Level yellow could be weeks away for 5-Star businesses

Post-holiday disease spike appears to taper off, but counties' data still in red zone

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In mid-December, businesses across Colorado saw state officials throw them what appeared to be an extra lifeline with the arrival of the “5-Star” program to allow them to operate with expanded capacity if they followed stepped-up COVID-19 safety protocols.

More than a month later, in some counties, that extra boost hasn’t materialized. And higher capacity for 5-star businesses may not arrive for weeks, one local public health leader for Adams, Arapahoe and Douglas counties says.

Gov. Jared Polis' unexpected announcement in late December that all of Colorado's “level red” counties would move to level orange restrictions rendered the 5-Star program temporarily irrelevant, causing confusion for business owners and local governments.

The 5-Star program allows qualifying businesses to follow restrictions that are one level less severe than they otherwise would need to based on their county's level on Colorado's color-coded COVID-19 “dial.” Before Polis' announcement, businesses in red counties expected to get the OK to operate at the looser orange restrictions by earning 5-Star certification, which involves following strict coronavirus-prevention protocols.

Polis' move of red counties down to orange sparked the possibility that 5-Star-qualified businesses could now operate at even more-relaxed level yellow rules, but that proved to be out of reach for most places across the state.

“I think it was very confusing and especially for counties that had received the approval for the 5-Star certification program or counties that were preparing to apply,” said Jennifer Ludwig, deputy director of Tri-County Health Department. “It really put us in this strange space.”

The state's COVID-19 dial is the set of restrictions counties must follow based on local virus spread. Level red, a relatively new addition that took effect Nov. 20 in metro Denver and other areas of the state, banned private gatherings and indoor dining at restaurants, and tightened capacity limits at some types of businesses. Red is the second-highest level next to purple, a stay-at-home order. Eventually, more than half the state's 64 counties operated in level red.

Amid pushback from some counties and businesses against the level red restrictions, the state rolled out its 5-Star State Certification Program, modeled after a system Mesa County had “pioneered and has successfully run since the summer,” according to the Colorado Department of Public Health and Environment.

The first step to increased business capacity under the program was for counties to apply for approval from the state public-health department. After that, businesses in approved counties still must apply for certification and have their buildings inspected — and generally must follow requirements such as daily symptom checks for employees, recording customers' names and contact information to support contact-tracing, and opening windows to maximize airflow, among others.

Amid the scramble for some local governments and businesses to apply, the blanket move to level orange came as an abrupt reshuffling of the process.

Some thought: “'Businesses were opened (further) in level orange, so what's the benefit of 5-star?' It caused a lot of confusion,” Ludwig said. “I do think people felt that, 'Why are we going to have the dial if we're not going to follow it?'”

The COVID-19 dial public health order — the document that outlines how the dial works — does give the state public-health department flexibility in choosing to change a county's level, Ludwig noted. A county's level usually depends on local rates of new cases, how many COVID-19 tests come back positive and the trend in hospitalizations.

But “CDPHE reserves the right to move counties one or more levels more quickly as circumstances warrant,” one part of the public health order says.

Getting to level yellow

Citing improving virus trends, Polis on Dec. 30 announced he told the state public-health department to move counties from red to orange effective Jan. 4 even though many didn't meet requirements for the orange level according to the dial system.

Starting just before that announcement and continuing after it, the state saw a spike in the rate of daily new COVID-19 cases. Asked whether the recent uptick was due to holiday gatherings or the move to level orange, Ludwig said “it was probably a combination,” noting that “we had Christmas and New Year's and restaurants opening back up for dine-in.”

The State Joint Information Center, which takes questions for the state public-health department, said there “isn't any evidence at this time that moving counties from red to orange contributed to any significant increases.”

The tide may be changing again: Since Jan. 9, the seven-day average case count has trended downward, the Joint Information Center said on Jan. 20.

But the recent upward turn in data put the benefit of 5-star certification further out of reach for many counties. Although the state manually moved counties to level orange, counties still must meet the orange requirements in earnest before 5-star certified businesses can operate one level lower — at level yellow — according to the state public-health department.

Counties should meet the orange marks for local rates of new cases, also known as a county's “incidence rate,” which is measured over two-week periods. They also need to meet thresholds for percent of COVID-19 tests come back positive and the trend in hospitalizations. Incidence rate and the test-positivity rate should be sustained for seven consecutive days, according to the Joint Information Center.

For orange counties hoping for business activity at yellow restrictions, that means tamping incidence rates down to 350 new virus cases or fewer per 100,000 people.

In Douglas County as of Dec. 30, that rate was still too high at 398, but with cases and hospitalizations appearing to improve, the county was expected at the time to hit the mark within roughly a week. 

Trends took a different turn. As of Jan. 19, Douglas County's rate sat at 436, according to Tri-County data. Arapahoe posted a 491, and Adams sat at 492.

Jefferson County sat at 383 and Denver at 448, according to the state’s website.

And although nearly all of Colorado is operating in level orange, the majority of counties — including Adams, Arapahoe, Douglas, Jefferson and Denver — still sat in red territory based on incidence rate. As of noon Jan. 20, Broomfield and Elbert counties' 5-star businesses were operating in yellow restrictions, according to the Joint Information Center. Those appeared to be the only such counties, according to Colorado's COVID-19 website.

But Tri-County Health's area — Adams, Arapahoe and Douglas — is on the right track, Ludwig said.

Asked when 5-Star-certified businesses will have low enough metrics get to operate at yellow, Ludwig said, “I think we're several weeks away,” adding that Tri-County's area may hit the mark sooner if residents adhere to coronavirus precautions well enough.

“Since (early January), all three of our counties have been coming down at a really great pace,” Ludwig said. She added: “We did not have as big of a post-holiday spike as expected.”

The Tri-County area saw “a huge decline” in the number of businesses applying for 5-Star certification after counties were moved to level orange, Ludwig said, but the area has since seen a “slow and steady” trickle of applications.

Arapahoe, Douglas, Elbert, Jefferson, Broomfield and Denver were among the counties approved for the 5-Star program, but Adams was not, as of Jan. 20.

Revert to red may be unlikely

Although many counties still show level-red virus trends based on incidence rate, health officials appear unlikely to move counties back to red restrictions unless the trends take a severe turn.

“I think it would have to get significantly worse,” Ludwig said. “And if numbers started to increase at a dramatic pace in which we were very nervous or we started seeing hospitalizations increasing to a point of not having ICU (intensive-care unit) capacity, I think the state health department would be having conversations about what needs to take place.”

Asked about possibly moving metro Denver counties or others back to red, the Joint Information Center said: “We need to find the delicate balance between protecting public health and doing what we can to provide much-needed economic relief — we know that economic hardships also cause poorer health outcomes. We will work closely with local public health agencies and will make decisions based on what best protects public health.”

Asked whether the dial system's benchmarks for incidence rate should be changed and whether the levels don't accurately reflect what restrictions ought to be, the center's statement said:

“Throughout the pandemic, we have updated policies based on new information and data available to us. Counties were moved from red to orange to provide much-needed economic relief and because we believed we could do so while also protecting public health. If we see a significant increase or decrease in disease transmission, hospitalizations and positivity rates, we will evaluate next steps.”

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