Monday, April 6, 2020

COVID-19 roundup for April 6: State updates crisis guidelines in case of shortages

Posted By on Mon, Apr 6, 2020 at 6:37 PM

click to enlarge ZIGRES / SHUTTERSTOCK.COM
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The number of confirmed COVID-19 cases in Colorado now stands at 5,172, with 150 deaths and 994 hospitalizations. El Paso County leads the state in deaths from the virus (28) despite ranking 5th in overall cases (441). The new figures include data through Sunday, April 5.

In response to the COVID-19 pandemic, the Governor’s Expert Emergency Epidemic Response Committee voted Sunday to update the state’s crisis standards of care guidelines. The revised recommendations and policies could determine which patients receive life-saving care and equipment should supplies run low and hospital capacity run thin.

The standards are recommendations for how the medical community should allocate scarce resources — like ventilators and intensive care unit beds — in extreme cases when patient needs exceed available resources.

In the most dire circumstances, the governor or a designated public health official may declare a public health emergency, at which point crisis standards of care would be authorized, "sanctioning the provision of medical care at levels of quality that would otherwise be significantly less than optimal,” according to a Sunday statement by the Colorado Department of Health and Environment (CDPHE).

Colorado developed crisis standards of care recommendations in 2018, but they’re not specific to COVID-19.

According to the statement from the CDPHE, a “recent American Hospital Association webinar on COVID-19 projected that 5 percent of COVID-19 patients would be hospitalized, 40 percent of those would be admitted to the ICU, and 50 percent of the ICU admissions would require a ventilator. The majority of patients with COVID-19 who experience respiratory failure require mechanical ventilation for more than 12 days.

”Experts have been working to update Colorado’s standards in the event they need to be activated during the pandemic. Several sub-groups reviewed the content, and community feedback and engagement were used to update these recommendations.
Details about the updated crisis standards of care include:
  • A triage team should consist of: an expert on ethics or palliative care; an attending physician familiar with critical care (for example, a hospitalist or critical care physician); a representative of nursing staff; and a representative of the hospital's leadership.
  • The primary medical team caring for a patient should not be involved in crisis triage decision-making for their own patient. Each institution should create a crisis triage team that is objective and removed from the patient.
  • Triage teams should not base decisions on factors clinically or ethically irrelevant to the triage process, such as:
The primary medical team caring for a patient should not be involved in crisis triage decision-making for their own patient. Each institution should create a crisis triage team that is objective and removed from the patient.
Triage teams should not base decisions on factors clinically or ethically irrelevant to the triage process, such as:

  • race
  • ethnicity
  • ability to pay
  • disability status
  • national origin
  • primary language
  • immigration status
  • sexual orientation
  • gender identity
  • HIV status
  • religion
  • veteran status
  • "VIP" status
  • criminal history
  • When PPE is scarce, health care providers may extend the use of or reuse some PPE, or may use alternate equipment to provide some protection from disease transmission.
  • Each hospital should have a crisis triage team that will be activated in a crisis when a hospital approaches its minimal operating capacity for resources like ventilators. The triage team should use a tiered approach for allocation/re-allocation of scarce resources like ventilators. In the event of a tie within a tier, the triage team should move to the next tier of considerations.
Tier 1: A scoring system based on a combination of acuity or severity of acute illness (the likelihood of surviving weeks) and morbidity, or measures of chronic illness (the likelihood of surviving months to years).

Tier 2:
Pediatric patients, health care workers and first responders.

Tier 3: Special considerations (pregnancy, life-years saved, sole caregivers).Tier 4: Random allocation.The CDPHE is recommending that all Coloradans have an advanced directive that is shared with their loved ones. An advanced directive, also called a living will, can name a health care power of attorney and outlines what kind of medical interventions a person does or does not want. “It is the best way to take control and ensure your wishes are carried out should you be unable to communicate them to a doctor,” the CDPHE statement said. 

The workgroup that updates the standards aligned Colorado's guidelines with the National Academies of Sciences, Engineering, and Medicine's Rapid Expert Consultation on Crisis Standards of Care for the COVID-19 Pandemic, published in March 2020.

A fact sheet about the crisis standards of care for hospitals for the COVID-19 pandemic can be found here. The crisis standards of care documents are available here.

In other news:

El Paso County Public Health has issued a local order to reinforce compliance with state orders regarding staying home and physical distancing.

The county order, the agency said Monday, serves as a reinforcement of the CDPHE orders to “reiterate their importance." The order does not call for residents to wear masks, as Governor Polis asked — but didn’t order — all Coloradans to do on Friday.

As for enforcement, El Paso County “continues to focus on education, outreach and voluntary cooperation as the preferred approaches to gaining compliance to the Stay At Home order, but a protocol has been put in place for the issuance of a criminal summons in cases where voluntary compliance cannot be obtained,” according to the health department.

The agency continues to receive a high number of calls on the enforcement of the CDPHE Stay at Home Order regarding both business and individual activities. Public Health strongly advises all residents to follow CDPHE’s Order and stay at home except for necessary activities or critical business.

Anyone who wants to report a business operating illegally should contact El Paso County Public Health at 719-578-3167. Continued violations by businesses can result in citations and possible fines and/or jail time, but El Paso County Public Health fully expects voluntary compliance by all businesses. People can also file a report with the Attorney General’s Office at

The Pikes Peak Joint Information Center issued guidance Monday for using face masks to help slow the spread of COVID-19.

The agency’s guidance is as follows:

When to use:
• In light of new evidence, the CDC recommends wearing cloth face coverings in public settings where other physical distancing measures are difficult to maintain.
• It is critical to still maintain the six feet of physical distance while wearing a mask to slow the spread of the virus.
• Bring a cloth face covering with you whenever you leave the house in case you encounter a place where physical distancing is difficult to maintain (e.g. grocery stores, pharmacies, crowded outdoor areas).
• It is acceptable to forgo wearing a mask while walking on a trail or riding a bike if you can maintain physical distance from others.

Make sure the mask:
• Fits snugly, but comfortably against the side of the face
• Is secured with ties or ear loops and include multiple layers of woven fabric
• Allows for unrestricted breathing
• Is made at home from common materials such as an old T-shirt, scarf, bandana or hand towel.

The recommended cloth face coverings are not surgical masks or N-95 respirators. Those are critical supplies that must be reserved for health care workers and other medical first responders, as recommended by current CDC guidance.

When using a mask:
• Wash your hands before putting on a face mask.
• Do not touch eyes, nose, and mouth while wearing the mask.
• When done, carefully remove mask to avoid touching eyes, nose and mouth.
• Wash hands immediately after removing.
• Routinely wash in a washing machine, depending on the frequency of use.

Cloth face coverings should not be placed on:
• young children under age 2;
• anyone who has trouble breathing;
• anyone who is unconscious or incapacitated;
• anyone otherwise unable to remove the cloth face covering without assistance.

City and county officials are also seeking masks that comply with Polis’ recommendation.

“Because first responders are out serving the public every day, there is a need for thousands of masks for our public servants. Anyone who has the skill set and the desire to help our community, is encouraged to help make and donate cloth masks,” the agency said in a Monday news brief. The Colorado Mask Project offers guidance and mask patterns.

Cloth mask donations will be accepted Tuesdays and Thursdays, from 1–4 p.m., at the Pikes Peak Regional Office of Emergency Management, 3755 Mark Dabling Blvd., Colorado Springs, 80907.

The Colorado Springs Parks, Recreation and Cultural Services Department has adjusted its policies and procedures for the municipal golf courses of Patty Jewett and Valley Hi to accommodate golfers during the state stay-at-home order. The courses opened for play on Sunday. The policy changes include the exclusive use of online tee times and payments, with no walk-on play permitted. The courses will be open for walking play only. Use of rental carts and other equipment has been suspended and shared touchable surfaces — including bunker rakes, ball washers, water stations and scorecards — have been removed. Clubhouses are closed for public use and food and beverage service is suspended. The driving range is also closed and the practice area is open only to those with tee times, available 10 a.m.-5 p.m. daily.

Gov. Polis and a handful of local government executives representing Colorado Counties Inc., the Colorado Municipal League, Colorado Counties Acting Together and the Special District Association of Colorado released a letter Friday urging Colorado’s federal delegation to ensure “robust budget relief for state and local governments” in future stimulus packages regarding the COVID-19 pandemic.

"As you look toward the Phase 4 stimulus package, we stand united as state and local partners on the front lines of this crisis, urging you to include at least $500 billion in direct, robust and immediate State and local aid,” the letter reads. “Absent this assistance, the State of Colorado and local governments who are directly helping Colorado's communities respond and recover from the impacts of this public health crisis, will face an unmitigated economic crisis."

Catholic Charities of Central Colorado, The Salvation Army in Colorado Springs, and Fuel Church have launched a mobile feeding program for those in the Colorado Springs community without access to hot meals. The program will distribute meals three times per week throughout the month of April.

Catholic Charities has volunteered to provide all the food and Fuel Church will be making the meals, which will then be distributed from The Salvation Army’s Emergency Disaster Services Truck.

The Salvation Army truck will be located at Dorchester Park, 1130 S. Nevada Ave., Mondays and Fridays 1-3 p.m., and at West Side Cares, 2808 W. Colorado Ave., on Wednesdays 1-3 p.m. To help support the program, contact Catholic Charities of Central Colorado (719-636-2345 or, The Salvation Army Colorado Springs (719-636-3891 or or Fuel Church (719-373-1882 or

UCHealth Memorial Hospital has trained about three dozen health care workers for new roles as Personal Protective Equipment specialists. Many of these employees typically work in surgical areas, according to a UCHealth statement, but will be moved to other key positions during the pandemic. The specialists will play an active role in ensuring that frontline staff — nurses, physicians and other caregivers — stay safe. UCHealth said they'll be “instrumental in spotting problems in how PPE is being used, educating caregivers about proper use in real time and helping them properly don and doff equipment to avoid any potential exposure.”

Their responsibilities will include anticipating and planning for risks associated with PPE, participating in daily infection control phone meetings, helping with cleaning of shields and other equipment, and ensuring a proper stock of equipment on carts. The specialists will be available 24/7 on units with COVID-19 patients.The U.S. Small Business Administration has clarified eligibility for faith-based organizations to participate in paycheck protection and economic injury disaster loan programs. All faith-based organizations impacted by COVID-19 are eligible to participate in both programs with no restrictions based on their religious identity or activities, to the extent they meet the eligibility criteria outlined in the CARES Act.

According to the SBA, the Paycheck Protection Program is designed to keep small business workers employed and provide small businesses with capital through the nation's banks and other lending institutions, with support from the SBA. The program’s maximum loan amount is $10 million with a fixed 1 percent interest rate and maturity of two years. The SBA will forgive the portion of loan proceeds used for payroll costs and other designated operating expenses for up to eight weeks, provided at least 75 percent of loan proceeds are used for payroll costs.

The Economic Injury Disaster Loan program provides qualifying small businesses and non-profits with working capital up to $2 million with low interest rates and terms extending up to 30 years.

The COVID-19 testing site in El Paso County, sponsored by the Federal Emergency Management Agency, has expanded to include testing for individuals over the age of 65. The site has been providing testing for health care workers and first responders and will now do the same for individuals over 65 who have symptoms of COVID-19 like fever, cough or shortness of breath. The testing site is open from 9 a.m.-5 p.m. at 175 S. Union Blvd, in the back parking lot. Qualified individuals will be tested, regardless of insurance status. There is no cost for the testing, and no need to have a doctor's prescription to receive testing. Individuals need to bring a picture ID and insurance information only if they have it. It is a drive-through site and individuals will not exit their vehicles for testing.

A member of the Colorado Unified Command Group working at the State Emergency Operations Center has tested positive for COVID-19. The staff member went through daily medical screenings and was asymptomatic until April 4 when symptoms started. The staff member then contacted executive leadership and self-isolated pending testing arrangements. Test results are positive and CDPHE is conducting a full epidemiological investigation to evaluate the level of exposure in the UCC.

The Colorado Springs-based nonprofit Partnership for Clean Competition PCC — which funds more than 70 percent of the world's anti-doping research — announced Monday it will help fund COVID-19 research through one of its most frequent collaborators. The project, according to a statement by the PCC, will provide community testing and results for 15,000 people in highly-affected areas of the United States. The Sports Medicine Research and Testing Laboratory in Salt Lake City, Utah will partner with the University of Southern California, Stanford University, and local boards of health to conduct the community testing. The PCC will allocate $120,000 to fund the test kits. Testing will be conducted in early April.

The Colorado Supreme Court has denied two emergency petitions requesting the court immediately issue guidance to safely limit the number of people arrested and booked into jail, held in jail pretrial on unaffordable money bond, and held on certain sentences. The Office of the Colorado State Public Defender, Colorado Criminal Defense Bar and the Office of Alternate Defense Counsel filed the petitions and the ACLU of Colorado, Colorado Criminal Justice Reform Coalition, Disability Law Colorado, Colorado Lawyers Committee and the Lawyers Civil Rights Coalition joined as parties in interest. The court dismissed the petitions on Friday, they same day they were submitted.

El Paso County residents can now renew their license plates at a self-service kiosk inside five local King Soopers stores. Three recently added Colorado MVExpress kiosks are at the King Soopers stores at: 1070 W. Baptist Road, 7915 Constitution Ave., and 3620 Austin Bluffs Pkwy. Kiosk services were already available at two other King Soopers locations at 6030 Stetson Hills Blvd. and 2910 S. Academy Blvd. The Clerk and Recorder's Office has now expanded the kiosk service for vehicle registration renewals to a total of nine locations, which includes four Clerk's Motor Vehicle offices and the five King Soopers locations.Peak Vista Community Health Centers is temporarily relocating the its health center at Rio Grande to the Spring Rescue Mission campus to protect people experiencing homelessness from the ongoing spread of COVID-19.

Peak Vista will be providing primary medical and behavioral health care, COVID-19 testing and transportation assistance to those in need. According to a statement, Peak Vista and Springs Rescue Mission share a common goal to protect those most vulnerable during the pandemic and will collaborate to take care of nearly 600 people daily. Peak Vista will provide services Monday through Friday from 8 a.m.-5 p.m. at the Springs Rescue Mission campus at 5 W. Las Vegas St.

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