We are John Daley and Kate Schmiel, the health reporter and editor at Colorado Public Radio. We've spent the past month and a half reporting on and trying to understand COVID-19 in Colorado. AMA!

How have your interactions with local authorities (like health districts, municipalities, policy makers, etc) changed as this has unfolded?

What a great question.

Well, for one, we talk to them a lot more frequently because the information changes so often. So to report a given story, we often circle back to the same person several times to make sure the information we received that morning is still accurate.

We also spend a lot more time deep in the weeds of the numbers they are sharing. I have had a several-week email thread going with state COVID-19 data experts about exactly how to correctly interpret what they're sharing.

At the same time, we are wanting more information right as they are drowning in requests and work. That's particularly true of smaller public health districts or agencies. And so we are sometimes pushing to get critical information more urgently and with less success than we'd like. -KS

Any reason to think altitude is a factor in infection rates or severity of symptoms?

What we have heard from the state is that it likely plays a role more in the severity of symptoms.

We know some mountain communities are hotspots, but that's likely due to early, undetected transmission, including from visitors who came from abroad as well as a lot of mixing in really tight spaces.

As the novel coronavirus affects the respiratory system, the thinner air in the mountains could exacerbate difficulty breathing or oxygenating blood.

Gov. Jared Polis has said in press conferences that some patients are being moved to hospitals at lower elevations for treatment. That said, we have not seen studies yet on the effects of altitude (send us ones if you have!). - KS + JD

alright thanks for the answer, and no I haven't seen any studies on it.

I live in the highlands of Ecuador and cases remain relatively low compared to the coast which is being devastated by the virus. Some people have said it could be related to altitude but no scientists

From Kate:

Aha! That's fascinating. I'd ask questions about mobility and availability of testing first, but don't know much about the situation of those in Ecuador. Given the density of high-elevation Quito, I have to think it's not about that. I'll be fascinated to see how this develops. Certainly here, we've seen lots of cases at high elevation.

From John:

That's fascinating.  And thank you for reaching out from Ecuador!  Do you have a Colorado connection?  I think the most important thing to consider about what places have high numbers or don't is driven by vectors of transmission.  In Colorado, our first cases were in the mountains and just a few people spread COVID-19 to a lot of other people.  Those first few cases all involved some sort of foreign travel.  That's how it made it's way from China to the US. One of Colorado's first cases came via a man who'd traveled to Italy.  In New York, I know a lot of the transmission there initially came not from China but Europe.  Also we know it was floating around in the US perhaps earlier than many people thought.

What would you most like to tell us that you do not see discussed often enough?

From Kate:

Oooh. So much. Let's see. I think the biggest thing I wish people understood on social media and in our audience is to be careful and considerate news consumers.

This is a very good time to read closely and understand the limits of what's being reported. I'd love to see more discussion of the limits of the science and the numbers we have. This is of course coming from a journalist, but it's a great time to come from a place of curiosity and understanding. Ask lots of questions! In the public health sphere, I feel very hungry for more information and discussion of underlying conditions and what the virus actually does to the body. Some reports indicate it has effects well beyond the respiratory system, so the heart and digestion as well. This piece from the Washington Post about that was so devastating and illuminating.

I'd also love more discussion and reporting (ahem, John) on why the medical system in particular has struggled to respond. We've heard so much about supply chains and the political preparations for pandemics. But are we missing something about what happened in hospitals? This is really testing the systems we have. Why were they built like this?

From John:

This is rapidly becoming, or perhaps already is, the most thoroughly covered news story of all time. Or at least seems be.  More than World War II...hmm, I'd have to think about that.  Who knows? 

Anyway, a lot of this has been and is being covered and reported on and discussed.  I think one thing that can't be discussed too often is the power of community and positivity. I realize that sounds really squishy, but humans are nothing if not social beings. That means we are driven by, inspired by, moved by collective action. Sometimes that can be troubling, but what we are capable of by working together is truly breathtaking.  And I think we will and are seeing that now and that will help lead us through all of this. So I look to great examples of people being kind, helping each other, working together. That I believe will make all of the difference. 

For example, if you scroll down to the 9:36 am item in our daily live blog from a few days ago, you'll see a great example of folks expressing gratitude to the front line health workers.  I think actions like this can and will make all of the difference, and probably don't get discussed enough. 

Are marijuana dispensaries considered essential businesses and remained open?

(Asking for a friend)

Yes, both recreational and medicinal marijuana shops are considered essential businesses (and will remain open) under Colorado's stay-at-home order, which ends April 26.

Here's a list of what the order deems as "essential" or "critical" businesses.

I've heard that infection may not confer immunity. Is this true?

This is a really tricky question that we just don't know the answer to for sure yet. The World Health Organization said Monday that they don't know if someone can be reinfected.

There have been reports of people testing positive again after testing negative, but it's not clear that's reinfection or a side-effect of somewhat imprecise testing or some other factor. We'll definitely be keeping a close eye on this. Researchers say this would play a big role in how long and extensive social distancing needs to be: https://www.statnews.com/2020/04/14/some-social-distancing-may-be-needed-into-2022-to-keep-coronavirus-in-check-new-study-says/ -KS

What are the key data points the governor's office and other state policymakers are tracking when considering an end to or relaxation of the "stay home" rule? Are you aware of targets for these numbers that would lead to a change in policy?

The governor's office and state policymakers I believe will be looking at key data points, including hospitalizations, deaths and overall number of cases.  I think the decisions will be guided by when they think they have clearly identified a flattening of the curve.  I'm not aware of specific targets, at least they haven't publicly disclosed any. 

My guess is that it will be based on several factors. Those would also include the availability of supplies and staffing to properly ramp up testing. I think staffing may be something Colorado can control, but supplies is a whole other matter and I could envision a scenario where the overall illness numbers look favorably for an easing of some restrictions but the state doesn't have enough of the needed testing supplies, like swabs and reagents, things like that, that some of the "opening up" could be delayed sooner. 

Two other things: 

1).  So much depends on social distancing.  We could see a quick reversal if people just go back to normal. 

2)  We DO NOT want a second wave.  In the Spanish Flu Pandemic, it was the 2nd wave that was absolutely devastating and that's what they will want to avoid at all costs.  Ideally, the world has learned that lesson and will be very thoughtful as it seeks to return to some sort of normalcy. - JD

Great question. This is one that we keep pushing for more information on.

I haven't seen the state publicly share specific quantitative benchmarks. What they have said is that they are watching certain numbers: hospitalizations (as those predict whether hospitals will be overwhelmed), deaths, and positive case numbers (with the caveat that limited testing means those are limited in usefulness). The governor has also said he's looking at supply chains. Is he confident the state can get the supplies it needs to treat the uptick in patients more social contact would produce? I'll tell you that I am unsatisfied with the specificity of those answers and am hungry for more! We do have what we know laid out in this story:

When Will Colorado’s Coronavirus Crisis End? These Are (Some Of) The Numbers To Watch - KS

Could Covid19 potentially cause any birth defects to babies born to mothers that were exposed to it?

Do you believe Covid19 could “reactivate” in people that recovered?

I've found the folks at Johns Hopkins in Maryland are a great resource for all things COVID and one of the best respected medical institutions. 

Here's some information they published on their website, with a doc saying one of the biggest risks in pregnancy is high fever, so it's something to be aware of and avoided.  It's something that will undoubtedly require more research, which may take some time. 

A comment from Dr. Jeanne Sheffield, a maternal-fetal expert at Johns Hopkins: “As of right now, it’s too early to tell if COVID-19 in particular is associated with pregnancy loss, miscarriage or stillbirth,” she says. “But we do know that high fevers in pregnancy, especially in the first trimester, can raise the risk of birth defects. That is why we encourage our patients to protect themselves from any illness that causes fever, including the flu.” 

Also — the World Health Organization, another very good resource, said the question about "reactivation" is unclear, that not all the people who recover from COVID-19 develop anti-bodies to fight it a second time.  This too will require a lot more research, which will take time.  - JD

With COVID-19 living on surfaces: have there been any surface tests with delivery and carry out items from restaurants to examine the spread of the virus in CO?

Hmmm, good question! I'm not aware of studies on delivery and takeout items specifically. There *have\* been tests done on how long the virus stays in a detectable state on various kinds of surfaces and under different environmental conditions.

I found this one particularly interesting: https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(20)30003-3/fulltext30003-3/fulltext)

This is nerdy as heck but if you go in the supplementary materials of that paper, they have charts showing roughly how long the virus is detectable on paper, glass, masks etc.

TL;DR it lasts a lot shorter on paper materials than on hard ones (or on masks!). So maybe be more careful of plastic containers than paper ones? Maybe? I'm sure I'll say this again in this chat, but it's really important to remember that science is always an ongoing conversation and right now, it's more like a speed-dating round.

There's just so much changing day to day and there's little I can confidently say we know for sure about how the virus behaves. **Our rule of thumb for reporting information is to run it by at least one other researcher, and we typically don't report on a single study. So we look across a body of research and say: What is in common here? What is different? -**KS

P.S. One more thing: When in doubt, wipe it down well with bleach, or high-concentration ethanol/sanitizer. You can find a chart showing what each disinfectant does to detection of the virus in those same supplementary materials 😎

[question] if you got success to make people aware of COVID 19 @ Colorado?? If yes what would you give rating to you and your efforts on scale between 1 to 3? 1 is negative ,2 is moderate and 3 is extremely satisfied.

We'd hope a 3? You'd have to ask one of our readers or listeners. We are always looking to better inform our community.

Our news director said it best: "At a time when so much is changing so significantly — and so quickly — the need for meaningful news and information is higher than on a normal day. CPR News has changed its work schedules and its priorities to meet that demand. We have more journalists working early mornings, evenings and weekends than ever before."

I would definitely say a 3! I almost exclusively follow the CPR Coronavirus Updates page on a daily basis. National news was just too much for mee, but the CPR updates are super informative and timely without being like overwhelmingly negative. I've been recommending it to all my CO friends/family.

Love u

Fellow Colorado resident here too and I'd say a 3 too!! There is a specific CPR page just for Coronavirus updates for our state and I have it as a permanent tab on my phone. I bring it up, refresh it a few times a day and the next day bring it up again, click on the link for the current day and good to go. It's super easy to use and provides the good, the bad and the funny. Governor Polis, imho, is doing an amazing job here as well. We hear from him constantly and he walks the walk.

Hi! Yes it's true! Here's that page.

Are you both from the future (date on proof says 4/16/20 😳)

Whoops. Yes, we are. Does time still exist?

Haha no worries. I do have a question though. With the limited supply of testing kits, have you heard any information regarding when anyone will be able to go get tested? Not just those who are showing symptoms. Since there are reports of people being asymptomatic.

This is a great question and one we ask on a regular basis. I wish I had a better answer than I don't know.

The guidance from the state is still for people even with mild symptoms to stay home. But that doesn't help those who truly never show symptoms (a fraction of overall cases, but one research increasingly suggests plays a role in transmission).

Antibody tests may be able to tell you if you had it and didn't know it. But we just don't have a firm timeline from the state on when those or the standard tests might be more widely available. We will continue to pursue this so stay tuned. When we know, we'll report it. - KS

Why does the sign in your picture say “4/16/20”?

Lately, it's been hard to remember what day it is.

What color is your toothbrush?

Kate's toothbrush? Or John's?

Both. I will guess green and white, and blue and white respectively.

Kate: Blue!

John: Great question.  I appreciate your level of inquisitiveness.  I have an electric, with a changeable head that is currently green.  I like green.

Do you have the breakdowns on the COVID-19 cases and deaths in CO? Demographics, health conditions, urban/sub/urban etc

Our best, and really only data, comes from the state health department. 

The data is not as specific and in-depth as we'd like and we've asked for more. And the state is working to provide that where possible, for example now giving race and ethnicity data (here's what we know so far about that), as well as more info about long-term care facilities.

I'd also keep in mind that health department budgets got hit hard by the recession of 2008-09 and research I've seen found they never really rebounded to staffing levels they had before, so that means the folks doing all this work have a huge amount on their plates with this crisis going on. 

Also, I think they've been relying on getting data from hospitals, which have varying levels of capacity to gather the data as well.  In a lot of ways, the whole society has been building the airplane while taking off (CPR journalists included), in this crisis. 

In general, I'd say we'll be getting better data as things go on. Hopefully that'll happen.  All that said, I'd like to see more Colorado specific data about underlying health conditions, and I'm curious about smoking and vaping.  As for urban and suburban and rural data, your best bet at this point is to look at the county by county data.  Also Denver has released info from zip codes, which our partners Denverite reported on. - JD

I'm a broken record, but so much less than I'd like.

We've asked for detailed breakdowns of underlying conditions and for example, how many healthcare workers are sick. We do have numbers of cases and deaths by county, although we haven't analyzed those based of urban/suburban/rural. There are 8 counties I believe without any cases, all rural.

As far as a breakdown of those sickened by race or ethnicity, we received information for the first time yesterday (yay!). Hispanic and Black Coloradans are getting sick at statistically significantly higher rates. - KS

Do you know how much testing is being done currently and if it has been consistently increasing?

While the number of cases is decreasing in terms of percentage of new cases per day, it would be nice to know if that is because the actual number of cases is dropping, or if we simply aren't increasing the amount of tests we are doing.

If the number of tests being done per day is not increasing, then that reduction in percentage could be misleading.

For example if we did 1000 tests per day and 100 came back positive when we were at at 1000 cases, that would be a 10% increase.

If we did 1000 tests per day and 100 came back positive when we were at 5000 cases, then that would only be a 2% increase.

We know an imperfect amount about the number of tests. This is an area John and other reporters are pushing on right now, in fact!

What we can see from the available state data is that the number of tests has fluctuated, but doesn't seem to be steadily increasing. The number of state tests seems to have dropped in recent days, but private or hospital labs are doing quite a few tests, in total ~1700 on Sunday for example. But that doesn't actually seem to include all the negative tests from state labs. This is a really important factor in safely lifting the stay-at-home order so we are VERY curious about the state's plans for ramping up the number of tests. - KS

Thanks for your hard work! What are doctors and researchers saying about when we can realistically “reopen”?

Also can you debunk the misinformation I keep seeing that “the MEDIA is making bank off the crisis” Thanks!

Hi! I work with these guys. Here's some reading on the financial situation at the moment. Since that story was published, several Colorado outlets have also announced layoffs and pretty severe furloughs.

Can confirm u/daveburdick works with us and works very hard.

Is there concern with officials and epidemiologists that wearing masks makes people too comfortable to where they get too close or exhibit risky behaviors?

We haven't heard that specifically, although we have heard experts and officials warn that masks are not a magical protective shield.

Just yesterday, the governor reminded people they still need to stay six feet apart when they have masks on. Especially the masks most people have access do likely cut down the number of virus particles circulating but they definitely don't bring them to zero. The bigger concern we are still hearing from our audience is that essential workers don't all have masks or wear them. - KS

I really don't know who else to ask, so I'll try you guys. What do you honestly believe will be the end of this trying time? Will a vaccine be developed and distributed to every major town and you'll be given it and then that's it? Or is it going to be more complex than that?

Like so many of the pressing question right now, the answer as I'm sure you've found is that we don't know for sure.

Certainly, a vaccine would give a lot more tools to use, beyond isolation. But as the WHO said yesterday, we don't really know what immunity looks like for this virus. If you get it, can you not get it again? How effective is a vaccine? It's likely even with a vaccine COVID-19 could reoccur, so you might see (hopefully smaller) outbreaks the way we do with H1N1. And Colorado and the U.S. more generally doesn't mandate flu vaccines in most cases, and the state has exemptions for other vaccinations, too. So there will always be limits to that approach.

To get a sense of what the next couple years would look like, this paper published in Science today might be helpful.

I also found these two news bits (from the Atlantic and the National Review respectively) helpful today for starting to parse out what our future might look like:

Our Pandemic Summer and Scott Gottlieb of AEI.

We'll also be continuing to dog this. I think it's important to be reporting out beyond just what's happening today, so we'll be talking to the state, public health departments and experts to parse out what the future looks like.

I also hear in your question perhaps a bit of a desire for certainty right now: a vision of how this will go. And I'd just say: No one knows for sure. We have some precedent in the Spanish Flu but there are just too many factors about how we behave and how the virus behaves. So the problem becomes more than an epidemiological one. It becomes a cultural and emotional one, of how to deal with what is certain to be a long process (and a disease we may end up dealing with for the rest of our lives as we do with the flu and other infectious diseases).

A reporter I really respect tweeted out this on what recovery from a disaster is like and I have found it quite helpful for contextualizing where we are:

https://twitter.com/jane_c_hu/status/1249799114759405568

We will try and play our part by reviewing information we get so that you get the proper context and you can have some faith in what you hear from us. And we will also try and give people tools for dealing with everything that is unknown and may remain unknown or confusing. Our daily talk show Colorado Matters is particularly good for that kind of perspective, as is our podcast At A Distance. Hang in there. - KS + JD

Are there any masks left in Colorado?

I would say that, from what I've heard from folks on the front line, masks, especially those of higher protection, like N95, are still in scarce supply and are being used very strategically. 

In fact, Colorado has now activated what are called crisis standards of care, specifically for personal protective equipment, PPE.

Crisis Standards of Care: This gives hospitals and other facilities the ability to go to emergency guidelines to guide things like the reuse of PPE, that they normally wouldn't do, without the fear of legal liability. 

Another issue is how much PPE will they need in the coming weeks and months?  The hospitals may feel like they have enough PPE now but also need to be thinking about what things will look like down the road should there be a big 2nd wave.  So in a way, this will be an ongoing story, until and unless there's a major improvement in the supply chain and/or a ramp up in manufacturing in the US and/or Colorado. - JD

One of the things that I've been trying to wrap my head around are the numbers of undiagnosed/untested people. Do you have any sense of how many people have symptoms but haven't been able to get tested?

Great question!  Because testing is still limited we don't really have great numbers for undiagnosed or untested people.  It would really good to have that data, but I really don't expect it for some time, probably not until the overall cases go down a lot and the testing ramps up a lot. - JD

Colorado had over 7,691 confirmed cases according to yesterday's data drop. But last week, state officials said that likely thousands and maybe even as many as 10 times more people have it and haven't been tested or won't be tested. John's right that our best shot at answering this may be antibody tests once case numbers drop and we move into the next phase of this epidemic. - KS

I understand this is a viral infection but can this underlying infection result in fungal or bacterial overloads affecting lymphatic and neurological systems- in turn resulting in organ failure?

We don't know the answer to this, but we'll keep asking researchers about what they're finding about how the virus behaves and that right now. We currently have little information from Colorado about underlying conditions or how specifically people are dying. - KS

Is there a website which tracks how many hospital and ICU beds exist in Colorado hospitals, how many are occupied by COVID-19 patients, and how many are still unoccupied?

Short answer: No. We don't have a real time tracker of how many hospital or ICU beds exist, let alone how many are still available. We ask the state for this pretty regularly, and we make the rounds of hospitals, but we don't have a complete census.

We've gotten some projections from the state, but those are estimates, not real numbers. If you've seen other trackers, like from IHME or ProPublica, know that those are based on older numbers (as old as 2018). The state and hospitals have told us they've expanded capacity, but we just do not have hard numbers. - KS

Are you getting many reports on mild cases? The media doesn't seem to be reporting on these.

Great question. 

To my understanding, in the U.S. and Colorado we don't have robust enough testing yet to capture reports of mild cases.  In fact, the best advice from the governor and public health officials is for people who think they have mild cases to isolate/self-quarantine and only seek medical care if they have more severe symptoms like shortness of breath.  So until there's much more broad testing, I'm not sure we'll ever know how many mild cases there were.  Maybe once more testing, including of anti-bodies in the blood, happens and broadly? -JD

Have you heard of any newer cases from people that took social distancing seriously early on? I'm talking about folks that are staying home for the most part and when grocery shopping (or whatever other essential reason) wipe carts, bring hand sanitizer, wash hands after, etc.

Good question!  I don't think there are any studies about this, but maybe we will hear about some research some day. 

I think the best advice from the governor and public health officials on this is sound.  COVID-19 is invisible, it could be anywhere but spreads in really specific ways, via droplets in the air that can fall on surfaces. 

The way to best protect yourself, your neighbors, your community is to stay at home and seriously limit your time outside of it.  If you are doing the things you're talking about like keeping social distance, washing hands, not touching your face, sanitizing, you are doing the -key- things to protect yourself.  It's no guarantee of course, but it's what we've got. - JD

Will we have an opportunity to ask questions of an actual expert rather than someone with the equivalent knowledge of a new user of r/coronavirus?

We may not be medical experts, but we are a health reporter and editor who have been covering COVID-19 in Colorado pretty extensively. Try us!