Masks, treatments and vaccines: Larimer County health leaders answer COVID-19 questions

From masks to vaccines and treatment, Larimer County residents have a lot of COVID-19 questions. 

More than 250 community members joined a virtual COVID-19 conversation Tuesday with the county's commissioners and health department leaders, who answered a handful out of hundreds of questions submitted before and during the forum. 

Public health leaders explained public health's role in the pandemic, talked about how and why they believe masks are effective, and addressed the safety and effectiveness of vaccines during the hourlong forum. 

County officials hosted the forum in response to months of increased public feedback and questions on the county’s response to COVID-19.

“The level of discussion has become more intense and perhaps more polarized as we’ve gone through the last almost two years, particularly since October of last year … when the mask requirement went into effect,” Commissioner John Kefalas said. 

While about 80% of Tuesday's attendees said they would attend future COVID-19 focused forums, many shared in the forum's Q&A chat that they were frustrated with their questions not being addressed. 

Commissioner Kristin Stephens said there are other ways for the community to share their feedback and noted commissioners have received numerous emails, phone calls and comments during public meetings in recent months. She said many questions they’ve received in recent months would be better answered by health professionals, so she hoped some of those could be addressed Tuesday. 

Here are the questions county leaders addressed during Tuesday's community forum:

What is the role of public health in response to the pandemic?

“The primary goal is prevention," Larimer County Public Health Director Tom Gonzales said. “So while doctors treat people while they’re sick, our goal is to make sure they don’t get sick or injured so they don’t have to go to the doctor.”

The county health department works closely with all the municipalities in the county and with the state health department, which works with the Centers for Disease Control and Prevention and the National Institutes of Health. 

The county has three objectives they've focused on achieving during the pandemic, Gonzales said: 

• To keep children learning in person at schools and in day care with minimal disruptions
• To help hospitals maintain sufficient resources to meet all critical health care needs in the community
• To ensure essential services are maintained with minimal disruptions

“We’ve learned early on that our children at home trying to learn virtually was very disruptive,” Gonzales said. “It was very hard on families, parents, grandparents, others as well as the child. We need to keep them in person and learning, so many of our strategies are doing that, to keep our kids (in) in-person learning with the least amount of disruptions as possible.”

Policy decisions and other actions by the health department are all in an effort to achieve those three objectives, Gonzales said. 

Why rely on public health policy and not let people make their own decisions?

“That’s a great question, it’s a serious question and one I don’t take very lightly,” Gonzales said. “What we’re trying to do … is we’re trying to maintain those three priorities."

An important piece to remember about COVID-19, Gonzales said, is how much it can be spread by people who aren’t experiencing symptoms — people who are pre-symptomatic or asymptomatic. 

“Somebody could be healthy, I could be healthy right now and go out into the community and I may have the omicron variant and I may be spreading that through my respiratory droplets,” Gonzales said. 

Enacting a mask mandate is a tool to prevent the spread of the virus and maintain those three priorities because face coverings prevent and reduce the spread of those droplets that could contain and spread the virus, Gonzales said. 

“It’s hard to make these kind of policies, but we know that it works in the long run,” Gonzales said. “It’s certainly not something we like to do, we’re not accustomed to doing that, certainly through the pandemic it’s our role to protect the entire community.”

COVID-19 has killed more than 400 Larimer County residents, Gonzales said. On Wednesday morning, the county's COVID-19 dashboard listed 429 COVID-related deaths.

"It's tragic. It's devastating," Gonzales said.

How does the county health department decide what COVID-19 treatments to support?

Larimer County’s health department doesn’t have any authority over what COVID-19 treatments are approved and not approved, Gonzales said. 

“Our guidance that we give comes from the National Institutes of Health’s published guidance on the treatments of COVID-19. It’s as simple as that,” Larimer County Chief Medical Officer Paul Mayer said. 

There are more than 100 potential therapeutics being studied that might treat or prevent COVID-19, so the county relies on the NIH to look through the data and the studies to make well-supported guidelines, Mayer said. 

Mayer said the county does advocate for the four outpatient treatments currently supported by the NIH.

There are also inpatient treatments hospitals can administer to COVID-19 patients, but Mayer said that is outside the scope of public health so they do not comment on inpatient treatments. 

More:Here's how Larimer County providers are allocating COVID-19 treatments amid low supply

The two most common therapeutics the county receives questions about are ivermectin and vitamin D, both of which are not treatments for COVID-19 according to the NIH, Mayer said. 

One study out of Egypt “early on looked like ivermectin might be beneficial,” Mayer said. Later studies discredited the first and found ivermectin “hasn’t been shown to be useful” against COVID-19, Mayer said. 

If tested against COVID-19 in a test tube, Mayer said ivermectin has shown to “neutralize the virus’s ability to get into cells, but that’s not the same as in vivo, meaning in people, effects.”

“When it's been studied in real life in people, it really doesn’t have an overall benefit that we know of now," Mayer said.

The same is true of vitamin D, Mayer said. An older study showed taking vitamin D supplements decreased the risk of contracting general upper respiratory infections, and early studies showed it could prevent COVID-19 infections, but additional studies found vitamin D to not be an effective treatment.

“Believe me, I wish vitamin D was a useful therapeutic because it's cheap and quite safe, but in follow-up it really wasn’t supported,” Mayer said.

Larimer County epidemiologist Jared Olson said people should consult a doctor before using any COVID-19 treatment because some of the approved treatments can have interfering effects with other prescription drugs. 

If people want to share other information they've found or ask questions about COVID-19 treatments or therapeutics with county health staff, they can email those to covidconcerns@larimer.org. 

“Sometimes, unfortunately, especially in a pandemic when there is so much uncertainty and so much difficulty and so much unfortunate loss of life, some things that look too good to be true are too good to be true,” Olson said. “There are no easy answers. There are no quick fixes.”

Are masks effective? 

Masks that have a good fit and good filtration are effective in controlling the spread of the virus, Olson said.

“This virus spreads through aerosols and through droplets,” Olson said. “When we speak, when we sing, when we talk, when we cough, when we sneeze, we’re ejecting very small droplets which carry the virus if we are at that time infectious. Anything we can do to reduce our exposure or others' exposure to those droplets is how we break up those chains of transmission.” 

Outside, the air disperses more quickly, Olson said. The virus can spread more easily indoors, depending on the prevalence of the virus in the community and how much the indoor air is circulated and filtered.

Related:Windsor and Severance schools made masks optional two weeks ago. Here's how it's going.

The state has estimated about 1 in 10 Coloradans are currently contagious with COVID-19, Olson said, so we know the virus is prevalent in the community. When someone is in the same indoor space, a mask can help prevent the spread in two ways, Olson said:

• If a contagious person speaks or coughs, their mask can catch some of those particles.
• If you’re in a room with someone who is contagious, your mask can offer some protection from breathing those particles in.

Masks with better filtration will be more effective, Olson said.

“If you can increase the filtration capacity of the material that’s covering your face — so that would be a nonwoven material like and N95 or KN95 or KF94, things like that — as well as the fit — no air gaps around the sides — that’s going to give you the most possible protection as well as the most reduction in transmission.”

How does Larimer County compare to other counties without a mask mandate?

“Across the state, we’re experiencing positivity rates that are somewhere between 20% to 30% as well as extremely high case rates,” Olson said. “When you have positivity rates that high, we know that the proportion of cases that we’re able to actually capture and identify is quite low. So comparing numbers at this level when so many of our cases are going uncaptured and testing behaviors are so different, testing is constrained and limited in so many places, it’s not an apples to apples comparison.”

Olson said it's more accurate to compare hospitalizations to other counties to measure the success of the mask mandate. 

“We feel like and we have evidence based on our hospitalizations and our ICU admissions that we’re doing a very good job keeping our admissions relatively low and low compared to other counties that do not have a mask mandate,” Olson said. 

Why do we still have a mask mandate and when will it be removed?

Gonzales said he is looking at the four metrics the county must meet for 21 consecutive days before lifting the mask mandate: 

• Fewer than 65 COVID-19 patients in Larimer hospitals 
• ICU utilization of less than 90% of usual and customary levels 
• A seven-day case rate per 100,000 residents of less than 300 
• A seven-day test positivity rate of less than 10%

The county health department has reevaluated public health policy through the different waves of the pandemic, and the omicron variant is no different, Gonzales said.

But removing the mask mandate now — while it appears the county may have peaked or be approaching the peak of the current omicron wave — could be bad for in-person learning or hospital capacity. 

“If we continue to come down, we’re going to reevaluate those metrics, and if we meet those metrics, we could go from this required to a recommended state,” Gonzales said, adding that the mandate could change “in the next couple weeks, absolutely.”

See the numbers:Here's where Larimer County stands with its mask mandate metrics, COVID vaccination rates

The state health department announced a few days ago they believe we’re at or just past the omicron peak, but Olson said he believes Larimer County is a little behind where the state is at with the omicron wave. 

Wastewater measurements of the virus have begun to drop off, the county’s positivity rate and case rates have started to stabilize and the county’s hospitalization admission rates have also begun to flatten, Olson said. 

Are there any studies backing the idea that wearing masks negatively impacts children?

The benefit of masks in schools outweighs the documented negative impacts on children, Mayer said. 

“The American Academy of Pediatrics declared a mental health crisis in children a while ago due to the COVID epidemic,” Mayer said. “That same group also overwhelmingly came out with a recommendation that all children mask in school. People should just realize that those two things can be compatible: recognition that we have a huge mental health issue and a recommendation to use masks."

Mayer said some studies have shown masks have impacted children's interpretation of visual and facial cues and nonverbal communication, specifically for younger children, but he said the studies showed "it was not felt to be significant enough to get rid of the mask mandate."

“Kids are very adaptable,” Mayer said. “They do really quite well.” 

National Science Teaching Association and National Association of Educators have both said they are in favor of masks in schools, Mayer said. 

Vaccines aren’t fully protecting people from contracting or spreading COVID-19, so why is the health department still recommending vaccines?

“Vaccines and especially the booster, which really should just be considered part of a regular three-dose series, (are) exceptionally protective against hospitalization, severe disease and death,” Olson said. 

The vaccines with the booster are still as effective against the omicron variant as they were against the delta variant, Olson said. 

“It is lifesaving,” Olson said. “It is absolutely the number one thing you can do to ensure that you are here and around for your family, for your friends, for your future.” 

Olson said the vaccine has lost some of the “sterilizing immunity” — the ability to not be infected at all if vaccinated — “but your body recognizes what it was trained to do when it got the vaccine. It recognizes the whole virus and it ramps up its second line of defense with your immune system.”

Mayer said there is no major scientific group nationally or internationally that calls into question the safety or effectiveness of the vaccines.

“I don’t think there’s any major scientific group that has any doubt that the vaccines are safe and highly effective,” Mayer said.

How to engage with Larimer County leaders on COVID-19

• Call the Joint Information Center at 970-498-5500 from 9 a.m. to 4 p.m. Mondays through Fridays
• Send a message through a form found at larimer.org/health/communicable-disease/coronavirus-covid-19
• Email covidconcerns@larimer.org
• Text 970-999-1770
• Attend an upcoming community discussion: 5:30 p.m. Feb. 7
  • Register in advance here: https://bit.ly/3r0hiAG
  • Submit questions in advance here: https://bit.ly/3FWyprn

Sady Swanson covers public safety, criminal justice, Larimer County government and more throughout Northern Colorado. You can send your story ideas to her at sswanson@coloradoan.com or on Twitter at @sadyswan. Support her work and that of other Coloradoan journalists by purchasing a digital subscription today.