(KHN) — San Juan County, Colorado, can boast that 99.9% of its eligible population has received at least one dose of the Covid-19 vaccine, ranking it among the top 10 counties in the country, according to data from the Centers for Disease Control and Prevention (CDC).
If vaccines were the only shield against the spread of covid, then on paper, San Juan County, with its approximately 730 registered residents, would be one of the most bulletproof places in the country.
However, recent months have shown the complexity of this phase of the pandemic. Even in an extremely vaccinated setting, vaccines alone are not enough because geographic boundaries are porous, the efficacy of vaccines can decrease 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 recorded its first hospitalizations from the pandemic in early August, this year, not 2020. Five summer residents were hospitalized. Three ended up with respirators: two recovered and the third, a 53-year-old woman, died in late August. All are believed to have been unvaccinated.
Contagions and alarms
Those cases, and even those that did not require hospitalization, set off county alarms with only one incorporated city: Silverton. It is a tight-knit former mining community nestled in the mountains of southwestern Colorado, where snowstorms and avalanches often block the only road that passes through.
“The pandemic is running its course,” says DeAnne Gallegos, county public information officer and director of the local chamber of commerce. “We kept thinking it was going to end before this summer. Then we thought November. Now we say, ‘No, we don’t know when.’
So the county decided to backtrack: “We went back to the tools we knew we had,” Gallegos said. “Mandatory indoor masks and then discourage indoor events.”
Outdoor events continued, including a marching band concert on the courthouse steps, and the iconic Hardrockers Holidays mining competition, with its pneumatic cleaning and spike nailing.
In general, if one takes into account those under 12 years of age, 85% of the total population of the county is fully vaccinated. But in the summer, the population nearly doubles as seasonal residents settle into second homes and RV parks, some of them on vacation and others with seasonal jobs.
Then there is what Gallegos described as “the tourism tsunami”: the daily influx of people arriving on the historic railroad from Durango and the dusty jeep trails through the mountains. Many of those visitors have unknown vaccination status.
The two-week incidence in the county soared in August to the highest rate in the state, and stayed that way for most of the month. Although that spike totaled about 40 known cases, it was nearly the same as the county’s recorded throughout the pandemic, and the cases extended to those vaccinated as well.
Any number of cases would be a big problem in a small place without its own hospital. “We are all one-man gangs trying to make it happen,” Gallegos said.
The county’s public health director, Becky Joyce, for example, does everything from contact tracing and coronavirus testing to giving people’s arms vaccines. And when the county resumed the mask mandate, it was Gallegos who designed the posters and spent his weekend hanging them all over town.
The highest concentration of COVID-19 cases occurred in a motorhome park and at a music festival that was forced to close by the rain.
“It makes sense that after three or four weeks of just tourism, people who work in restaurants, in motorhome parks, would start to get sick,” Gallegos said. “And then bringing all the locals together for a couple of concert nights, it was the trifecta.”
Dana Chambers, who runs the Silverton hardware store, got vaccinated as soon as possible. He said going back to a mask mandate felt in a way like “a step backwards.” But, he said, businesses like hers need the summer tourist rush to survive the quiet winter, when only a few hundred tourists come, largely to jump from helicopters onto ski terrain. “If we have to wear the mask, that’s what we will do.”
Julia Raifman, an epidemiologist at the Boston University School of Public Health who follows state policies against the pandemic, is not surprised that covid can strike a place like San Juan County despite high vaccination rates.
Data shows that vaccines protect against death and hospitalization due to COVID. But even effective vaccines are no match for delta transmissibility.
“Even in the best case – if vaccines reduce transmission by 80% – you are actually twice as likely to get coronavirus now as you were in July,” Raifman said, due to the recent proliferation of the virus. “It is statistically impossible to achieve herd immunity with the delta variant,” he added.
Covid-19 vaccines, the chosen path
Meanwhile, many local and national leaders, including in Colorado, continue to focus almost exclusively on vaccines as the way forward.
Talia Quandelacy, an epidemiologist at 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 exaggerated.
“It’s a useful guide to having some kind of goal to aspire to,” he said. “But normally, if we reach a certain metric, that does not mean that the transmission or the pandemic will just disappear.”
Many scientists agree that, especially considering that most of the world remains unvaccinated, Covid-19 is likely here to stay, eventually morphing into something more like the common cold. “It will probably be a matter of a couple of years,” Quandelacy said. “But that seems to be the trajectory we are on,” he explained.
This is why the “finish line” language used by many politicians has frustrated Anne Sosin, a researcher at Dartmouth College’s Nelson A. Rockefeller Center for Public Policy, who studies COVID-19 and rural health. Vaccines do what they are supposed to do – keep people from really getting sick, never keep them from getting infected – but that has not been well communicated. “The messages on this issue have not been very nuanced,” he said.
He pointed to the experience of an epidemiologist who wrote last month in The Baltimore Sun newspaper that he had caught COVID at a party where all 14 guests and the host were vaccinated. The host had infected him and nine others. “As miraculous as they are at keeping people out of the hospital and alive, we cannot just rely on them to prevent infection,” Sosin said of vaccines.
Measures against covid-19, beyond vaccines
And public health experts said San Juan County shows that measures like face masks, ventilation and distancing are also necessary. They are spreading the “Swiss cheese” model of defense against COVID-19, in which each preventive measure (or layer of cheese) has holes, 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 closely connected, and disease travels quickly within social media.
Joyce, the Director of Public Health, who declined an interview request, wrote on Facebook in August that recent county experience showed that “the vaccine creates a line of defense, but it does not make us invincible to this disease or its variants.”
Raifman sees that finding – along with the ensuing mandate to wear indoor masks from San Juan – was a success at a crucial time. The month-long mandate was lifted on September 10, as the county had once again had a low rate of covid-19 transmission. At the time, it was the only county in Colorado with such a low transmission.
“This is the moment in which we define: How are we going to manage the virus in the long term?” Raifman said. “So far, we are defining that we do not handle it; we let it handle us.”
Even after lifting his mask mandate, the county’s public health department’s Facebook page urges residents to wear them and “pay attention to the COVID-19 situation just as attention is paid to the weather.”