units than it had during the worst of the fall 2020 surge, and the odds any given person was contagious with COVID-19 were at their highest levels of the year. State officials urged Coloradans to get booster shots to reduce the odds of breakthrough infections. They also encouraged everyone to wear masks in indoor public spaces, though Polis ruled out a statewide mandate.
Colorado didn't take more aggressive measures until early November, when Polis announced the state was calling on the Federal Emergency Management Agency for staffing help; opening booster eligibility to all adults; and expanding access to monoclonal antibody treatments, which reduce the odds a high-risk person with COVID-19 will be hospitalized.
It's not clear if those measures made the difference, but hospitalizations began to fall shortly before Thanksgiving. Between early July and the peak, more than 2,500 people had died. More died in the following weeks, as some of those infected earlier lost their battles.
There's widespread agreement that states couldn't return to lockdowns, said Lisa Miller, a professor of epidemiology at the Colorado School of Public Health. It's difficult to know if the outcome would have been any different if the state had taken the actions it did sooner, or had taken other steps like mandating masks again, she said.
"I think researchers will be looking at these questions for years," she said.
The level of death many states saw wasn't "inevitable," given the relative success countries like Canada have had in limiting mortality, said Dr. David Dowdy, an infectious disease epidemiologist at Johns Hopkins University. Canada has recorded about 80 deaths for every 100,000 people, and the United States' rate is roughly three times that.
Given the difficulty getting people to accept new public health measures and an unwillingness to comply with the more-restrictive precautions used last year, though, states may not have had many options to reduce their death tolls, Dowdy said.
"In a perfect world, many of those deaths would have been prevented, but we don't live in a perfect world," he said. "It's unlikely that Colorado could have kept itself safe while (the virus) was raging in the rest of the country."
How Many More Will We Lose?
Experts agree that the SARS-CoV-2 virus is unlikely to ever be eradicated, meaning it will continue to cause some harm for the foreseeable future. How much depends on how many people get vaccinated, or get a booster shot; how long immunity lasts; how virulent future versions of the virus are; and what level of death people are willing to tolerate before accepting restrictions again.
"The right balance is not no death. The right balance is less death than what we're having now," Dowdy said, citing public tolerance of flu deaths.
Colorado isn't close to bringing COVID-19 deaths down to seasonal flu levels, though. In 2019, the state lost 468 people to flu or pneumonia across the multi-month season — roughly two weeks' worth of deaths from COVID-19 this November.
The state isn't likely to vaccinate everyone who remains susceptible any time soon. While uptake has increased any time a new variant is announced and when hospitals are filling up, there's a natural plateauing with any new vaccine or treatment after the most-eager people have received it, France said.
While some counties reinstated mask mandates until hospitalizations came down, there's little appetite for any restrictions at the state level. Polis has pushed booster shots and announced plans to add 500 staffed beds in hospitals and facilities like nursing homes, to ease the strain on capacity. He's largely framed illness and death among the unvaccinated as the result of free choice.
"I have no qualms if (unvaccinated people) have a death wish, but they're clogging our hospitals," the governor said at a press conference in early November.
It's unclear what the newest variant, omicron, will bring. Models from the CDC projected two possible scenarios: a large wave of cases, possibly peaking as soon as January, or a smaller wave topping out in the spring. Omicron is more contagious than delta and more likely to cause breakthrough cases in people who were vaccinated or reinfect those who recovered from a previous variant. Some early data suggests it may cause less-severe illness, but that's not certain at this point.
Over time, waves of the virus are expected to become less severe as more people develop some level of immunity, Dowdy said.
"This wave is not as bad as the one before," he said. "I think we should just accept the reality that they're going to happen."
(c)2021 The Denver Post Distributed by Tribune Content Agency, LLC.
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