3 years after pandemic emergency, Colorado normalizes COVID care

Exactly three years after Gov. Jared Polis — on March 10, 2020 — issued a disaster emergency declaration related to the pandemic, Colorado still has one remaining executive order in place to support the state’s efforts to mitigate COVID-19. 

Polis hasn’t issued any new declarations relating to COVID since he ended the health emergency executive order and originally issued a disaster recovery order in July 2021, and he has only continued to renew that executive order on a monthly basis. 

The Biden administration announced in January that it intends to end all remaining federal emergency declarations relating to COVID-19 on May 11, and Polis’ office confirmed that the state’s order would not outlast any federal ones. The main purpose of the order remaining in place is to ensure Colorado has access to federal funding still available because of the pandemic, but the order imposes no restrictions for Coloradans. 

Melissa Dworkin, a spokesperson for the governor’s office, said the COVID Disaster Recovery Order is necessary to ensure Colorado captures as much federal Medicaid match funding as possible. She said this matching has brought “significant federal funding” that’s been essential to Colorado since the onset of the pandemic.

“The state’s Medicaid program received an additional $1.7 billion dollars through December 2022,” Dworkin said in an email. “Colorado is continuing to receive an enhanced federal Medicaid match, though the federal government is ramping down the match rate, and it will return to its pre-COVID match rate in January 2024.”

Scott Bookman, Colorado’s COVID-19 incident commander, said the recovery order has also helped the state move more quickly in response to surges, as was seen last fall with what he called the “tripledemic” of COVID, influenza and RSV, which is another contagious virus that infects the respiratory tract, particularly in infants and children. 

“We were right back into emergency response mode again,” Bookman said. “We were coordinating with children’s hospitals, we opened up our combined hospital transfer center with the Colorado Hospital Association, and so we have still seen great benefit to the flexibility that comes with that executive order.”

The latest update to the disaster order came on March 7, with an additional note that the state’s General Assembly is working on legislation to codify parts of the executive order that keep the state eligible for federal funding. No bills have yet been introduced in either chamber related to this purpose.

Dr. Rachel Herlihy, Colorado’s state epidemiologist, said data shows that COVID hospitalizations over the last few months are much lower than they had been and are becoming relatively stable. Managing the pandemic is different now than it was three years ago, as there’s so much experts have learned about the virus since March 2020, Herlihy said. Now, she said, hospitalization data has become a better indicator of the current situation, with less reliance on straight case-number data. 

One factor contributing to lower hospitalization numbers, Herlihy said, is how everyone’s bodies have changed since March 2020, being at a lower risk now than at the start of the pandemic after multiple vaccines and COVID infections. 

“We know that the virus has continued to emerge, and that’s obviously one of our critical ongoing roles is to monitor changes in the virus over time and understand how the virus is going to potentially change and impact us going forward,” Herlihy said. 

She said the most important thing anyone can do right now to continue to protect themselves against the virus is to get the latest version of the Omicron vaccine. Herlihy said the state’s COVID website will be updated soon to include data on the effectiveness of the Omicron dose of the vaccine. 

Bookman noted it’s been just over a year since the state released its “Roadmap to Moving Forward,” which he said started to bring Colorado away from its emergency COVID response and into a more normalized part of the traditional health care setting. 

“As we move past the three-year anniversary and work toward the end of the federal public health emergency, that’s really where our heads are today is continuing to normalize COVID in traditional systems,” Bookman said. 

Better prepared

At one point, the state had over 150 community COVID testing centers up and running in parking lots, and the same goes for vaccination sites, Bookman said. Now, he said the traditional medical system has built the capacity to take over testing and vaccinations. This also includes the availability of Paxlovid, an oral therapeutic for COVID, at local pharmacies and rapid testing. 

“We knew that would come — this was a novel virus, it was a novel response,” Bookman said. “This is where the state was able to step in, in that emergency response phase, but over the last year, we’ve seen the ability of doctors’ offices to take on testing, to take on vaccination work.” 

Public health workers are now working more behind the scenes, Bookman said, monitoring and preparing to respond when necessary. He said this will continue throughout the year as they evaluate the state’s remaining COVID operational components, like the mobile vaccine clinics the state still runs.

To Bookman, the forthcoming end of the federal public health emergency is another indicator of COVID becoming a normalized part of the health system.

Bookman and Herlihy agreed that the COVID pandemic has made the state’s public health system better prepared to handle future surges or similar challenges that may come up. Bookman said last fall’s “tripledemic” is a perfect example of how public health staff had already met such a challenge, because “we had the skills, we had the muscle memory there.” The same goes for the monkeypox outbreak last summer. 

“The lessons learned from COVID are preparing us to respond to any future set of outbreaks,” Bookman said. 

Herlihy also emphasized how the COVID response shone light on challenges around health equity and how the state adjusted its response to prioritize health equity. 

“We developed close relationships with community partners and engaged them in our response from the very beginning of the response, and I think that made a huge difference,” Herlihy said.