The Colorado Department of Public Health and Environment said in a Monday afternoon news conference that while the state has recorded 5,172 cases of COVID-19, the real number is likely closer to 17,000 to 18,000 cases, or as much as 0.3% of the state’s total population.

“It’s more than we’ve been talking about,” said Dr. Jill Hunsaker Ryan, the CDPHE executive director. She also said that more people are recovering or will recover soon, and will have immunity, but “we are still at the beginning of this epidemic.” And hospitals are feeling the strain, she said. 

CDPHE officials addressed a model from the Institute for Health Metrics and Evaluation, from the University of Washington in Seattle, that showed Colorado had reached its peak infection rate. 

Sadly, that’s not true, according to state Epidemiologist Rachel Herlihy. While the state is considering the IHME model, the best model is one developed by the Colorado School of Public Health, using real-time Colorado data. She said the IHME model uses different assumptions than the ones modeled by the School of Public Health.

Herlihy said the IHME model uses social distancing strategies from the pandemic when it hit Wuhan, China, not the same strategies employed in Colorado, she said. In addition, the Colorado model assumes those in intensive care units will need ventilators, an assumption not built into the IHME model. “We are certain the peak has not hit,” Ryan said.

It’s too soon to know when the peak will happen, Herlihy said, although the social distancing efforts, including the stay at home order, are showing that people are taking those orders seriously. The disease is spreading more slowly in Colorado than it was a month ago, she said. At that time, cases were doubling every two days; now it’s down to five or six days.

Dr. Eric France, the state’s chief medical officer, also explained the Crisis Standards of Care, approved on Sunday by the governor, and how that will be used to determine who gets ventilators and health care for COVID-19.

The standards have four tiers, with a scoring system.

• Tier one: acuity of illness and morbidity; if there is a tie,
• Points to pediatric patients, health care workers and first responders. If there is a tie:
• Special considerations, such as pregnancy or a primary caregiver, or the number of years of life the patent is expected to have, with more points for younger people. 
• In case of a tie: A random allocation to choose how to use scarce resources

“It’s clear this is a difficult time. We are in crisis,” France said. Those standards of care also are applied to the use of personal protective equipment .

France also said that he expects 30% to 40% of Coloradans to eventually catch COVID-19. About 5% of those patients will need to be hospitalized, and 40% of those patients will be in an intensive care unit, with half on ventilators.

“With that kind of burden facing us, we may run the risk of scarce healthcare resources,” France said. Every hospital and/or health care system is expected to have a standards of care triage team that does not include doctors or nurses working on the front lines of the pandemic, he explained.

The triage team will make those difficult decisions, blind to irrelevant information such as race or nationality that doesn’t predict health care outcomes.

The social distancing strategies, from closing restaurants, bars, schools, limiting the size of gatherings, and finally the stay-at-home order on March 26, has so far reduced the spread by 45%, Herlihy said, although the state goal is to get to 60% to 80%. 

One of the goals of social distancing, Herlihy said, is to flatten the curve and reduce the need for ICU beds. At a 60%, Colorado would hit its threshold on May 15. Anything above that, Colorado would never reach maximum capacity for COVID-19, she said. 

“Now is not the time to back off, or to pat ourselves on the back,” she said.

Testing is still an issue; the public health officials did not answer a question on whether or when more tests would be available, instead talking about the number of tests being processed by the state lab and commercial partners.

Mid-day numbers on Monday show that 148 people in Colorado have died from COVID-19, up eight from Sunday; 5,172 cases, up 222 from Sunday, and 976 people have been hospitalized, up 52 from Sunday.

And 41 non-hospital health care facilities – nursing homes, assisted living and rehab centers – now have a COVID-19 outbreak.

On Friday, Gov. Jared Polis asked Coloradans to wear non-surgical masks, which people can make out of t-shirts or even shop towels, no sewing required. “We are asking the public not to buy surgical masks,” as those should be saved for hospital and health care workers, Ryan said.

Polis will address Coloradans in a statewide-broadcast speech at 6:30 p.m. Monday.