John Daley, Colorado Public Radio, Author at ��ýҕ�l Health News

Wary of RFK Jr., Colorado Started Revamping Its Vaccine Policies in the Spring

John Daley, Colorado Public Radio — Tue, 07 Oct 2025 09:00:00 +0000

As Health and Human Services Secretary Robert F. Kennedy Jr.’s dismantling of federal vaccine policy continues to roil the Centers for Disease Control and Prevention, some Democratic-led states have struck out on their own, setting up new systems to help them assess the science and maintain immunization access for their residents.

Four western states — California, Hawaii, Oregon, and Washington — have created a collaborative to . Several northeastern states have done the same.

New York’s governor declared a “” that allows pharmacists to give covid-19 vaccines without a separate prescription. Minnesota made a similar change, and Massachusetts is to pay for vaccines recommended by its health department, not only those recommended by the CDC.

The changes represent a significant shift in public health authority from the federal government to the states. Traditionally, states have looked to the CDC for expertise and guidance on public health issues — including, in addition to vaccines, workplace safety, water fluoridation, vaping, and sexually transmitted infections.

Now, amid concerns that Kennedy is in vaccines and public health science, some states are charting new paths, seeking out new sources of scientific consensus and changing how they regulate insurance companies, prescribers, and pharmacists.

Colorado has been at the front of this wave. On Sept. 3, state officials issued a to let pharmacists provide covid shots .

“I will not allow ridiculous and costly red tape or decisions made far away in Washington to keep Coloradans from accessing vaccines,” said .

But Colorado’s leadership had already been clearing the way for more autonomy on vaccine policy for months.

In March, the state legislature voted to so the state could consider scientific sources other than the federal government when setting school vaccine requirements.

“You could see the writing on the wall that it was just becoming overly politicized rather than relying on actual science with this new HHS director,” said .

Mullica, who co-sponsored the new law, is a Democrat and works as an emergency room nurse in the Denver area.

Colorado is among the first states to change its laws to allow it to recommend vaccines based on sources other than the CDC. The state health board can now also consult leading medical groups, like the , , and .

“We decided to protect Colorado,” Mullica said, so it “wouldn’t be as vulnerable to political upheaval that we’re seeing right now.”

The Democratic-led legislature passed the bill in a near-party-line vote. Polis signed it into law in April, despite Kennedy’s selection last fall.

“Colorado I think is really leading the way on this,” said , a pediatrician at the University of Colorado who was part of a stakeholder group that helped craft the bill.

Higgins pointed to a , signed in May, that he said makes Colorado’s push even stronger. It deals with insurance coverage for preventive health care services, aiming to ensure state-regulated insurance plans cover the cost of some vaccines, regardless of future moves by the CDC.

“Effectively, it’s meant to help ensure that Coloradans will still have access to vaccines,” he said.

The Colorado chapter of Children’s Health Defense, the anti-vaccine advocacy group that Kennedy led before taking over HHS, did not respond to a request for comment.

Another co-sponsor of the first bill, Democratic state , said the circulation of so much false information about vaccines, including for covid, makes it important to hear from a range of trusted medical experts.

Colorado had previously looked to the CDC for scientific guidance on vaccines, particularly for children entering school. Like other states, it had tracked the recommendations of a CDC panel known as Advisory Committee on Immunization Practices.

all 17 members in June and replaced them with 12 new appointees, some of whom critics warn are vaccine skeptics and aren’t qualified to provide critical guidance for Americans.

“I think where the confusion will lie is the difference in the recommendations between the ACIP, who we traditionally defer to, and then everyone else,” said Ned Calonge, Colorado’s chief medical officer.

He expects that the national professional physician groups that Colorado is now empowered to consult will likely be aligned in their overall guidance and will “look at the last evidence-based recommendations that were provided by the ACIP” before Kennedy replaced its members.

In May, the federal government had removed covid vaccines from the list of shots recommended for healthy pregnant women and children.

But Colorado is still recommending a covid vaccine during pregnancy, Calonge said.

“There’s been no new evidence of issues of safety in that population,” . “So, we’re telling providers that our recommendation is to continue to follow the recommendation as it was in place in January of 2025.”

In on its website, the American College of Obstetricians and Gynecologists strongly recommended pregnant individuals get vaccinated against covid. “ACOG continues to recommend that all pregnant and lactating individuals receive an updated COVID-19 vaccine or ‘booster,'” it said.

Likewise, the American Academy of Pediatrics that all children from 6 to 23 months old get vaccinated against covid, as well as older children in certain risk groups.

For now, Colorado is following the same immunization recommendations it used last year.

The most recent ACIP meeting, on Sept. 18 and 19, was chaotic, with members admitting they did not understand what they were voting on and even opting to redo a vote on pediatric MMRV vaccine access. The next ACIP meeting is scheduled to take place Oct. 22 and 23 and could result in additional changes to vaccine recommendations.

Doctors and vaccine scientists have expressed alarm at the splintering national consensus on vaccines.

“There’s now going to be much more confusion and distrust of vaccines among the public,” said , a professor of pediatrics at the University of Colorado School of Medicine, who served on ACIP from 2013 to 2018.

Still, she said she’s glad Colorado is forging ahead with its own recommendations.

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Medicaid Cuts Could Have Vast Ripple Effects in This Rural Colorado Community

John Daley, Colorado Public Radio — Wed, 13 Aug 2025 09:00:00 +0000

In southern Colorado’s , clouds billow above the towering mountains of the Sangre de Cristo range. A chorus of blackbirds whistle as they flit among the reeds of a wildlife refuge. Big, circular fields of crops, interspersed with native shrubs, give it a feel of bucolic quiet.

But amid the stark beauty in one of the state’s most , there was a sense of unease among the community’s leaders as Congress debated a budget bill that could radically reshape for low-income people.

“I’m trying to be worried and optimistic,” said Konnie Martin, CEO of in Alamosa, Colorado, the hub for health care services for 50,000 people in six rural counties.

Martin said Medicaid is vital to rural health care.

“I think in Colorado right now, nearly 70% of rural hospitals are operating in a negative margin,” in the red, Martin said.

The health system’s annual budget is $140 million, and Medicaid revenue makes up nearly a third of that, according to Shane Mortensen, chief financial officer for SLV Health.

The operating margin is razor-thin, so federal cuts to Medicaid could force difficult cuts at SLV. “It will be devastating to us,” Mortensen said.

is one of the state’s poorest. In Alamosa County, residents are enrolled in , the state’s Medicaid program.

It’s a lifeline, especially for people who wouldn’t otherwise have easy access to health care. That includes low-income seniors who need supplemental coverage in addition to Medicare, and people of all ages with disabilities.

Envisioning a future with deep Medicaid cutbacks leaves many patients on edge.

“I looked into our insurance and, oh my goodness, it’s just going to take half my check to pay insurance,” said Julianna Mascarenas, a mother of six. She said Medicaid has helped her cover her family for years. Mascarenas works as a counselor treating people with substance use disorders. Her ex-husband farms — potatoes and cattle — for employers that don’t offer health insurance.

Julianna Mascarenas, a mother of six, says Medicaid has helped cover health care for her family for years. (Hart Van Denburg/CPR News)

Across the state, Medicaid covers , .

That includes children in foster care.

“We’ve had 13 kids in and out of our home, six of which have been born here at this hospital with drugs in their system,” foster parent Chance Padilla said, referring to SLV’s flagship hospital in Alamosa.

“Medicaid has played a huge part in just being able to give them the normal life that they deserve,” he said. “These kids require a lot of medical intervention.”

Chris Padilla, Chance’s husband, said: “At one point, we had a preteen that needed to be seen three times a week by a mental health professional. There’s no way that we could have done that without Medicaid.”

Staff and administrators at SLV Health wonder whether federal cuts will make it hard for the system to keep its cancer center running.

“It could be pretty dramatically affected,” said Carmelo Hernandez, SLV’s chief medical officer.

The hospital in Alamosa has its own labor and delivery unit, the type of service that other rural hospitals across the U.S. . About 85% of the hospital’s labor and delivery patients are covered by Medicaid, Hernandez said.

Carmelo Hernandez, chief medical officer at San Luis Valley Health in Alamosa, Colorado, specializes in obstetrics and gynecology. He and other hospital leaders wonder if some services, including obstetrics, can survive deep Medicaid cuts. (Hart Van Denburg/CPR News)

“If we don’t have obstetric services here, then where are they going to go?” said Hernandez, whose specialty is obstetrics and gynecology. “They’re going to travel an hour and 20 minutes north to Salida to get health care. Or they can travel to Pueblo, another two-hour drive over a mountain pass.”

Tiffany Martinez, 34, was recently forced to think about that possibility after giving birth to her fourth child.

Her pregnancy was high-risk, requiring twice-a-week ultrasounds and stress tests at the hospital. She’s enrolled in Medicaid.

“Everything down here is low-pay,” Martinez said. “It’s not like we have money to just be able to pay for the doctor. It’s not like we have money to travel often to go to the doctor. So it’s definitely beneficial.”

Providing Health Care — And Jobs

With 750 workers, the health system is the . Clint Sowards, a primary care physician, said having less Medicaid funds will make it harder to attract the next generation of doctors, nurses, and other health care workers.

Certain medical specialties might no longer be available, Sowards said. “People will have to leave. They will have to leave the San Luis Valley.”

Kristina Steinberg is a family medicine physician with , a network of small clinics serving thousands in the region. She said Medicaid covers most nursing home residents in the area. “If seniors lost access to Medicaid for long-term care, we would lose some nursing homes,” she said. “They would consolidate.”

Audrey Reich Loy, a licensed social worker and SLV Health’s director of programs, said the system utilizes Medicaid “as sort of the backbone of our infrastructure.”

“It doesn’t just support those that are recipients of Medicaid,” she said. “But as a result of what it brings to our community, it allows us to ensure that we have sort of a safety net of services that we can then expand upon and provide for the entire community.”

Konnie Martin is CEO of San Luis Valley Health in Alamosa. (Hart Van Denburg/CPR News)

Seeking More Efficiency

Republicans in Congress who pushed for the big spending and tax law, which estimates suggest will result in large cuts to Medicaid, say they want to save money and make the government more efficient.

Many in the Alamosa County region “He’s potentially affecting his voter base pretty dramatically,” Hernandez said.

He said Medicaid cuts could give President Trump’s supporters second thoughts, but he noted that politics is a sensitive topic that he mostly doesn’t discuss with patients.

Sowards said he understands that some people believe the Medicaid system is ailing and costly. But he said he has grave doubts about the proposed cure.

“Losing Medicaid would have drastic repercussions that we can’t foresee,” Sowards said.

Cuts Would Create Ripple Effect

SLV Health’s regional economic impact is , with Medicaid accounting for a major part of that, Martin said.

Any Medicaid cuts would hit the health system hard, but they would also affect small businesses and their employees. The region is feeling economic stress from other changes, like recent cuts the Trump administration made to the federal workforce.

The San Luis Valley is home to the Monte Vista National Wildlife Refuge, Great Sand Dunes National Park, and other federally managed lands.

Joe Martinez, president of , said that recently laid-off federal workers are already coming to banks saying: “‘Can I find a way to get my next two months’ mortgage payments forgiven? Or can we do an extension?’ Or: ‘I lost my job. What can we do to make sure that I don’t lose my vehicle?’”

Ty Coleman, , traveled to Washington, D.C., in April to talk to Colorado’s congressional delegation. He said his message about Medicaid cuts was straightforward: “It can have a devastating economic impact.” Coleman put together a long list of possible troubles: More chronic disease and higher mortality rates. Longer wait times for care. Medical debt and financial strain on families.

“It’s not just our rural community but the communities, rural communities, across Colorado as well, and the United States,” Coleman said. “And I don’t think people are getting it.”

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Dogs Paired With Providers at Hospitals Help Ease Staff and Patient Stress

John Daley, Colorado Public Radio — Tue, 21 Jan 2025 10:00:00 +0000

DENVER — Outside medical center, the snow is flying. Inside, on the third floor, there’s a flurry of activity within the labor and delivery unit.

“There’s a lot of action up here. It can be very stressful at times,” said Kristina Fraser, an OB-GYN in blue scrubs.

Nurses wheel a very pregnant mom past.

“We’re going to bring a baby into this world safely,” Fraser said, “and off we go.”

She said she feels ready in part due to a calming moment she had just a few minutes earlier with some canine colleagues.

A pair of dogs, tails wagging, had come by a nearby nursing station, causing about a dozen medical professionals to melt into a collective puddle of affection. A yellow Lab named Peppi showered Fraser in nuzzles and kisses. “I don’t know if a human baby smells as good as that puppy breath!” Fraser had said as her colleagues laughed.

The dogs aren’t visitors. They work here, too, specifically for the benefit of the staff. “I feel like that dog just walks on and everybody takes a big deep breath and gets down on the ground and has a few moments of just decompressing,” Fraser said. “It’s great. It’s amazing.”

Hospital staffers who work with the dogs say there is virtually no bite risk with the carefully trained Labradors, the preferred breed for this work.

The dogs are kept away from allergic patients and washed regularly to prevent germs from spreading, and people must wash their hands before and after petting them.

Nurses on a break crowd around to pet Peppi. (Hart Van Denburg/CPR News)

Doctors and nurses are facing a growing mental health crisis driven by their experiences at work. They and other health care colleagues face , anxiety, , , and burnout. Nearly half of health workers reported often feeling burned out in 2022, an increase from 2018, according to the . And the percentage of health care workers who at work more than doubled over that four-year period. Advocates for the presence of dogs in hospitals see the animals as one thing that can help.

That includes Peppi’s handler, Susan Ryan, an emergency medicine physician at Rose.

Ryan said years working as an emergency room doctor left her with symptoms of PTSD. “I just was messed up and I knew it,” said Ryan, who isolated more at home and didn’t want to engage with friends. “I shoved it all in. I think we all do.”

She said doctors and other providers can be good at hiding their struggles, because they have to compartmentalize. “How else can I go from a patient who had a cardiac arrest, deal with the family members telling them that, and go to a room where another person is mad that they’ve had to wait 45 minutes for their ear pain? And I have to flip that switch.”

To cope with her symptoms of post-traumatic stress disorder, Ryan started doing therapy with horses. But she couldn’t have a horse in her backyard, so she got a Labrador.

Ryan received training from a national service dog group called , becoming the first doctor trained by the group to have a facility dog in an emergency room. Canine Companions has graduated more than 8,000 service dogs.

The Rose medical center gave Ryan approval to bring a dog to work during her ER shifts. Ryan’s colleagues said they are delighted that a dog is part of their work life.

“When I have a bad day at work and I come to Rose and Peppi is here, my day’s going to be made better,” EMT Jasmine Richardson said. “And if I have a patient who’s having a tough day, Peppi just knows how to light up the room.”

Nursing supervisor Eric Vaillancourt agreed, calling Peppi “joyful.”

Ryan had another dog, Wynn, working with her during the height of the pandemic. She said she thinks Wynn made a huge difference. “It saved people,” she said. “We had new nurses that had never seen death before, and now they’re seeing a covid death. And we were worried sick we were dying.”

She said her hospital system has lost a couple of physicians to suicide in the past two years, which HCA confirmed to ��ýҕ�l Health News and NPR. Ryan hopes the canine connection can help with trauma. “Anything that brings you back to the present time helps ground you again. A dog can be that calming influence,” she said. “You can get down on the ground, pet them, and you just get calm.”

Peppi with her handler, emergency medicine physician Susan Ryan. (Hart Van Denburg/CPR News)

Ryan said research has shown the advantages. For example, on human-animal interactions found benefits for a variety of conditions including behavioral and mood issues and physical symptoms of stress.

Rose’s president and CEO, Casey Guber, became such a believer in the canine connection he got his own trained dog to bring to the hospital, a black Lab-retriever mix named Ralphie.

She wears a badge: Chief Dog Officer.

Guber said she’s a big morale booster. “Phenomenal,” he said. “It is not uncommon to see a surgeon coming down to our administration office and rolling on the ground with Ralphie, or one of our nurses taking Ralphie out for a walk in the park.”

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Many Young Adults Who Began Vaping as Teens Can’t Shake the Habit

John Daley, Colorado Public Radio — Wed, 12 Jun 2024 09:00:00 +0000

G Kumar’s vaping addiction peaked in college at the University of Colorado, when flavored, disposable vapes were taking off.

“I’d go through, let’s say, 1,200 puffs in a week,” Kumar said.

Vaping became a crutch for them. Like losing a cellphone, losing a vape pen would set off a mad scramble.

“It needs to be right next to my head when I fall asleep at night, and then in the morning, I have to thrash through the sheets and pick it up and find it,” Kumar recalled.

They got sick often, including catching covid-19 — and vaping through all of it.

Kumar, now 24, eventually quit. But many of their generation can’t shake the habit.

“Everyone knows it’s not good for you and everyone wants to stop,” said Jacob Garza, a University of Colorado student who worked to raise awareness about substance use as part of the school’s health promotion program.

“But at this point, doing it all these years … it’s just second nature now,” he said.

Marketing by e-cigarette companies, touting the allure of fruity or candy-like flavors and names, led many teens to try vaping. As more high schoolers and younger kids experimented with e-cigarettes, physicians and it could lead to widespread addiction, creating a “Generation Vape.”

Research has shown to the brains of young people.

New data on substance use among adults ages 18-24 suggests that many former teen vapers remain e-cigarette users. National vaping rates for young adults increased from to .

Rows of flavored tobacco vape juice on display at a store in Fresno, California, on Oct. 18. (Marek Warszawski/Fresno Bee/Tribune News Service via Getty Images)

It’s not surprising that many of them start in high school for social reasons, for all sorts of reasons,” said Delaney Ruston, a primary care physician and documentary filmmaker. “And many of them now — we’re seeing this — have continued to college and beyond.”

Her is “Screenagers Under the Influence: Addressing Vaping, Drugs & Alcohol in the Digital Age.”

In Colorado, the share of those 18 to 24 who regularly vaped rose by about 61% from 2020 to 2022 — to nearly a quarter of that age group.

“That’s an astounding increase in just two years,” Ruston said.

Trends in that state are worth noting because, before the pandemic, in youth vaping among high school students, surpassing 36 other states surveyed.

Nationally, vaping rates among high schoolers dropped from to , according to the Annual National Youth Tobacco Survey. But for many young people who started vaping at the height of the trend, a habit was set.

At Children’s Hospital Colorado, pediatric pulmonologist displayed on her screen a clouded X-ray of the lung of a young adult damaged by vaping.

For years, doctors like her and public health experts wondered about the potentially on pre-adult bodies and brains — especially the big risk of addiction.

“I think, unfortunately, those lessons that we were worried we were going to be learning, we’re learning,” said De Keyser, an associate professor of pediatrics in the .

“We’re seeing increases in those young adults. They weren’t able to stop.”

Heather De Keyser, a pediatric pulmonologist at Children’s Hospital Colorado, points to the X-ray of a lung of a young adult damaged by vaping. (John Daley/Colorado Public Radio)

It’s no coincidence the vaping rates soared during the pandemic, according to several public health experts.

For the past couple of years, undergraduates have talked about the challenges of isolation and using more substances, said Alyssa Wright, who manages early intervention health promotion programs at CU-Boulder.

“Just being home, being bored, being a little bit anxious, not knowing what’s happening in the world,” Wright said. “We don’t have that social connection, and it feels like people are still even trying to catch up from that experience.”

Other factors driving addiction are the high nicotine levels in vaping devices, and “stealth culture,” said Chris Lord, CU-Boulder’s associate director of the .

“The products they were using had than previous vapes had,” he said. “So getting hooked on that was … almost impossible to avoid.”

By “stealth culture,” Lord means that vaping is exciting, something forbidden and secret. “As an adolescent, our brains are kind of wired that way, a lot of us,” Lord said.

All over the U.S., state and local governments have filed suits against , alleging the company misrepresented the health risks of its products.

The lawsuits argued that Juul became a top e-cigarette company by aggressively marketing directly to kids, who then spread the word themselves by posting to social media sites like YouTube, Instagram, and TikTok.

“What vaping has done, getting high schoolers, in some cases even middle schoolers, hooked on vaping, is now playing out,” said .

Juul agreed to pay . The company did not respond to requests for comment on this article.

R.J. Reynolds, which , Vuse, sent this statement: “We steer clear of youth enticing flavors, such as bubble gum and cotton candy, providing a stark juxtaposition to illicit disposable vapor products.”

Other , like Esco Bar, Elf Bar, Breeze Smoke, and Puff Bar, didn’t respond to requests for comment.

“If we lived in an ideal world, adults would reach the age of 24 without ever having experimented with adult substances. In reality, young adults experiment,” said Greg Conley, director of legislative and external affairs with American Vapor Manufacturers. “This predates the advent of nicotine vaping.”

Disposable vapes are displayed in a convenience store on June 23, 2022, in El Segundo, California. (Patrick T. Fallon/AFP via Getty Images)

The FDA banned flavored vape cartridges in 2020 to crack down on marketing to minors, but the .

Joe Miklosi, a consultant to the Rocky Mountain Smoke-Free Alliance, a trade group for vape shops, contends the shops are not driving vaping rates among young adults in Colorado. “We keep demographic data in our 125 stores. Our average age [of customers] is 42,” he said.

He has spoken with thousands of consumers who say vaping helped them quit smoking cigarettes, he said. Vape shops sell products to help adult smokers quit, Miklosi said.

Colorado statistics belie that claim, according to longtime tobacco researcher . The data is “completely inconsistent with the argument that most e-cigarette use is adult smokers trying to use them to quit,” said Glantz, the former director of the at the University of California-San Francisco.

For recent college graduate G Kumar, now a rock climber, the impetus to quit vaping was more ecological than health-related. They said they were turned off by the amount of trash generated from used vape devices and the amount of money they were spending.

Kumar got help from cessation literature and quitting aids from the university’s health promotion program, including boxes of eucalyptus-flavored toothpicks, which tasted awful but provided a distraction and helped with oral cravings.

It took a while and a lot of willpower to overcome the intense psychological cravings.

“The fact that I could just gnaw on toothpicks for weeks on end was, I think, what kept me sane,” Kumar said.

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Colorado Voters to Decide Whether All Schoolkids Get a Free Lunch

John Daley, Colorado Public Radio — Thu, 03 Nov 2022 09:00:00 +0000

During most of the pandemic, in every public school cafeteria throughout the country, every kid could get a free lunch, not just those from the poorest homes. Everyone.

The program that fed 50.6 million U.S. students expired in September, but some states are figuring out ways to extend it. and have both passed legislation to fund universal free lunch.

In Colorado, a coalition of parents, teachers, and anti-hunger advocates are pushing to make permanent universal free school lunches, and lawmakers in the Democratic-controlled legislature .

GlendaRika Garcia, a bilingual food assistance navigator for Hunger Free Colorado, strongly backs the idea.

“I think that the kids being able to eat for free at school is really important, for all families, all kids,” said Garcia, a widow and a single mom of four boys.

Two of them, Alonzo and Pedro, tossed a football around in front of their apartment building, as Garcia explained proposal on the ballot.

“Kids can’t learn if they don’t have good nutrition,” said Garcia, whose job entails signing up people for benefits and making sure they’re eligible.

The measure, known as , would use state funds to offer free meals for all public school students. It would also fund pay increases for school cafeteria workers, helping schools deal with staff shortages, and would incentivize schools to buy Colorado-grown food. That has some families, workers, and farmers cheering.

But critics point to a steep price tag for a new government program, which raises $100 million annually from a tax on households that make $300,000 or more a year.

School-aged members of a family of four making less than about $51,000 a year are eligible for free lunch. But that right now more than 60,000 Colorado kids can’t afford school meals yet aren’t eligible.

Garcia sees the proposal as a game changer, an equalizer. Depending on her job, Garcia at times qualified for her sons to get free lunches and at times didn’t, a blow to her budget.

Another issue, Garcia said, is that some kids bully others for getting a free lunch. It happened to her as a child when she also qualified for free lunch, and it happened to one of her sons.

“They know that people can identify if they can’t afford it. It hurts my heart,” she said.

Her son Alonzo said that at his high school some kids avoid the lunchroom rather than admit they qualify for free lunch.

“I think that they get embarrassed because they can’t afford it,” he said.

Many Colorado districts reported a clear uptick during the pandemic of provided for free at school.

“We were feeding kids that we have never fed before, and it was good to see them coming up, and not just buying junk food,” said Andrea Cisneros, the kitchen manager at West Woods Elementary School in Arvada.

Many students arrive at school without food, said Dan Sharp, the school nutrition director in Mesa County Valley School District 51 in Grand Junction.

The district saw a 40% year-over-year increase in meals served during the pandemic, said Sharp.

“I really believe there’s more households here and students that could qualify but don’t, due to the stigma that goes with applying for free and reduced meals,” he said.

Proponents said they did several throughout the pandemic and, according to a recent survey, 44% of respondents with kids at home reported struggling to have access to nutritious food.

Low-income students will keep receiving free meals through federal funding, whether the proposal passes or not. There’s no organized opposition to the measure, but it does have critics.

“Nobody wants to be evil enough to say it, but this is a really stupid idea,” said Jon Caldara, president of the , a libertarian think tank. “Most kids in Colorado do not need this. And in fact, those who do, already have this.”

The group’s voter’s guide .

“This proposal is, ‘Hey, let’s get the rich guys to buy our kids’ lunch,’” he said. “This is another expansion of state bureaucracy that is just not necessary.”

The governor told Colorado Public Radio’s he hasn’t made his mind up about how he’ll vote on it.

“I don’t have an objection to the funding mechanism, but at the same time I sort of ask myself, ‘If we had this, would it be better just to be able to pay teachers better, reduce class size?’” said Gov. Jared Polis, a Democrat. “Or is the best use of it lunches for upper-middle-income families?”

He added that the measure “doesn’t affect the state finances one way or the other because it’s effectively revenue-neutral with the mechanism.”

His Republican opponent seemed to lean toward supporting Proposition FF in .

“I haven’t had a chance to look at it, but I do want to make sure that every child has access to healthy food and lunches, so I’m certainly open to it,” said Heidi Ganahl.

The , a nonpartisan free-market think tank, analyzed the measure and raised several concerns, with modeling that showed it could be underfunded or raise more money than is needed.

“There needs to be some good oversight on the program so that costs are managed well, and also that they don’t develop a huge surplus,” said Steven Byers, the group’s senior economist.

Despite concerns about cost, universal free school lunch appears popular throughout the nation.

from its state budget to fund and support its universal free school meals program for the 2022-23 school year. Maine’s program was estimated by lawmakers to cost .

Washington, Minnesota, Wisconsin, Ohio, Pennsylvania, New York, Massachusetts, and North Carolina introduced bills similar to the one on the Colorado ballot, most of them during the current legislative session. All of them are still in committee and have yet to go up for a vote.

by the Urban Institute, a nonpartisan think tank focused on social and economic research, found that 76% of adults living with children enrolled in public school and 67% of adults not living with children enrolled in public school supported permanent free school meals.

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Colorado Moves Toward Statewide Coverage of Wastewater Surveillance

John Daley, Colorado Public Radio — Tue, 12 Apr 2022 09:00:00 +0000

On a Sunday morning in March 2020, right at the start of the pandemic, an article in Popular Mechanics caught engineer Pieter Van Ry’s eye. It had a catchy title: “.”

“At the end of that article, it said, ‘If you have a wastewater facility and you’re interested in participating in this study, please contact us,’” he said.

As a matter of fact, Van Ry did have a wastewater facility. He is the director of , a wastewater treatment plant in Englewood, Colorado, that serves 300,000 people. He filled out the form, and South Platte joined the first facilities in the nation to start testing wastewater for covid-19.

Now, as the federal government expands its , Colorado has begun to extend its surveillance project to the entire state. The state’s public health agency is now working with 47 wastewater utilities that serve about 60% of Colorado’s population.

People infected with SARS-CoV-2, the virus that causes covid-19, shed viral RNA — genetic material from the virus — in their feces. In wastewater tests, scientists use that RNA to tell what’s there.

Rachel Jervis, an epidemiologist with the Colorado Department of Public Health and Environment, noted that wastewater testing can offer an early warning sign about where covid spread is highest. “We found that up to 50% of people will shed covid virus in their stool regardless of whether or not they have symptoms,” she said.

The state compiles the data from a variety of sites on a . It also shares its numbers with the Centers for Disease Control and Prevention. About $9.4 million in federal funds is paying for the state’s wastewater testing project from January 2021 through at least July 2023. The total includes personnel, supplies, equipment, and contracts.

From the start, lab results from the South Platte plant’s samples showed exactly what the virus was doing, Van Ry said: “It was spreading rapidly through the community.” He showed a slide of data from samples. All the surges were clear: alpha, delta, and then a spectacular spike driven by the omicron variant in early 2022.

The South Platte team sends the wastewater samples it collects to a Massachusetts company called . Its mission: “population health analytics powered by sewage.”

The technique caught on around Colorado and the country. Colorado Mesa University, in collaboration with the Broad Institute of MIT and Harvard, was in the state.

, director of the state lab in Denver, said Colorado’s public health agency started testing wastewater five years ago for foodborne illnesses like salmonella. “We were able to pivot that expertise toward covid-19 as the pandemic emerged, and build upon that expertise within the laboratory,” she said.

While the approach is groundbreaking in the U.S., it’s been used overseas for decades in polio eradication efforts. “They use it essentially the same way we do — to look for communities where polio is circulating and then use that as a trigger for additional clinical surveillance in those communities,” Amy Kirby, CDC microbiologist and team lead for the National Wastewater Surveillance System, said during a .

In fall 2020, during the first weeks of the school year, a response team at the University of Denver started pulling samples from pipes on campus.

, a mechanical engineer who oversees the campus’s saliva testing lab, said a wastewater sample taken at one dorm early in the semester showed high concentrations of the virus. “It was a million virus units per one liter,” she said. “Holy Toledo!”

School officials had the dorm’s residents undergo rapid nasal testing. The wastewater data, followed up with quick testing, allowed school officials to quickly identify and isolate 10 infectious students.

Without that, Lengsfeld said, perhaps 100 more students in the dorm of 300 might have caught it. “It works,” she said. “It definitely is a case study, I think, of exactly how to control spread.”

Jude Bayham, an assistant professor at Colorado State University and the Colorado School of Public Health, said that as overall covid trends improve and Colorado pivots to the next phase — and maybe scales down other testing — still-evolving wastewater analysis promises to step up. “Wastewater surveillance is a relatively cheap alternative that can provide a lot of information,” said Bayham, who is also a member of the state’s covid modeling team.

That kind of information can guide coronavirus response.

Brandon Hinkhouse, lead operator at the South Platte Renew wastewater treatment facility in Englewood, Colorado, brushes snow away from equipment that collects samples to be tested for coronavirus. ((Hart Van Denburg/Colorado Public Radio))

“We are really excited about this new tool,” said state epidemiologist Dr. Rachel Herlihy. “It will help us understand regional differences. It’s also been incredibly useful for us in understanding the emergence of new variants.”

“We’re still really figuring out how to best put it to use,” Herlihy added.

Kirby, of the National Wastewater Surveillance System team, said the CDC anticipates using the system to monitor infectious diseases, as well as other public health issues, like substance use disorders.

“One of the strengths of wastewater surveillance is that it is very flexible,” Kirby said. “So once we have built this infrastructure to collect the samples, get them to a laboratory, get the data to CDC, we can add tests for new pathogens fairly quickly.”

Should a new pathogen of interest pop up, she said, they could ramp up this system within a few weeks to start gathering community-level data on it.

This story is part of a partnership that includes , and KHN.

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The Stress of Restaurant Work Is Reaching a Boiling Point. Could a Staff Therapist Help?

John Daley, Colorado Public Radio — Fri, 25 Feb 2022 10:00:00 +0000

Restaurant jobs have always been difficult, but the mental stress has gotten worse during the pandemic as restaurants closed or cut hours — or became ground zero for the fight over mask-wearing.

“It is totally nerve-wracking sometimes because all of my tables I’m interacting with aren’t wearing their masks,” said Nikki Perri, a server at , a restaurant in downtown Denver. “I am within 6 feet of people who are maskless.”

Perri is 23, a DJ, and a music producer. And she’s not just worrying about her own health.

“I’m more nervous about my partner. He’s disabled. He doesn’t have the greatest immune system,” she said.

After the initial shutdown, French 75 was having problems finding employees when it reopened. So were other restaurants.

“We put a Survey Monkey out and pay was No. 3,” said chef and owner Frank Bonanno. “Mental health was No. 1. Employees wanted security, and mental health, and then pay.”

His company, , runs 10 Denver restaurants including French 75, , and . The survey went out to employees of all 10. Bonanno said these jobs offer competitive pay and good health insurance, but the mental health benefits aren’t very good.

“Most such psychologists and psychiatrists are out-of-pocket for people to go to. And we were looking for a way to make our employees happy,” he said.

Frank Bonanno, owner of the Bonanno Concepts restaurant group, in the kitchen at French 75 in downtown Denver. Bonanno hired a full-time mental health clinician, Qiana Torres Flores, to be the company’s wellness director. (Hart Van Denburg/CPR)

That, according to his wife and co-owner, Jacqueline, was when they had a revelation: Let’s hire a full-time mental health clinician.

“I know of no other restaurants that are doing this, groups or individual restaurants,” she said. “It’s a pretty big leap of faith.”

It took a little while to figure out what exactly employees wanted and what would be most helpful. Focus groups began in summer 2021 and they made a hire in October 2021.

Qiana Torres Flores, a licensed professional counselor, took on the new and unusual role. Her title is “wellness director.” She’d previously worked one-on-one with clients and in community mental health. She said she jumped at the chance to carve out a profession within the restaurant world.

“Especially in the restaurant and hospitality industry, that stress bucket is really full a lot of the time. So I think having someone in this kind of capacity, just accessible and approachable, can be really useful,” she said.

Traveling among the 10 restaurants, Flores has led group sessions and mediated conflicts between employees. She has taught the company’s 400 employees techniques to cope with stress, and put on Santa’s Mental Health Workshop to help with holiday-related sadness and grief. She has done one-on-one counseling and referred some employees to more specific types of therapy.

“Not only is there help, but it’s literally 5 feet away from you and it’s free and it’s confidential. And it’s only for you,” Flores said.

The owners say her presence gives them a competitive advantage and hope it helps them retain their employees.

Qiana Torres Flores is the wellness director for the Bonanno Concepts restaurant group. It’s her job to host seminars and teach about 400 employees coping techniques. She also provides one-on-one sessions for any employee who needs someone to talk to. (Hart Van Denburg/CPR)

Restaurant staff members often work difficult hours and can be prone to substance use issues — a grind-it-out mentality is part of the job culture. Many workers either don’t ask for help or don’t always see mental self-care as important.

“It has been a really important option and a resource for our team right now,” said Abby Hoffman, general manager of French 75. “I was just overjoyed when I found out that this program was starting.”

She gives the effort high marks, and said it builds on earlier efforts to recognize the psychological toll of restaurant jobs.

“I think the conversation really started around the death of Anthony Bourdain, knowing how important mental health and caring for ourselves was,” Hoffman said.

The death by suicide of the charismatic , a celebrity chef who openly struggled with addiction and mental illness, resonated with many restaurant workers.

Bourdain died in mid-2018. Then, Hoffman said, came the pandemic, which helped relaunch tough conversations about the psychological impacts of their jobs: “We were, again, able to say, ‘This is so stressful and scary, and we need to be able to talk about this.’”

Voicing these concerns, she speaks for an entire industry. The Colorado Restaurant Association recently conducted a survey, and a spokesperson says more than 80% of its members reported an increase in the stress levels of their staff over the past year. A third of the restaurants fielded requests for mental health services or resources from employees in the past year. More than 3 in 4 restaurants reported a rise in customer aggression toward staff members.

Denise Mickelsen, a spokesperson for Colorado’s restaurant association, said she’s unaware of other restaurants or groups hiring a full-time staffer dedicated to health and wellness.

“It’s fair to call what they’re doing fairly unique and/or innovative,” said Vanessa Sink, director of media relations for the . “It’s something that some of the larger chains have been trying but is not widespread.”

Other projects in a similar vein are springing up. One is called . It describes itself as a “movement fighting for a more resilient and sustainable foodservice and hospitality industry, calling for change by showing that a healthier culture makes for a healthier business.” It by Britain-based Unilever Food Solutions that found most chefs were “sleep deprived to the point of exhaustion” and “felt depressed.”

Back in Denver, the server Perri said she’s grateful her employers see workers as more than anonymous, interchangeable vessels who bring the food and drinks “and actually do care about us and see us as humans. I think that’s great. And I think other places should catch up and follow on cue here.”

And if that happens, she said, it could be a positive legacy from an otherwise tough time.

This story is part of a partnership that includes , and KHN.

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Colorado Hospitals in ‘Critical Condition’ as State Weathers Another Surge

John Daley, Colorado Public Radio — Wed, 15 Dec 2021 10:00:00 +0000

Harold Burch’s home has a spectacular view in Paonia, a rural part of Colorado’s Western Slope at the foot of Mount Lamborn. But the landscape has been little consolation to the 60-year-old as he has battled a cascade of health problems during the pandemic.

“It’s been a real rodeo,” Burch said. “It’s been a lot of ups and downs and lately it’s been mostly just downers.”

Burch has battled chronic osteoarthritis and rheumatoid arthritis and has had two major intestinal surgeries. One specialist he was seeing left her practice last year. Another wouldn’t accept his insurance. Then, Nov. 1, he started experiencing major stomach pain.

“When we talk terrible problems, I can’t leave the house,” he said. He hasn’t eaten anything substantial in three weeks, he added.

Burch had to wait that long to be seen by a primary care doctor. He said the doctor told him, “‘If things were different, I would tell you to go to the hospital and be diagnosed, have some tests run and see what’s going on with you.’ But he says, ‘As of today, Delta County hospital is clear full. There are no beds available.’”

The covid variant delta has overwhelmed the Colorado county of the same name. Hospitals on the Western Slope have been slammed for weeks, and the statewide picture is similarly grim. As of Monday, the state’s reported 1,294 patients hospitalized with covid-19. Half of the state’s hospitals said they anticipated a staffing shortage in mid-December; more than a third of them anticipated bed shortages in their intensive care units at the same time.

And behind those numbers, patients are feeling the impact.

Burch’s doctor told him he might have to wait hours in the emergency room, perhaps with people who have flu or covid symptoms. So Burch stayed home.

He’s fully vaccinated. But just have received at least one dose of a covid vaccine. And in Colorado are not vaccinated.

“It’s really frustrating because I did the right thing and like so many other people have, and we’re being just kind of like told, ‘Unless you have a really serious problem, like a heart attack, a stroke, you’re going to have a baby or something like that, we really don’t have time to mess with you,’” Burch said. “I mean, it’s just wrong.”

Burch’s situation is not uncommon this fall, as the state faces its second-worst covid surge for hospitalizations and deaths. Hospitals are under tremendous strain and that means delays and changes from normal care, as strapped providers do more with less.

“Hospitals across Colorado are in critical condition. We have been at 90%-plus capacity in our ICU and acute care beds for weeks now. And unfortunately, there doesn’t appear to be an end to that situation in the near future,” said Cara Welch, a spokesperson for the Colorado Hospital Association.

Diann Cullen, 72, a retiree in Broomfield, Colorado, was told by her doctor that her hernia surgery would have to be postponed for weeks. Her reaction: “Frustration, extreme frustration, actually anger, because I said a bad word. … He flat-out told me we can’t even do it because of too many covid patients.”

The combination of too many covid patients, the need to treat those who delayed care and staff shortages have pushed hospitals into crisis, said Robin Wittenstein, CEO of Denver Health, which runs one of the state’s biggest hospital and clinic systems.

“They’re coming into hospitals now sicker than ever before. And they’re coming in larger numbers than we’ve ever seen before,” Wittenstein said on the day when most metro-area counties announced they were . “Our system is on the brink of collapse.”

At the academic medical center UCHealth, Dr. Abbey Lara said the crush of unvaccinated patients in the ICU means patients face longer waits or they don’t get much-needed diagnostic tests. In the worst-case scenario, “patients who could have survived something had their life cut short because they weren’t able to access care,” she said.

And when there are too many patients being treated by too few staffers, Lara said, that ratchets up the difficulty for providers.

“I just worry that there’s going to be not only a lot of turnover in the near future,” Lara said. “But I think that access to health care is just going to get even worse in the future.”

Lara predicted the effects of the pandemic will be felt long after the emergency ends: “The sky isn’t falling, but the sky is going to turn a very different color.”

In Longmont, Colorado, about 50 miles north of Denver, nearly a third of Longmont United Hospital’s registered nurses have left since the start of July and many have not been replaced, said Kris Kloster, who has been a nurse for 32 years. She is backing an effort by nurses to unionize there.

The stress nurses and doctors feel is compounded when they feel powerless to take what they regard as an ethically correct action in treating a patient.

There’s a term for that, “moral distress,” said Dr. Barbara Statland, a hospitalist at Denver Health. The tension comes “because you can’t do what you feel is ethically proper. And I’d say that health care workers have been riddled with this.”

Despite the stress and distress, many front-line providers are hanging in there, continuing to care for patients every day. That made the difference for at least one covid patient who said he was appreciative he was able to get care — just in time.

“They saved my life. I do feel grateful for everything they did,” said 58-year-old Rob Blessin, of Fort Collins.

He caught the virus this fall and spent 30 days in an ICU ward with pneumonia at North Colorado Medical Center in Greeley. He described the efforts of his doctors and nurses as heroic, some working nine or 10 days in a row, many taking overtime. And others, Blessin said, were filling in.

“So often you’d have people from different departments being trained on the fly,” Blessin said. “So there’s a lot of pressure on people. They’re just trying to get warm bodies in there.”

Respiratory therapists are in short supply in hospitals, and Blessin said as more coronavirus patients were admitted, the staff struggled to keep up.

Blessin said he landed in the hospital because he was swayed by internet misinformation and didn’t get vaccinated. It’s a decision he came to regret.

“I guess my recommendation would be to get vaxed, you know, even if you’re totally against it; don’t fall into the internet hype,” Blessin said.

After his experience being hospitalized for a month due to the coronavirus, and having talked with his physicians there, he now plans to get vaccinated.

This story is from a reporting partnership that includes , and .

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Fútbol, Flags and Fun: Getting Creative to Reach Unvaccinated Latinos in Colorado

John Daley, Colorado Public Radio — Fri, 16 Jul 2021 09:00:00 +0000

Horns blared and drums pounded a constant beat as fans of the Mexican national soccer team gathered recently at Empower Field at Mile High in Denver for a high-profile international tournament.

But the sounds were muted inside a mobile medical RV parked near the stadium, and the tone was professional. During halftime of Mexico’s game against the U.S., soccer fan Oscar Felipe Sanchez rolled up his sleeve to receive the one-dose covid-19 vaccine.

Sanchez is a house painter in Colorado Springs. After getting sick with covid a few months ago, he thought he should get the vaccine. But because of the illness, he was advised to wait a few weeks before getting the shot. Asked if he’s glad he got it, Sanchez answered through a translator: “Yes! He’s more trusting to go out.”

Bringing the mobile vaccine program to an international soccer match was the latest effort by the state of Colorado and its local partners to meet unvaccinated residents wherever they are, rather than ask them to find the vaccine themselves.

During halftime at a Mexico-USA match in Denver, Oscar Felipe Sanchez receives the Johnson & Johnson covid-19 vaccination inside a mobile health clinic parked outside Empower Field at Mile High. (John Daley/Colorado Public Radio)

Long gone are the days in early spring when vaccine appointments were snatched up the instant they became available, and health care workers worried about making sure patients were eligible under state and federal criteria for age and health status.

Colorado, and most of the nation, has now moved into a new phase involving targeted efforts and individual interactions and using trusted community influencers to persuade the hesitant to get jabbed.

With about half of Colorado’s 5.78 million people now fully immunized, the challenge cuts across all demographic groups. According to the state’s vaccination dashboard, men are slightly more hesitant than women and rural residents are more hesitant than urban dwellers. Younger Coloradans have been less likely than their elders to prioritize the shots.

But perhaps no group has been harder to get vaccinated than Coloradans who identify as Hispanic. Despite Hispanics making up more than 20% of the state population, only about 10% of the state’s doses have gone to Hispanic residents, according to the .

The gap is not as wide nationally: Hispanics, or Latinos, make up 17.2% of the U.S. population, and 15.8% of people who have gotten at least one dose — and whose race/ethnicity is known — are Hispanic.

At first, the gap in Colorado seemed to be an issue of inadequate access to health care. Nearly 16% of Hispanic Coloradans are uninsured, according to a KFF . That’s more than double the rate for white Coloradans. That disparity may play a role, even though the vaccine itself is free, with no insurance requirement.

Denver has hit the for resident vaccination, but some Latino neighborhoods are getting vaccinated at much lower rates, according to Dr. Lilia Cervantes, an associate professor in the department of medicine at Denver Health.

“There are some very high-risk neighborhoods where most of the community are first-generation or foreign-born individuals,” said Cervantes. “And that is where we’re seeing the highest disparities.”

According to from Denver’s health agencies, about 40% of Latinos older than 12 are vaccinated in Denver County — that’s far below the roughly 75% rate for whites.

Latinos make up 29% of the Denver population but represent nearly half of cases and hospitalizations.

If the state hopes to reach broad levels of protection from the virus, Cervantes said, “I think that it is critical that we improve vaccine uptake in our most marginalized groups, including those who are undocumented and those who are Spanish-language dominant.” Cervantes added she’s concerned the state will keep seeing a higher covid positivity rate in those marginalized groups, who make up much of the essential workforce. “This past year, I think we have seen stark health inequities in the Latino community.”

All this portends a more uneven pandemic, said Dr. Fernando Holguin, a pulmonologist and critical care doctor at the

He worries cases, hospitalizations and deaths will keep flaring up in less vaccinated communities, especially predominantly Hispanic populations in parts of Colorado or other states where overall vaccination rates are poor. “They’re at risk, especially moving into the fall of seeing increasing waves of infections. I think it is really critical that people really become vaccinated,” Holguin said. Even as parts of Colorado and parts of the U.S. — like the Northeast — are getting vaccinated at high rates, for the mostly unvaccinated “covid infections in certain communities still will be devastating for them,” he said.

He’s especially concerned about migrant farmworkers, who often have poor access to the internet and may struggle to find good information about the vaccine and avoiding the virus. “So overcoming those access, cultural, language barriers is important,” he said.

When asked what the state has done to reach out to Latino Coloradans, a health department spokesperson pointed to over 1,500” in 56 counties; the , which partners with businesses and organizations to provide vaccine clinics at worksites; and a Spanish-language Facebook page and covid website. She said the state’s “Power the Comeback” campaign is available in English and Spanish and aims to reach disproportionately affected populations with , videos and.

About a third of all adults in the U.S. are unvaccinated, a “shrinking pool” that skews younger and includes people more likely to identify as Republican or Republican-leaning, according to a .

They also tend to be poorer, less educated and more likely to be uninsured. The KFF report found 19% of unvaccinated adults are Hispanic; of that group, 20% said they will “wait and see” about getting vaccinated, and 11% said they’d “definitely not” get it.

Both Cervantes and Holguin credit local, state and community groups with aggressively looking to boost vaccination rates among Latino Coloradans, while also encouraging them to keep recruiting trusted community voices from within, to help deliver the message.

“You know, it’s not going to be Dr. [Anthony] Fauci saying something, that someone translates in Spanish, that you need to get vaccinated,” Holguin said. “There’s going to be people in the community convincing others to get vaccinated.”

At Empower Field, soccer fan Diego Montemayor of Denver echoed that sentiment, saying some fans who got shots themselves urged friends who came to the stadium to visit the RV and get one, too. “When they hear people that they trust sharing their experiences, that goes a long way,” Montemayor said.

Community health advocate Karimme Quintana agreed. She had come to the game as well to spread the word about the safety and efficacy of the vaccine. She works as a promotora de salud pública, a public health outreach worker, focusing her efforts on Denver’s majority-Latino Westwood neighborhood. Quintana said that population may trust someone close to them more than even a doctor.

Karimme Quintana, a community health advocate known as a promotora, works with the Latino population of Denver’s Westwood neighborhood. (John Daley/Colorado Public Radio)

“They need to be more educated about the covid because they have a lot of questions,” said Quintana, whose button read “¿Tiene preguntas sobre covid? Pregúnteme.” (“Do you have questions about covid? Ask me.”)

“Latino people, they listen [to] the neighbor, they listen [to] my friend,” Quintana said.

University of Colorado Health nurse Danica Farrington said the vaccine effort at the soccer tournament was heavily promoted beforehand on billboards and big screens inside the stadium during the game.

“They just plastered it everywhere and said, go get your shot,” she said. “That’s pretty influential.”

The carnival atmosphere at the stadium helped him make the pitch, said Jesus Romero Serrano, a community ambassador with Denver’s mayor’s office: “It’s a Mexico game versus Honduras! So lots of Latinos are here. This is the perfect place to be, to reach the Latin community. Absolutely!”

To capitalize on the playful spirit of the day, Romero Serrano wore a Mexico soccer jersey and a red-and-green luchador wrestling mask. In his work with the city government, he’s what you could call a community influencer. He filtered through the tailgate crowd in the parking lot, handing out cards about where to get a vaccine.

As he circulated, he admitted it’s sometimes hard for some Latino Coloradans to overcome what they see as years of historical mistreatment or neglect from medical providers. “They don’t trust the health care system,” he said.

Still, Romero Serrano kept wading into the crowd, shaking hands and shouting over the constant din of the drum bands, asking people whether they had gotten a vaccine.

The most common answer he heard was “everybody has it” — but he was skeptical about that, thinking people were just being nice.

A few miles from the stadium is the in the predominantly Hispanic Globeville neighborhood. That’s home base for , a family physician and the chief health officer at the clinic. She tries to address her patients’ fears and concerns about the new vaccines, but many have told her they still want to wait and see that people don’t have serious side effects.

Valenza’s clinic recently held more vaccine events, at more convenient times that didn’t interfere with work, like Friday evenings, and offered free grocery cards for the vaccinated. She said she likes the idea of pairing vaccines with fun.

“The Latino culture — food, culture and community — is such a central part of the Latino community,” Valenza said. “Making the events maybe a little bit more than just a vaccine might encourage some community members to come out.”

This story is part of a partnership that includes ,�� and KHN.

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What Happened When the Only ER Doctor in a Rural Town Got COVID

John Daley, Colorado Public Radio — Fri, 04 Dec 2020 10:00:38 +0000

Kurt Papenfus, a doctor in , Colorado, started to feel sick around Halloween. He developed a scary cough, intestinal symptoms and a headache. In the midst of a pandemic, the news that he had COVID-19 wasn’t surprising, but Papenfus’ illness would have repercussions far beyond his own health.

Papenfus is the lone full-time emergency room doctor in the town of 900, not far from the Kansas line.

“I’m chief of staff and medical director of everything at currently in Cheyenne County, Colorado,” he said.

With Papenfus sick, the hospital scrambled to find a replacement. As coronavirus cases in rural Colorado, and the state’s Eastern Plains especially, surge to unprecedented levels, Papenfus’ illness is a test case for how the pandemic affects the fragile rural health care system.

“He is the main guy. And it is a very large challenge,” said Stella Worley, CEO of the hospital.

If she couldn’t find someone to fill in while he was sick, Worley might have to divert trauma and emergency patients nearly 40 miles north to Burlington.

“Time is life sometimes,” she said. “And that is not something you ever want to do.”

‘The ‘Rona Beast Is a Very Nasty Beast’

As deaths from the coronavirus have surpassed 250,000 in the U.S., new data show the pandemic has been particularly lethal in rural areas — it’s taking lives in those areas at a rate reportedly nearly than in metropolitan communities.

About 63 people in have been diagnosed with COVID-19, most of them in the past three weeks.

Papenfus, a lively 63-year-old, was discharged after a nine-day stay at St. Joseph’s Hospital in Denver, and he was eager to sound the alarm about the disease he calls the ‘rona.

“The ‘rona beast is a very nasty beast, and it is not fun. It has a very mean temper. It loves a fight, and it loves to keep coming after you,” Papenfus said.

He isn’t sure where he picked it up but thinks it might have been on a trip east in October. He said he was meticulous on the plane, sitting in the front, last on, first off. But on landing at Denver International Airport, Papenfus boarded the crowded train to the terminal, and soon alarm bells went off in his head.

“There are people literally like inches from me, and we’re all crammed like sardines in this train,” Papenfus said. “And I’m going, ‘Oh, my God, I am in a superspreader event right now.'”

An airport spokeswoman declined to comment about Papenfus’ experience.

A week later, the symptoms hit. He tested positive and decided to drive himself the three hours to the hospital in Denver. “I’m not going to let anybody get in this car with me and get COVID, because I don’t want to give anybody the ‘rona,” he said. County sheriff’s deputies followed his car to ensure he made it.

Once in the hospital, chest X-rays revealed he’d developed pneumonia.

“Dude, I didn’t get a tap on the shoulder by ‘rona, I got a big viral load,” he texted a reporter, sending images of his chest scans that show large, opaque, white areas of his lung. Just a week earlier, his chest X-ray was normal, he said.

Back in Cheyenne Wells, Dr. Christine Connolly picked up some of Papenfus’ shifts, although she had to drive 10 hours each way from Fort Worth, Texas, to do it. She said the hospital staff is spread thin already.

“It’s not just the doctors; it’s the nurses, you know. It’s hard to get spare nurses,” she said. “There’s not a lot of spares of anything out that far.”

Besides himself, six other employees — out of a staff of 62 at Keefe Memorial — also recently got a positive test, Papenfus said.

Hospitals on the Plains often send their sickest patients to bigger hospitals in Denver and Colorado Springs. But with so many people around the region getting sick, Connolly is getting worried hospitals could be overwhelmed. Health care leaders created a new command system to transfer patients around the state to make more room, but Connolly said there is a limit.

“It’s dangerous when the hospitals in the cities fill up, and when it becomes a problem for us to send out,” she said.

‘Bank Robbers Wear Masks Out There’

The impact of Papenfus’ absence stretches across Colorado’s Eastern Plains. He usually worked shifts an hour to the northwest, at in Hugo. Its CEO, Kevin Stansbury, said the town mostly dodged the spring surge and his facility could take in recovering COVID patients from Colorado’s cities. Now, Stansbury said, the virus is reaching places such as Lincoln County, It has had 144 cases, according to , and neighboring Kit Carson has had 301. Crowley County to the south, home to a privately managed state prison, has had 1,239 cases. It is far and away the No. 1 most affected county per capita in the state.

“So those numbers are huge,” Stansbury said. He said that as of mid-November about a half-dozen hospital staffers had tested positive for the virus; they think that outbreak is unrelated to Papenfus’ case.

Lincoln Community Hospital is ready once again to take recovering patients. Finances in rural health care are always tight, and accepting new patients would help.

“We have the staff to do that, so long as my staff doesn’t get ravaged with the disease,” Stansbury said.

Rural communities are particularly vulnerable. Residents tend to suffer from underlying health conditions that can make COVID-19 more severe, including high rates of cigarette smoking, high blood pressure and obesity. And Brock Slabach of the National Rural Health Association said 61% of rural hospitals do not have an intensive care unit.

“This is an unprecedented situation that we find ourselves in right now,” Slabach said. “I don’t think that in our lifetimes we’ve seen anything like what is developing in terms of surge capacity.”

A couple of hours east of Cheyenne Wells, COVID-19 recently hit Gove County, Kansas, hard.

The county’s emergency management director, the local hospital CEO and more than 50 medical staff members tested positive. In a nursing home, most of the more than 30 residents caught the virus; six have died since late September, . A county sheriff ended up in a hospital more than an hour from home, fighting to breathe, because of the lack of space at the local medical center.

Papenfus fretted about his home county and its odds of fighting off the virus.

“The western prairie isn’t mask country,” he said. “People don’t wear masks out there; bank robbers wear masks out there.” He is urging Coloradans to stay vigilant, calling the virus an existential threat. “It’s a huge wake-up call.”

Since being released from the hospital, Papenfus has had a rocky recovery. His wife, Joanne, drove him back to Cheyenne Wells, wearing an N95 mask and gloves, while he rode in the back on oxygen, coughing through the three-hour drive.

Once back at home after that initial nine-day stay, Papenfus hunkered down, with the occasional trip outside to hang out with his pet falcon.

But a week after going home, he started having nightly fevers. He had a CT scan done at Keefe Memorial, the hospital where he works. It revealed pneumonia in his lungs, so he went back to Denver, getting readmitted at St. Joseph’s Hospital. This time, Papenfus arrived via ambulance.

Finding a replacement for Papenfus at Keefe has been hard. The hospital is working with services that provide substitute physicians, but these days, with the coronavirus roaring across the country, the competition is fierce.

“They’re really scrambling to get coverage,” Papenfus texted from his hospital bed. “Whole county can’t wait for my return but this illness has really taken me down.”

He said he was now at Day 35 from his first symptoms, lying in his hospital bed in Denver, “wondering when I’ll ever get back.” Papenfus noted that COVID-19 has affected his critical thinking and that he will need to be cleared cognitively to return to work. He said he knows he won’t have the physical stamina to get back to full duty “for a while, if ever.”

This story is from a reporting partnership that includes ,��Ի��ᱷ.

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