San Juan County, Colorado, can boast that 99.9% of its eligible population has received at least one dose of covid-19 vaccine, putting it in the top 10 counties in the nation, from the Centers for Disease Control and Prevention.
If vaccines were the singular armor against covid鈥檚 spread, then on paper, San Juan County, with its 730 or so residents on file, would be one of the most bulletproof places in the nation.
Yet the past few months have shown the complexity of this phase of the pandemic. Even in an extremely vaccinated place, the shots alone aren鈥檛 enough because geographic boundaries are porous, vaccine effectiveness may be waning over time and the delta variant is highly contagious. Infectious-disease experts say masks are still necessary to control the spread of the virus.
The county logged its first hospitalizations of the pandemic in early August 鈥� this year, not 2020. Five summer residents were hospitalized. Three ended up on ventilators: Two recovered and the third, a 53-year-old woman, died at the end of August. All were believed to be unvaccinated.
Those cases and even the ones that didn鈥檛 need hospitalization raised the alarms for the county with a single incorporated town: Silverton. It鈥檚 a tightknit former mining community nestled in the mountains of southwestern Colorado, where snowstorms and avalanches often block the lone road that passes through.
鈥淭he pandemic is just still going on,鈥� said DeAnne Gallegos, the county鈥檚 public information officer and director of the local chamber of commerce. 鈥淲e kept thinking it was going to end before this summer. Then we were thinking in November. Now we鈥檙e like, 鈥楴o, we don鈥檛 know when.鈥欌��
So the county decided to backtrack: 鈥淲e went back to the tools that we knew we had,鈥� Gallegos said. 鈥淢ask mandate indoors and then discouraging indoor events.鈥� Outdoor events continued, such as a brass band concert on the courthouse steps, and the area鈥檚 signature Hardrockers Holidays mining competition, with its
On the whole, once the under-12 set is taken into account, 85% of the county鈥檚 total population is fully vaccinated. But in the summer, the population nearly doubles as seasonal residents roost in second homes and RV parks, some vacationing while others take up seasonal jobs. Then, there鈥檚 what Gallegos described as 鈥渢he tsunami of tourism鈥� 鈥� the daily influx of people arriving on the historical railroad from Durango and the dusty jeep trails through the mountains. Many of those visitors are of unknown vaccination status.
The county鈥檚 two-week incidence shot up in August to the highest rate in the state, and stayed there for most of the month. Even though that spike amounted to a grand total of about 40 known cases, it was nearly as many as the county had logged during the entirety of the pandemic 鈥� and cases spilled into the vaccinated as well.
Any number of cases would be a big deal in a small place without its own hospital. 鈥淲e are all one-man bands just trying to make it happen,鈥� Gallegos said. The county鈥檚 public health director, Becky Joyce, for example, does everything from contact tracing and covid testing to putting shots in arms. And when the county restarted its mask mandate, it was Gallegos who designed the signs and spent her weekend zip-tying them around town.
The biggest concentration of covid cases happened at an RV park and a music festival driven indoors by rain.
鈥淚t makes sense that coming out of three or four weeks of just jamming tourism, people were starting to get sick who work in the restaurants, at the RV parks,鈥� Gallegos said. 鈥淎nd then you bring all the locals condensed together for a couple of nights of concerts and it was just the trifecta.鈥�
Dana Chambers, who runs the hardware store in Silverton, was vaccinated as soon as possible. She said returning to a mask mandate felt in some ways like 鈥渁 step back.鈥� But, she said, businesses like hers need the summer tourism rush to survive the quiet winter, when just a few hundred tourists come, largely to jump out of helicopters onto ski terrain. 鈥淚f we have to wear the mask, that鈥檚 what we鈥檒l do.鈥�
, a Boston University School of Public Health epidemiologist who is following state pandemic policies, isn鈥檛 surprised covid can attack a place like San Juan County despite high vaccination rates.
Data shows the vaccines protect against death and hospitalization due to covid. But even effective vaccines are no match for the transmissibility of delta. 鈥淓ven in the best-case scenario 鈥� if vaccines reduce transmission by 80% 鈥� you鈥檙e actually twice as likely to get covid now than you were in July,鈥� Raifman said, due to the virus鈥檚 recent proliferation. 鈥淚t鈥檚 impossible statistically to achieve herd immunity with the delta variant.鈥�
Meanwhile, many local and national leaders, including in Colorado, continue to focus on the vaccines almost exclusively as the path forward.
, an epidemiologist with the University of Colorado-Denver and the Colorado School of Public Health, said the concept of herd immunity in this pandemic has been oversimplified and over-relied-on. 鈥淚t鈥檚 a useful guide to have some sort of target to aim for,鈥� she said. 鈥淏ut usually, if we hit a certain metric, that doesn鈥檛 mean that transmission or the pandemic is just going to disappear.鈥�
Many scientists agree that, especially with most of the world still unvaccinated, covid is , eventually into something more like the common cold. 鈥淚t鈥檚 probably going to be a matter of a couple of years,鈥� Quandelacy said. 鈥淏ut that seems to be the trajectory that we are on.鈥�
For that reason, the 鈥渇inish line鈥� language used by many politicians has frustrated , a policy fellow at the Nelson A. Rockefeller Center for Public Policy at Dartmouth College studying covid and rural health. The vaccines are doing what they鈥檙e supposed to do 鈥� keeping people from getting really sick, not keeping them from ever getting infected 鈥� but that hasn鈥檛 been communicated well. 鈥淭he messaging around this has not been very nuanced,鈥� she said.
She pointed to the experience of an epidemiologist who that he鈥檇 caught covid at a house party where all 14 guests and the host were vaccinated. The host had infected him and nine others. 鈥淎s miraculous as they are in keeping people out of the hospital and alive, we can鈥檛 rely on them alone to prevent infection,鈥� Sosin said of the vaccines.
And public health experts said San Juan County shows that measures such as masks, ventilation and distancing are also needed. They are circulating the 鈥淪wiss cheese鈥� in which each prevention measure (or layer of cheese) has holes in it, but when stacked together they create an effective defense. Sosin said rural places, in particular, may need those layers of defense because residents are often tightly connected, and disease travels quickly within social networks.
Joyce, the public health director, who declined an interview request, wrote on in August that the county鈥檚 recent experience proved 鈥渢he vaccine creates a line of defense but does not make us invincible to this disease or the variants.鈥�
Raifman views that realization 鈥� paired with San Juan鈥檚 ensuing indoor mask requirement 鈥� as a success at a pivotal moment. The month-long mandate was then lifted Sept. 10, as the county had dropped back to a low covid transmission rate. At the time, it was the only county in Colorado with such low transmission.
鈥淭his is the moment where we kind of define: How are we managing the virus over the longer term?鈥� Raifman said. 鈥淪o far, we鈥檙e defining that we don鈥檛 manage it; we let it manage us.鈥�
Even after lifting its mask mandate, the of the county鈥檚 public health department residents to wear masks and 鈥減ay attention to the covid-19 situation just as you pay attention to the weather.鈥�