Must-Read Q&A with Vail Health’s Chris Lindley: ‘COVID-19 is Here to Stay’
This article first appeared in Real Vail on April 16, 2020.
Yes, Eagle County has “beat the peak,” so to speak, bending the curve of coronavirus infections and COVID-19 cases that threatened to overwhelm the local health care system a month ago, but health officials want to make it very clear that the virus is here to stay and all the measures put in place to turn back the tide of infection must also stay in place.
Vail Health and Colorado Mountain Medical have achieved a nearly 5% testing rate in the Eagle River Valley portion of Eagle County – conducting 2,162 COVID-19 tests as of Thursday morning among the 45,000 or so residents of the valley that runs from Red Cliff to Dotsero.
That’s a testing rate of about 4.8% as of Wednesday afternoon, with 498 confirmed cases and four deaths. The other two Eagle County deaths were of residents of the Roaring Fork River Valley section of Eagle County (Basalt and El Jebel) and therefore not patients of the Vail Health/CMM system.
The fatality rate of Eagle River Valley portion of Eagle County is .86%, which is well below the national fatality rate of 4% of confirmed cases, according to Vail Health’s Chris Lindley, an epidemiologist who’s executive director of Eagle Valley Behavioral Health.
As of Wednesday, Vail Health had just one COVID-19 patient in the hospital, and that patient was close to going home. No one is on a ventilator with the disease, and the last time anyone was transported to Denver for care was two weeks ago, Lindley said.
One of the biggest reasons a basically rural hospital with just 53 beds was able to flatten the curve and avoid being overwhelmed was the local economy, including the two local ski areas, shut down overnight on March 15, sending seasonal workers and tourists back home.
The population dropped from anywhere between 100,000 to 200,000 people during peak season to 55,000 permanent residents (45,000 in this valley and 10,000 in the Roaring Fork Valley). But the local economy is based on hosting those big crowds in winter and summer.
RealVail.com caught up with Lindley and Vail Health spokeswoman Sally Welsh Wednesday afternoon for a discussion of what it will take just to get back to a “new normal” of business in Eagle County. Here’s a Q&A based on that conversation:
RV: Will we have to wait for serological [antibody] testing to be available in the late summer or early fall to really give people the confidence to resume business in a tourism-dependent valley?
CL: The national story on testing is very different than our local story, so we want to clarify that. We’re trying to … get the idea out there that regardless of what testing is available today or becomes available, we all have to start living with the notion that COVID-19 is here to stay. It is endemic in our community and will remain in our community and will remain transmitting at some low level until there’s a vaccine.
That message and that education is critically important. I’m a little bit fearful that folks think whether they get a serological [antibody] test or they somehow get [COVID-19] now and test positive and recover that they’re in the clear, that they won’t get it again and that there’s no risk. The truth is we don’t know. We do not know what the immunity of this is.
Traditionally, when you’re exposed to a virus, with all viruses, you develop antibodies and those antibodies live with you for a period of time and if you’re exposed again to the virus, those antibodies will fight off that virus for, again, a period of time. With COVID-19, we do know in fact that you develop antibodies and that’s why they’re creating these new tests, these serological tests. But we don’t know how long those antibodies stay with you and how much protection they provide.
No one’s studied this. This is a brand-new novel virus. And so no one knows what the answer is. And so regardless of if someone has the antibodies for COVID-19 or has recovered from COVID-19 infection, we want everybody in this community to continue to practice healthy hand hygiene, healthy social distancing, staying home when they’re sick, not being around folks that are sick, and, probably most importantly right now until there is a vaccine, really protecting the vulnerable population — limiting the time we spend with grandma and grandpa and folks that have underlying health issues from obesity to diabetes to immunocompromised things.
COVID is here to stay. We now have to learn how to live with it. And we’re not going to be able to stay in our homes forever. We need to transition out of our homes, and we need to transition out safely and appropriately, and testing in this valley is a great way to do that.
RV: How will testing make that happen, and how did it help us beat the peak?
CL: So we got our first [positive] result back on March 6, and one thing we did that was and still is to this day very unique is we did not follow the national testing criteria or even the local testing criteria because we believed that the virus was already here in our community circulating and we began testing because we are an international destination, have so much travel and it was during the peak time here in this community. So we tested very broadly. That is one of the reasons why we have so many cases is we’ve been very aggressively identifying those cases in the community. We’ve actually tested more on a per capita basis than any community in America. In fact, there’s only one country that has tested more than us on a per capita basis, Iceland. It’s actually now 4.8%. It’s just under 5% as of today [Wednesday].
RV: It’s been widely reported Eagle County has had six deaths from the disease so far, but you’re reporting four deaths. Please explain.
CL: Four of them have been within our larger patient population – the Colorado Mountain Medical, Vail Health systems. The other two have been outside of our patient population, so we don’t know about them, nor have we cared for them or tested them
SW: Chris, that 4.8% of population tested, is that only people that have been tested by Vail Health and CMM?
CL: We’re only looking at our testing. There’s been more testing in this valley, but we can’t report on it because we haven’t done it. So we don’t know how many tests they’ve done. So private labs and other primary care providers, Valley View [Hospital in Glenwood], groups like that are also doing testing. Centura was doing testing. But we’re not reporting on those. This is just what we’ve done. So it’s much higher than what we’re even reporting, because we’re only reporting our own
SW: And our testing is done at both the state lab and a commercial private lab?
CL: So we started off using the state lab because that was the only lab available. And we’ve now transitioned to a commercial lab. We’re using Quest and we’re solely using Quest right now and Quest is turning around the results very, very quickly.
RV: So that early logjam in diagnostic testing has been solved to some degree, at least locally, but what’s happening nationally with serology testing for antibodies?
CL: That is massively log jammed. Nobody is getting them anywhere. The national message is antibody tests or serology, whatever you want to call it, is going to be available. And we’re all going be able to take it and we’ll know if we’re protected or not. That is not true. They’re not available. They’re tens of millions behind demand. Every community has requested these and has ordered them, as have we, and we don’t know for sure when we’re going to get them. So we don’t want to put out any false idea that it’s going to be available in this community because we don’t know when it will be available. But the point is, it’s not necessarily needed in this community. We have not turned away anybody who wants to be tested [for COVID-19].
We have a great genetic test in place that we’ve had since March 4th, we’re getting results now in a day to two days max. There was a time period where it got backed up where the national labs were having some issues, but now the results are very quick. We also have what we call a point of care test, which is a rapid test also looking for genetic material that we can do on site. We’ve had it here all week and we can get results from that in about 45 minutes. And so we have a few different mechanisms and abilities to test. And we, again, are testing anybody that feels like they need to be tested.
We’re also seeking or going out and aggressively testing in other neighborhoods. With MIRA [Bus] we’ve taken now MIRA to every mobile home community in this valley and now we’re starting to think about where else we could deploy near us. And next week it’ll be in the Lake Creek Apartments [in Edwards], and we’ll be at the gas station down in Gypsum. So we’re trying to do everything we can to bring the testing to the communities and get folks tested.
Not rapid, we’re doing our standard tests. You have diagnostic tests, and you have results in 24 to 48 hours. Where we’re using the rapid testing is in our hospital and in our clinics where we need to know right away if somebody has got it.
RV: So if someone has symptoms, they can get tested and then if they have the disease, they can isolate and keep other from getting sick?
CL: We have nothing holding us back from doing quick identification of those that are sick, that then need to be isolated to ensure they don’t infect any other people. You hit it exactly right there. That’s really what we’re trying to clarify.
RV: Talk to me about masks.
CL: We’re actually delivering masks via MIRA to everybody we test in those communities, so we’re distributing masks. Our entire marketing team has been working with local businesses and different organizations to help distribute masks. We’ve had a large group of people that started making homemade masks with very good material. We’ve also been donating a lot of masks and so we’ve been working really hard to get masks out.
SW: Now, as of [Wednesday], we have over 15,000 masks that have been made, either the cotton or the blue masks, with over 2,200 delivered to our clinics and then 6,200 to essential businesses and partners in Eagle County. And then we’ve provided over 600 to MIRA to take to those community members that they are testing in those neighborhoods. And they have even taken some of those masks over to Basalt, so sharing throughout all of Eagle County.
CL: We have both CMM and Val health clinicians that are doing the testing on MIRA
SW: And our staff, the CMM and VaIl health clinicians, are the ones that follow up with them once the results come in as well. And they are also the ones that if someone tests positive, they have been doing the follow-up calls with them to see how they’re doing.
CL: They been very receptive, and we continue to do testing every time we go out. The good news is the testing volume is going down, but that’s because the illness in the community is also going down, so that’s good.
RV: What other numbers do we need to know?
CL: The percentage of tests that come back positive continues to decrease and we’re now on week three of seeing the continued decrease of the percentage of those tests we send in coming back positive. When this thing was really active in our environment, when coronavirus was really spreading actively in the community, 30 to 35% of all the tests that we were doing were coming back positive for coronavirus and in just the last five days, that’s now below 8%. We are really excited about that. That shows that the great work of social distancing and people washing their hands and doing all the measures that public health has asked them to do are really, really paying off.
RV: How quickly will be able to start figuring out the “new normal” of reopening out economy?
We’re all going to learn together and the crawl, walk, run analogy is one we’re using ourselves. We do feel [good about] our ability to rapidly test and our ability with public health to isolate and quarantine those that do get sick. Again, people will continue to get sick and we’re going to have to continue to practice these great new [measures of] hand hygiene and staying home when you’re sick and isolating when you’re sick and really protecting the vulnerable population.
But we have to balance this, and we have to get this economy working again and it’s going to take all of us. It’s the business leaders, it’s public health, it’s the county commissioners, it’s the governor and a lot of this will weigh heavy on local public health decisions that they’re going to have to make and are going to roll up to Colorado Department of Public Health and Environment, Jill Ryan and [Gov.] Jared Polis. They’re all close partners and Jill is a resident here and good friend and we look forward to working with her and her team. We’re looking forward to working with them to find the most appropriate way to do that. But we feel like because we are kind of an isolated bubble here, hopefully we can get started earlier than maybe some other places that are two or three weeks behind us and we can learn how to do some of these new measures and can share those with other communities.
RV: But if we go back to the way we used to do business, will we go right back to having our hospital nearly overwhelmed?
CL: We’re not going to go back to that. It will be a new normal.
SW: And I think as we look ahead, we kind of can do what we have been doing in the last few months, which is looking to other states or other countries that are ahead of us and kind of see how they’re integrating back and what this next step might look like.