Letter to Colorado Governor Polis: Striving for Better and Better: Continuous Improvements to Bolster the State’s COVID-19 Response from CCI, CML, CALPHO, CHA & CCAT Collective Vision for Engagement
As Colorado continues to respond to the pandemic for the health and wellbeing of our communities and economies, we believe it is essential that we all act in an inclusive, nonpartisan way, every step of the way. Local elected officials through Colorado Counties, Inc. (CCI), the Colorado Municipal League (CML), and Counties & Commissioners Acting Together (CCAT), local public health directors through the Colorado Association of Local Public Health Officials (CALPHO), and local hospitals through the Colorado Hospital Association (CHA) resoundingly support the need for early, authentic and ongoing engagement in COVID policy development. This becomes increasingly important as the factors that potentially impact policy options become more complex in light of local conditions. The time and effort that LPHAs and local governments invest in policy development will pay dividends in sound, cohesive policy options that have wide buy-in from all parties, while anticipating and addressing obstacles and challenges that may arise ahead of implementation. This also presents the opportunity for everyone to directly receive the same information at the same time and carry the same messages and present a unified front to the public.
With that, we are proposing a collective vision with the State on engagement and communication that builds on the essential partnership, cooperation, and coordination between the State, public health, and local governments. We deem this partnership to be not only strategic, but critically necessary in achieving our shared goals of curbing cases and hospitalizations, and ultimately, helping our Coloradan communities get through and recover from this historic public health emergency. The single most effective tool to overcome resistance and to build readiness for change is communication with all government entities speaking the same clear message.
In the spirit of working together, CCI, CML, CALPHO, CHA, and CCAT respectfully request that we be part of the dialogue as the State COVID-19 Response Team crafts decisions and policies, so that we may collectively identify issues and partner on solutions. In doing so, we will be able to speak with one voice to the public and address a primary and shared challenge to effective pandemic response: voluntary compliance. To do so, we
respectfully suggest that the following improvements be implemented immediately to bolster the state’s COVID-19 response:
No Surprises & Early Engagement
- Surprises undermine our collective credibility and puts us at odds unnecessarily with the public we are trying to impress upon. Commissioners and other local elected and appointed officials can locally elevate a unified message in tandem with the State, but to do so, we must be involved at the onset.
- First Step Implementation: With the help of CCI, CML, CALPHO, CHA, and CCAT, include all county commissioners, municipal elected officials, municipal managers/administrators, and local public health directors on all appropriate communications from both the Governor’s Office and the Colorado Dept. of Public Health and Environment.
Non-Partisan, Inclusive Approach
Relying on local opinion leaders is key in achieving voluntary compliance. County commissioners, mayors, city council members, and local health officials live in the community with their constituents, and this strengthens their ability to influence local behavior around social distancing, the wearing of masks, hand washing, cooperation with contact tracing to control outbreaks, staying home when vulnerable or symptomatic and compliance with public health orders.
First Step Implementation: Work with CCI, CML, CALPHO, CHA, and CCAT to identify a small cohort of local leaders that can weigh in as updates are developed.
Cooperation breeds more cooperation
Local opinion leaders have diverse perspectives that are shaped by their lived experiences and upbringing. While universal agreement is rarely achievable, the process of listening and considering feedback in an authentic dialog engenders cooperation and collaboration. We will not always agree. The goal is a two-way exchange where people feel valued and respected.
First Step Implementation: Work with CCI, CML, CALPHO, CHA, and CCAT to develop all plans, orders, and restrictions designed to be implemented on a local basis. While a statewide system is necessary to best combat the virus, localized plans under a statewide network developed and based upon a.) the data on the ground locally of the locations of virus contamination and b.) the severity in various areas of each county would work best to target the site of the virus spread and the controls necessary to reverse it. These localized plans are best developed in coordination between the State and the local jurisdictions. And once developed cooperatively, there would be greater buy in by local officials in implementation and enforcement as well as better credibility in the effort and buy in by the public.
First Step Implementation: Work with CCI, CML, CALPHO, CHA, and CCAT to develop all messaging taking input from local officials into consideration when the message is to be pushed out locally. If we are all “singing off the same sheet of music” the message is unified and all of our credibility increases. The result will be less divisiveness and there is a greater chance of acceptance and cooperation from the public.
CCI & CML Vision for Refinements When Conditions Are Appropriate
In addition to these short-term action items, county commissioners/local elected officials and appropriate staff through CCI and CML seek continued dialog on Colorado’s dial framework and restrictions around ‘openness’.
Once cases and hospitalizations trend downwards again, we would like the opportunity to discuss and more thoroughly assess two ideas that have surfaced in CCI and CML meetings in a shared forum with you and other
experts. We value open dialogs and believe these exchanges lead to better, improved approaches. We know that is a shared value, and these ideas may provide a good starting point.
Opt-in Severity Metric for Intermediate Incidence Epidemiologic Contexts: While case numbers are increasing, case severity is decreasing. Additionally, hospital care is improving. For counties with epidemiologists and other qualified experts, allow them to opt-in to an approach that considers the severity of hospitalization stays. For counties lacking this expertise, the state should explore hiring additional epidemiologists to assist counties with this level of support. Severity metrics can help us more precisely capture the range of relative seriousness of COVID cases in a community. This more granular metric coupled with the ground knowledge of our local public health officials and the relationships they have with businesses, hospitals, and community groups can help us achieve greater voluntary compliance. While this index is not perfect, it does create a ‘weight’ to the hospitalization metric and addresses the shortcomings of relying solely on cases (which can lead to public disenfranchisement and resistance to testing).
Targeted (rather than blanket) Restrictions Under Specific Epidemiologic Circumstances: For counties with epidemiologists and other qualified experts that can identify where their spread is occurring,
allow them to develop targeted restrictions as opposed to blanket restrictions. For counties lacking this expertise, the state should explore hiring additional epidemiologists to assist counties with this level of
support. A targeted approach could result in better outcomes and increase the public’s acceptance of the measures that reduce transmissions.
This suggestion is different from the variance approach. The variance approach included capacity limits and counties had to specify the modifications they were using to protect public health. This will allow counties to locally identify both capacity limits for various industries (restaurants, essential business, gyms, etc.) and the modifications (plexiglass shields, hand sanitizing stations, etc.) that must be in place to address the specific transmission patterns and circumstances their contact tracers are seeing in their communities.
Working cooperatively and in coordination with each other is the best way to achieve a united effort to confront and defeat this unprecedent challenge on a timely basis. Thank you for your continued efforts, engagement, and consideration of this well intended proposal.
To view an original copy of the letter above – CLICK HERE
Listen to Colorado Governor Polis response to the following question regarding the letter from Brian Allmer of The BARN on the December 18, 2020 Press Conference, it’s question #11, move your cursor to 45:30