Colorado could surpass its current hospital capacity and mark its worst peak of the pandemic by the end of the year, state health officials said Wednesday, even if three-quarters of eligible Colorado adults receive boosters by then.

To address the crisis, Gov. Jared Polis said the state was preparing to significantly expand hospital capacity and staffing and is working with local authorities, particularly in Denver, to consider vaccine mandates for indoor events.

On its current trajectory, the state is projected to hit 2,258 hospitalizations by Jan. 1, state epidemiologist Rachel Herlihy told members of the Governor’s Expert Emergency Epidemic Response Committee on Wednesday. There are 1,426 COVID-19 patients hospitalized now, she said, and there has been an average of 759 beds left statewide over the past week. 

Even if Colorado doubles its projected uptake of boosters, hospitalizations may still hit 2,156 by Christmas Eve. If 75% of eligible adults are boosted, the peak would be 2,082, Herlihy said. She said the state’s current hospital capacity is roughly 2,000 patients, though it may be as high as 2,200. 

Last year, when the state was in the midst of its worst pandemic wave, Colorado peaked at 1,841 confirmed patients. If Herlihy’s latest projections are correct, the state would blow past that record in the next eight weeks. Cara Welch, spokeswoman for the Colorado Hospital Association, told The Gazette on Wednesday that the state “seems likely” to surpass 2,000 COVID-19 hospitalizations by the end of the year.

The new projections are a sharp increase from models released just five days ago, when state health experts said the state may reach its 2020 peak but was unlikely to do so. But that team’s hospitalization projections for the entire month of November were surpassed by Monday afternoon, three days after the model was released. Thanks in part to COVID-19 and more acutely to staffing shortages, intensive care and acute care bed capacity have both been stretched to more than 90%. Welch said there are currently 720 total beds available. Those numbers often fluctuate within even 24-hour periods, but that level marks the lowest levels of the pandemic thus far.

To address the crisis, which has grown steadily for weeks and has spiraled further in the past week, Polis told the committee – made up of various health officials statewide – that he’s seeking to surge hospital capacity by as many as 500 beds in the coming weeks, when the projected peak is expected to come.

“We’ve challenged the team to make sure, by the time of that peak in about 30 to 45 days, we do have 500 additional beds,” he said. “Now, it’s not going to be the same when we built thousands of beds and they were stand-alone facilities. This is generally working with providers to activate floors that have been closed, to repurpose other areas. It’s both the staffing and the space.”

Welch said adding 500 more beds “would require nearly all of our available resources.” 

“We hope the state and FEMA can provide additional support, especially staff, to help us surge additional beds as we will absolutely need those in the weeks and months ahead,” she said in an email.

Polis said he would issue an executive order soon to define Colorado as a high-risk institution, in order to allow booster doses to be available to all adult residents who received their vaccine doses months ago. The state has already moved to make that policy. Federal guidance limits boosters to certain at-risk individuals and to people working in high-risk settings; the order would expand high-risk settings to include the entire state.

Messages sent to spokespeople for the Centers for Disease Control and Prevention and the Food and Drug Administration were not immediately returned Wednesday.

The governor told the health officials that he’s also considering addressing indoor events to make them “safer” and avoid super-spreader events. He suggested vaccine requirements are being considered. He pointed to Denver, which he said has a majority of venues, as a current focus, and he referenced Ball Arena – which already has a vaccine requirement – as an example. He said the state could not “afford a super-spreader event.”

“Large indoor events where everybody’s vaccinated – is it possible the virus could spread to a few people there? It is,” he said. “It’s a very different characteristic of how effective the delta variant is at seeking out and infecting the unvaccinated. If you have a sizable amount of unvaccinated in a super-spreader event – it might not be five or 10 people, it could be hundreds of people who get the (disease).”

He said the state is “looking to work with other cities and venues for this to play a more significant role in the short-to-medium term suppressing the virus. Policies like this also make our events safer for everyone to go out.”

The Denver Department of Public Health and Environment said in a statement the agency was working with the state closely and that it supported vaccination requirements already in place at some venues. But requirements “are not our way out of the pandemic. Vaccines are our way out,” the agency said, which is why the city requires them for a broad swath of the publicly facing workforce.

The state will also continue to push boosters, which have been demonstrated to improve immunity. State leaders have repeatedly said the pandemic is one of the unvaccinated – the vast majority of hospitalized patients are unvaccinated. But Eric France, the state’s chief medical officer, said Wednesday that a third of new infections recently are among people who are vaccinated, signaling concerns about waning immunity and the vital role boosters will play in the coming weeks.

Monoclonal antibodies are also going to continue to be a focus moving forward; the treatment has been demonstrated to help reduce hospitalizations when given early after symptoms begin. More than 150 providers statewide are able to administer the medicine.

Further relief, the governor said, may come to enhance the health care worker workforce, including bringing in retired or out-of-state nurses and providers, as well as temporarily expanding the scope of practice for providers. The state activated its crisis standards of care for hospital staffing Tuesday, which further gives leeway for providers.

One provider team from the Federal Emergency Management Agency has already been deployed in the state, to the Parkview Medical Center in Pueblo. Two more are likely to come soon. 

Polis’ new strategies will “happen over the next few weeks,” he said, ” … to make sure we don’t exceed hospital capacity in the newly projected peak in December.”

Dan Pastula, of the Colorado School of Public Health and the University of Colorado, asked Herlihy about masking, particularly “targeted” requirements for hot-spot areas in the state.

Herlihy said the state has “looked at a variety of scenarios” and is “doing some updated work looking at additional scenarios, including a variety of strategies around mask use.” The state has resisted instituting any behavior-based public health orders amid this latest surge. It has instead allowed local public health agencies to make those decisions. Thus far, Larimer and Boulder counties have both enacted masking orders.