Author: Christie Aschwanden

 

Ski Resorts Work to Stay Open as COVID Cases Snowball

TELLURIDE, Colo. — The day after Thanksgiving, Dr. Jana Eller and Dr. Shiraz Naqvi were seated beside an outdoor fire pit at the base of Telluride Ski Resort, taking a short break from skiing.

The two physicians from Houston had driven more than 18 hours to get here for the holiday weekend, and they were staying (and preparing meals) in a rented home. They traveled with another couple and their kids, colleagues they’ve been “bubbling” with in Houston.

“We got a COVID test prior to leaving and will get another when we return,” Naqvi said.

The skiing itself doesn’t feel much different during the pandemic, Eller said, but “the après ski scene is just gone.”

In March, at the beginning of the pandemic, Colorado Gov. Jared Polis issued an executive order requiring the state’s ski resorts to close in response to COVID-19, which had hit the state’s ski towns early and hard. Now, as the resorts enter their busy season, the state has taken pains to avoid blanket closures even though cases of COVID-19 are reaching their highest levels yet.

How to stay open amid the pandemic is an issue resorts across the U.S. are facing. Mandatory face coverings have become the norm, but other COVID mitigation efforts vary by site. Vermont resorts ask skiers to certify their compliance with rules governing interstate travel during the pandemic when buying a lift ticket, and in Colorado’s Pitkin County (home to Aspen), visitors will be required to confirm they’ve had a negative COVID test result within 72 hours of travel or pledge to quarantine for 14 days after arrival or until they obtain a negative test result.

Telluride is an internationally renowned destination trying to operate safely while protecting the 8,000 or so permanent residents in the area. Located in a remote southwestern part of Colorado, its economy depends on tourism, and the resort posts as many as 6,500 visitors on its busiest days.

On Nov. 25, with its COVID case numbers skyrocketing and its positivity rate hitting 4.6%, San Miguel County, which includes Telluride, closed its bars and restricted its restaurants to takeout and outdoor dining only. Signs posted throughout the resort remind visitors of the “five commitments of containment” — wear a mask, maintain 6 feet of physical distance, minimize group size, wash hands frequently and, when you feel sick, stay home and get tested.

How bad would things have to get to close the resort? That’s hard to gauge, said Grace Franklin, public health director for the county. People are going to do what they will regardless, she said.

“If we shut down the ski resort, how many people will take to the backcountry and get injured or trigger avalanches where the impact is greater? It’s a ‘damned if you do, damned if you don’t’ situation,” Franklin said.

Instead, Franklin said, the question becomes “How do we create safer, engineered events so people have an outlet, but we minimize as much risk as possible?”

Skiing itself poses relatively little risk, said Kate Langwig, an epidemiologist at Virginia Tech. “You’re outside with a lot of airflow, you’ve got something strapped to your feet so you’re not in super close contact with other people, and most of the time you’re riding the lift with people in your group.”

Gathering in the lodge or bar is by far the biggest COVID risk associated with skiing, said Langwig, who grew up skiing in northern New York. “In my family, one of the things you do after a day of skiing is connect with friends and have a beer in the lodge,” and it’s this social aspect of skiing that’s too risky right now, she said.

In an effort to discourage tourists and residents from congregating, local governments, medical facilities and the ski resort released a co-signed letter in November urging people to cancel any plans to gather with those outside their immediate household and celebrate the holidays solely with people from their own household. Keeping the resort open will require everybody to do their part, said Lindsey Mills, COVID public information consultant for San Miguel County.

“We are not telling anybody not to come, at least not yet,” said Todd Brown, Telluride’s mayor pro tem. But local officials are broadcasting a strong message to everyone in the area — “Chill out. Don’t have the big party with five families.”

Officials aren’t worried only about coronavirus transmission; they’re also concerned about overtaxing their medical facilities. San Miguel County has an urgent care center but no hospital, and its medical center experienced a 22% staffing shortage at the end of November, mostly because so many employees are in quarantine. Hospitals in nearby Mesa County reached their ICU capacity last month, and other hospitals in the region are also pinched.

“We can’t have a situation where people break their legs on the slopes and we can’t get them care,” said Franklin.

The resort has taken steps to facilitate physical distancing among visitors. Reservations aren’t required at Telluride, but lift tickets must be purchased in advance, and the resort can restrict ticket sales if necessary, said Jeff Proteau, vice president of operations and planning at the Telluride Ski Resort. Gondolas are operating with the windows open and each load is restricted to members of the same household.

To reduce contact in and around the lifts, workers have created “ghost lines” of empty space to ensure a 6-foot distance between groups while they wait in lift lines. People from the same household can stand in line together and ride the two- to four-person lifts next to one another, Proteau said, but when riding a lift with someone from another household, guests are asked to leave a vacant seat between them.

Langwig was a children’s ski instructor for many years and worries about ski school. “You interact pretty closely with the kids,” she said, noting that runny noses are common. “You spend a lot of time getting kids bundled up and to and from the bathroom.” This could be especially challenging if indoor spaces are closed, she said. “Hot chocolate breaks are one of the ways you get kids through the day, and that’s not safe anymore.”

In anticipation of visitors needing to take breaks to warm up, the resort has installed six temporary structures around the mountain with insulated ceilings and heated panels. When the sides are rolled up, they’re considered outdoor spaces, Proteau said, but they can be closed into confined spaces with limited occupancy as needed, especially on a blustery day.

The risk for most employees on the mountain should be relatively minimal, Langwig said, at least at work. “Lift attendants are outside wearing thick gloves and a mask most of the time. Compared to someone who works in a restaurant, their risk is pretty low.”

Employees are generally assigned to work in small groups that can be quarantined, if necessary, without wiping out a whole department, Proteau said. There’s also contact tracing in place for resort employees.

Arizona native Joey Rague moved to Telluride last year and works as a ski valet on the mountain. He said there’s a huge incentive among employees to keep the resort open. With affordable housing sparse in Telluride, “all of us are struggling seasonally to be able to pay rent.”

So far, he said, most visitors have been respectful and conscientious of the rules.

“It seems as though people understand that if we want to stay open, we have to come together,” he said.

This article was originally published on Ski Resorts Work to Stay Open as COVID Cases Snowball

A Colorado Ski Community Planned To Test Everyone For COVID-19. Here’s What Happened.

In late March, residents of the Colorado town of Telluride and surrounding San Miguel County stood in line, along marked spots spaced 6 feet apart, to have their blood drawn by medical technicians wearing Tyvek suits, face shields and gloves for a new COVID-19 test.

While the Centers for Disease Control and Prevention’s tests for the virus that causes the respiratory illness have been in short supply since the outbreak began, this was a new type of test. It wasn’t to see who was sick right now. It was an antibody test that would assess who had been exposed and how widespread the virus was in the community to inform decisions about managing the outbreak.

When part-time Telluride residents and United Biomedical Inc. co-CEOs Mei Mei Hu and Lou Reese had offered to provide their company’s newly developed COVID-19 antibody tests for free to not just Telluride, but all of San Miguel County too, more than 6,000 of the county’s estimated 8,000 residents jumped at the chance.

“People really want to be part of it,” said Donna Fernald, a home health nurse who was tested the first day.

“This was a gift and an opportunity,” said San Miguel County spokesperson Susan Lilly.

That was the original plan, anyway. But on Tuesday, the grand experiment with bold aspirations appeared to fall apart. Lilly put out a statement announcing that testing was being “delayed indefinitely due to United Biomedical Inc.’s reduced ability to process the tests due to the COVID-19 pandemic.” Lilly declined to comment on the decision.

The test that Hu and Reese’s company had promoted as “fast — results in two hours” had slowed to a virtual halt. The company had initially told the county to expect results within 48 to 72 hours after the samples arrived at the company’s New York lab. Results from tests conducted March 26 and 27 were announced April 1, but results from subsequent tests have still not come in.

A San Miguel County Department of Public Health and Environment press release quoted a company statement that blamed the delay on operations and the majority of staff being located in New York, where the pandemic has hit especially hard. The press release issued Tuesday said the company is aiming to resume processing the estimated 4,000 outstanding tests from the first round of testing.

But with only a fraction of the results in so far, and additional testing in question, the COVAXX testing appears to be yet another example of the chaotic response to the coronavirus crisis gone wrong.

A Different Kind Of Test

The test that Hu and Reese donated to the Telluride community is an antibody test developed by COVAXX, a newly formed subsidiary of their New York-based United Biomedical. It’s one of more than 30 commercially available tests without Food and Drug Administration approval under flexible rules adopted to address the COVID-19 pandemic. So far only one antibody test has received official FDA approval — a test made by Cellex, which uses just a pinprick of blood and produces results in about 15 minutes.

Antibody tests are fundamentally different than the CDC swab tests currently used to make official diagnoses. Where the swab test looks for the virus’s genetic material to determine active infections, an antibody test looks for antibodies in a person’s blood that show an immune response to the virus that causes COVID-19. Robert Garry, a virologist at Tulane University School of Medicine, said the test can’t tell whether the person is currently sick or infectious.

The plan in Telluride was for participants to be tested twice, two weeks apart, with the COVAXX test because it can take a while for someone infected to show up as positive when measuring antibodies.

The COVAXX website claims its test has 100% sensitivity (that’s the test’s ability to find antibodies to the virus) and 100% specificity (a measure of how good the test is at differentiating this novel coronavirus’ antibodies from other antibodies).

But, Garry said, no test is perfect. And creating an antibody test for the virus being called SARS-CoV-2 is “tricky,” he said, because it needs to distinguish among several seasonal coronaviruses. Furthermore, he added, the COVAXX test is a peptide assay, which he said typically is not very sensitive.

“We know 100% is an almost impossible bar to reach,” Garry said. “It kind of raises some red flags.”

In an interview with KHN before the Telluride program stopped, Hu said that “I always hesitate when I say 100%,” but she said that the company validated the test against 900 samples collected before the COVID-19 outbreak, with no false positives. She added the test also correctly produced positive results from blood samples that have been verified as positive through other tests.

Theoretically, having antibodies to SARS-CoV-2 could make a person immune to the virus, but how robust this immunity is and how long it might last remain open questions. The big promise behind testing a whole community is that if one can identify people who have been infected and recovered (or never gotten sick in the first place), one can safely send them back to work or out in the community, Reese said.

“It’s absolutely my goal to make this standard for how we get the country back to a new normal,” Reese had said before the test was suspended. “If we tested everyone in the whole country and were prepared to do it twice, you would know exactly when you would be back at functioning — everybody back at work.”

Reese isn’t alone in his excitement. Hedge fund billionaire Bill Ackman invested an undisclosed amount of capital into COVAXX through his Pershing Square Foundation, and bestselling author and XPrize founder Dr. Peter Diamandis is listed as part of the COVAXX leadership team on the company’s website. Diamandis presents a fawning interview with Hu and Reese in a widely shared YouTube video, which does not disclose his relationship with the company. Neither responded to requests for comment.

Testing Results

In all, about 6,000 of San Miguel residents were tested at three locations across the county, which covers about 1,300 square miles. As of Monday, only 1,631 of the tests had been processed, with eight (0.5%) of them deemed positive, 25 (1.5%) “borderline” and 1,598 (98%) negative. Borderline results indicate the person may be in the early stages of producing antibodies, Lilly said.

Yet the single tests alone can’t provide a clear picture of how many people have been exposed.

As of Thursday, a total of 11 cases in San Miguel County had been identified with standard swab tests. Officials continue to recommend that all residents practice social distancing and that those experiencing symptoms practice further isolation to prevent the potential spread of COVID-19.

One way to look at this attempt at large-scale testing is that “everybody’s getting together and trying to do something cooperative and innovative,” said George Annas, director of the center for health law, ethics and human rights at Boston University School of Public Health.

“If you wanted to be cruel, you could say this is a publicity stunt,” Annas said.

The program certainly won COVAXX a lot of good publicity, along with gratitude from local residents — at least initially.

And a resort town in Wyoming is following suit. John Goettler, president of St. John’s Health Foundation in Jackson, said his organization is spending “less than $20,000” on COVAXX tests for about 500 health professionals and first responders. Goettler said Jackson resident Dakin Sloss, a hedge fund owner listed as another member of COVAXX’s leadership team, helped secure the tests. Testing is set to begin next week, and the test will be processed at a local lab, rather than in New York.

But in Ouray County, adjacent to San Miguel County, officials decided against such testing even before the Telluride suspension.

The cost “would shoot a hole in my budget for at least the next two years,” said Ouray County public health director Tanner Kingery.

But that wasn’t the only concern, Kingery said. It would have required a large supply of precious masks and other personal protective equipment, he said, while potentially exposing health care workers and community members to the virus.

Dr. Andrew Yeowell, an emergency room physician and Ouray County EMS medical director, also was concerned that negative tests might give people a false sense of security. If people with negative tests felt emboldened to go out in the community and interact with others, he said, it could undermine the county’s advisory to stay home.

“If you’re having symptoms or feel sick, stay home,” Kingery added. “That guidance doesn’t really change if you have a positive test.”

The article was published at A Colorado Ski Community Planned To Test Everyone For COVID-19. Here’s What Happened.